Opinion
Civil Action No. 03-30212-KPN
February 20, 2004
This matter is before the court pursuant to 42 U.S.C. § 405(g) and 1383(c)(3) which provide for judicial review of a final decision by the Commissioner of the Social Security Administration (the "Commissioner") regarding an individual's entitlement to Supplemental Security Income ("SSI") disability benefits. Jennie Puglielli ("Plaintiff") claims that the Commissioner's decision denying her SSI benefits — memorialized in an April 8, 2003 decision by an administrative law judge — is not supported by substantial evidence and is predicated on errors of law. Plaintiff has moved to reverse or remand the decision and the Commissioner, in turn, has moved to affirm.
With the parties' consent, this matter has been reassigned to the undersigned pursuant to 28 U.S.C. § 636(c) for all purposes, including entry of judgment. For the reasons set forth below, Plaintiff's motion to reverse or remand will be denied and the Commissioner's motion to affirm will be allowed.
I. STANDARD OF REVIEW
A court may not disturb the Commissioner's decision if it is grounded in substantial evidence. See 42 U.S.C. § 405(g) and 1383(c)(3). Substantial evidence is such relevant evidence as a reasonable mind accepts as adequate to support a conclusion. Rodriguez v. Sec'y of Health Human Servs., 647 F.2d 218, 222 (1st Cir. 1981). The Supreme Court has defined substantial evidence as "more than a mere scintilla." Richardson v. Perales, 402 U.S. 389, 401 (1971). Thus, even if the administrative record could support multiple conclusions, a court must uphold the Commissioner's findings "if a reasonable mind, reviewing the evidence in the record as a whole, could accept it as adequate to support [her] conclusion." Irlanda Ortiz v. Sec'y of Health Human Servs., 955 F.2d 765, 769 (1st Cir. 1991) (citation and internal quotation marks omitted).To be sure, the resolution of conflicts in evidence and the determination of credibility are for the Commissioner, not for doctors or the courts. Rodriguez, 647 F.2d at 222; Evangelista v. Sec'y of Health Human Servs., 826 F.2d 136, 141 (1st Cir. 1987). A denial of benefits, however, will not be upheld if there has been an error of law in the evaluation of a particular claim. See Manso-Pizzaro v. Sec'y of Health Human Servs., 76 F.3d 15, 16 (1st Cir. 1996). In the end, the court maintains the power, in appropriate circumstances, "to enter . . . a judgment affirming, modifying, or reversing the [Commissioner's] decision" or to "remand[ ] the cause for a rehearing." 42 U.S.C. § 405(g).
II. BACKGROUND
Plaintiff, born on May 17, 1953, graduated from high school and received her Associate's Degree as a pediatric medical assistant. (A.R. at 275.) Her past work includes jobs as a phlebotomist, medical assistant, laboratory technician, beach house attendant and volunteer clerical worker. (A.R. at 82, 275, 278-89.) Since January of 2002, Plaintiff has studied social services and developmental disabilities, part-time, at the University of Massachusetts. (A.R. at 275-76.) She has not worked in the past twelve years, however, in order to stay at home with her young son. (A.R. at 277.)A. MEDICAL HISTORY
The main physical impairments which Plaintiff claims to be disabling are neck and lower back injuries, including spondylolisthesis. (A.R. at 69.) Additionally, Plaintiff has been seeing a therapist for attention deficit hyperactivity disorder ("ADHD") and, thus, claims a mental impairment. (A.R. at 90, 201.) Plaintiff asserts that these conditions limit her ability to work because she tires easily and experiences numbness in her hands. (A.R. at 69.) Plaintiff further alleges that her lower back pain limits her ability to sit, stand or lift for extended periods and exacerbates her ADD. (A.R. at 69, 90.) Although Plaintiff can attend to most of her personal needs, certain tasks, such as dressing, require additional time. (A.R. at 295.) Nonetheless, Plaintiff is able to prepare meals, grocery shop, vacuum and drive. (A.R. at 296-97, 282-83.)
Spondylolisthesis is the forward movement of one of the lower lumbar vertebrae on the vertebra below it, or upon the sacrum. Stedman's Medical Dictionary at 1678 (27th ed. 2000). Plaintiff also mentions Hepatitis C as a physical impairment. (A.R. at 69.)
1. Physical Impairment
The first documentation in the administrative record of Plaintiff's neck and back ailments is a record from Andrew Hall, M.D., dated January 7, 2000. (A.R. at 127.) According to Dr. Hall, Plaintiff was looking for a chiropractic referral for treatment of her "chronic cervical arthritis." ( Id.) Plaintiff was treated by a chiropractor, Dr. Howard T. Ewart, between February and December of 2000. (A.R. at 178-79, 185-86.)
On April 18, 2001, Plaintiff was evaluated by Dr. Arkam Rehman. (A.R. at 196.) Plaintiff complained to Dr. Rehman of a gradual onset of lower back pain that had increased in severity over the previous six months. ( Id.) X-rays revealed disc degeneration and "mild grade 1 spondylolisthesis." ( Id.) Dr. Rehman's impression was that Plaintiff was suffering from lumbar discogenic pain or spondylolisthesis at the L3-4 level. ( Id.) He recommended physical therapy. ( Id.)
On May 13, 2001, Plaintiff was evaluated at Cooley Dickinson Hospital Rehabilitation Services. (A.R. at 148.) There, Plaintiff reported that ice, Vicodin and lying down relieved her pain, while standing straight exacerbated it. ( Id.) On examination, Plaintiffs flexion and extension were normal, her strength was rated "5/5," and her muscle flexibility was good. (A.R. at 148-49.) Therapy prescribed for Plaintiff included spinal exercises and the use of an electrical nerve stimulation unit. (A.R. at 150.) Physical therapy notes dated May 29, 2001, indicate that Plaintiff was "doing well" and had reported being "pain free." (A.R. at 151.)
On August 27, 2001, Plaintiff was again examined by Dr. Ewert, the chiropractor, for low back pain, arm pain, and arm and hand numbness. (A.R. at 174, 187.) Dr. Ewert — noting that Plaintiffs lumbar range of motion was "normal, but less than she used to be able to do" — began further chiropractic treatments (A.R. at 176, 186-88.) Plaintiff underwent six such treatments through October 15, 2001, during which time Dr. Ewert noted gradual improvement in her condition. (A.R. at 188.)
In the interim, Plaintiffs primary care physician, Dr. Andrew Larkin, monitored her back pain. (A.R. at 129-32, 251-69.) X-rays taken on August 28, 2001, revealed disc and stenosis issues. (A.R. at 165.) In a letter dated September 20, 2001, Dr. Larkin opined that Plaintiff was "disabled" from work as a result of cervical disc disease and ongoing fatigue. (A.R. at 203.) On September 27, 2001, Dr. Larkin diagnosed Plaintiff with degenerative disc disease of her cervical spine and spondylolisthesis of her lumbar spine. (A.R. at 129). He prescribed OxyContin. ( Id.)
Dr. John Scola, a state agency physician, completed a Physical Residual Functional Capacity ("RFC") Assessment on October 12, 2001. (A.R. at 205-12.) Dr. Scola reported that Plaintiff retained the capacity to occasionally lift twenty pounds, frequently lift ten pounds, stand and/or walk for about six hours in an eight hour work day, sit for about six hours in an eight hour work day, and push and pull without limitation. (A.R. at 206.) In addition, Dr. Scola noted that Plaintiff could occasionally climb, balance, stoop, kneel, crouch and crawl, but that her ability to reach in all directions, including overhead, was limited. (A.R. at 207-08.)
On January 18, 2002, Dr. Larkin stated that Plaintiffs chronic spinal problems were being managed with pain medication. (A.R. at 218.) In Dr. Larkin's view, however, Plaintiffs neck and back problems significantly limited her ability to "hold down any meaningful job." ( Id.) He further opined that Plaintiff was not receiving significant benefit from physical therapy. ( Id.)
Physical therapy notes dated October 15, 2001, show that Plaintiff had reported cervical spasms, with a pain rating of seven out often, and numbness in both hands. (A.R. at 144-45.) After examination, Plaintiffs physical therapists recommended cervical stretching, deep tissue massage and good posture. (A.R. at 145.) Over the following two months, through mid-December of 2001, Plaintiff consistently reported that her pain was "better" and the therapists noted that Plaintiffs cervical range of motion was returning to normal. (A.R. at 137-39, 141.)
Dr. William Straub, another state agency physician, completed a Physical RFC Assessment on February 20, 2002. (A.R. at 241-46.) He noted limitations similar to those found by Dr. Scola, except he found that Plaintiff could frequently — rather than occasionally — balance, stoop, kneel, crouch and crawl. ( Id.) Dr. Straub stated further that his assessment evidenced, among other things, a normal gait, full range of motion and soft paraspinals without trigger points. (A.R. at 243.)
Dr. Larkin continued to treat Plaintiff and renew her pain medication from March 29, 2002, through January 23, 2003. (A.R. at 251-70.) At one point, Dr. Larkin changed Plaintiffs prescription to MS Contin, whereupon Plaintiff stated that her pain was being adequately controlled and Dr. Larkin himself observed an increase in her cervical range of motion. (A.R. at 253, 259, 260, 266.)
2. Mental Impairment
In the meantime, on August 13 and 24, 2001, Plaintiff consulted with Dr. Nancy Haffey, a licensed psychologist, to establish a support system to help her "deal with family issues." (A.R. at 200-01.) Dr. Haffey's initial impression was that Plaintiff had multiple current stresses and poor coping skills and she diagnosed Plaintiff as suffering from ADHD. (A.R. at 201.) By November 9, 2001, after seeing Dr. Haffey approximately four times, Plaintiff stated that she was "doing fine" and would "call as needed." (A.R. at 197.)
On January 16, 2002, Dr. Haffey completed a disability form in which she again diagnosed Plaintiff with ADHD. (A.R. at 215-17.) She also noted that Plaintiff was relational and cooperative with normal mood and affect, had good impulse control, could maintain a routine and remember work-like tasks and instructions, did not require excessive supervision, and had appropriate relationships. ( Id.) As problem areas, Dr. Haffey observed that Plaintiff was restless, easily distracted, disorganized and overwhelmed by stress. ( Id.) Still, she listed Plaintiffs prognosis as "good." (A.R. at 217.)
On February 1, 2002, M. Davies, PhD., a state agency medical consultant, completed a Mental RFC Assessment. (A.R. at 219-37.) Dr. Davies determined that Plaintiff retained the capacity to understand and remember short, simple directions, to complete simple, repetitive, one and two-step tasks, to make appropriate decisions once established in a routine and to adapt to routine changes in the work setting. (A.R. at 219-23.) Dr. Davies further found that Plaintiff could interact appropriately with co-workers, supervisors and the general public. (A. R. at 222.)
Plaintiff agin saw Dr. Haffey on March 7, 2002, this time complaining of difficulties in concentration and organization. (A.R. at 250.) Dr. Haffey — noting that Plaintiff had not pursued treatment with medication and had not consistently used strategies to help her symptoms — referred Plaintiff for medication and relevant ADHD strategies. ( Id.) Dr. Larkin subsequently prescribed Ritalin, which Plaintiff tolerated well. (A.R. at 266.) Except for a visit in May of 2002 (to deal with the death of friend), Plaintiff did not see Dr. Haffey again until January 8, 2003, when she reported that she was doing well in school. (A.R. at 248-49.) Dr. Haffey observed at the time that Plaintiff was more organized and had accomplished some of her goals. (A.R. at 248.)
B. PROCEDURAL HISTORY
On August 19, 2001, in the midst of these medical benchmarks, Plaintiff applied for SSI disability benefits. (A.R. at 59-62.) Her application was denied initially on October 23, 2001, because her condition was not deemed severe enough to affect her ability to work. (A.R. at 26-29.) Plaintiff filed a timely request for reconsideration, which was denied on February 28, 2002. (A.R. at 30, 34.)
Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"), which was held on March 14, 2003. (A.R. at 38, 42-46.) After reviewing the evidence of record, the ALJ concluded on April 8, 2003, that Plaintiff was not disabled. (A.R. at 19.) Plaintiffs request for review by the Appeals Council was denied on June 20, 2003, thereby making the ALJ's decision the final decision of the Commissioner. (A.R. at 5-7.) See 20 C.F.R. § 416.1455, 416.1481 (2004).
III. DISCUSSION
An individual is entitled to SSI benefits if, among other things, she is needy and disabled. See 42 U.S.C. § 1381 a and 1382c(a)(3). Plaintiff's financial need is not challenged. The question, therefore, is whether she suffers from a disability.
A. DISABILITY STANDARD AND THE ALJ's DECISION
An individual is considered disabled if she is unable to participate in "any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months." 42 U.S.C. § 1382c(a)(3)(A). A claimant is considered disabled under the Act:
only if [her] physical or mental impairments are of such severity that [she] is not only unable to do [her] previous work but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the immediate area in which [she] lives, or whether a specific job vacancy exists for [her], or whether [she] would be hired if [she] applied for work.42 U.S.C. § 1382c(a)(3)(B). See generally Bowen v. Yuckert, 482 U.S. 137, 146-49 (1987).
In determining disability, the Commissioner follows the five-step protocol described by the First Circuit as follows:
First, is the claimant currently employed? If [she] is, the claimant is automatically considered not disabled.
Second, does the claimant have a severe impairment? A "severe impairment" means an impairment "which significantly limits the claimant's physical or mental capacity to perform basic work-related functions." If [she] does not have an impairment of at least this degree of severity, [she] is automatically considered not disabled.
Third, does the claimant have an impairment equivalent to a specific list of impairments contained in the regulations' Appendix 1 ? If the claimant has an impairment of so serious a degree of severity, the claimant is automatically found disabled.
. . .
Fourth, does the claimant's impairment prevent [her] from performing work of the sort [she] has done in the past? If not, [she] is not disabled. If so, the agency asks the fifth question.
Fifth, does the claimant's impairment prevent [her] from performing other work of the sort found in the economy? If so, [she] is disabled; if not, [she] is not disabled.Goodermote v. Sec'y of Health Human Servs., 690 F.2d 5, 6-7 (1st Cir. 1982).
In the instant case, the ALJ found as follows with respect to these questions: that Plaintiff had not engaged in substantial gainful activity since the alleged onset of her disability (question one); that she had an impairment or combination of impairments that were "severe," although not severe enough to be listed in Appendix 1 (questions two and three); that Plaintiff was unable to perform any of her past relevant work (question four); but that Plaintiff was able to perform "a significant range of light work" in the national economy (question five). (A.R. at 17-23.) As a result, the ALJ concluded that Plaintiff does not suffer from a disability.
B. ANALYSIS OF PLAINTIFF'S CHALLENGE TO ALJ's DECISION
Plaintiff argues that the ALJ failed to properly: (1) determine the severity of her impairments; (2) evaluate her subjective complaints of pain; and (3) credit the opinions of her treating physician, Dr. Larkin. In response, the Commissioner argues that the ALJ's decision is based on substantial evidence. For the reasons which follow, the court finds the Commissioner to have the stronger argument.
1. Severity of Plaintiff's Impairments
As a preliminary matter, Plaintiff argues that the ALJ failed to find any of her impairments "severe." This is simply wrong. In fact, the ALJ found that a number of Plaintiffs impairments (e.g., headaches, degenerative disc disease, Hepatitis C, ADHD and depression) were "severe" within the meaning of the regulations, albeit not severe enough to meet or equal one of the impairments listed in Appendix 1. (A.R. at 19.)
Plaintiffs related argument that the ALJ failed to properly consider her ADHD is similarly misplaced. Not only did the ALJ specifically conclude that Plaintiffs ADHD was "severe," he included limitations stemming from that condition in his own RFC assessment. (A.R. at 19, 20, 22.) He also noted that, as a result of her ADHD, Plaintiff had moderate limitations in her ability to understand and remember detailed instructions, maintain attention and concentration for extended periods, make simple work-related decisions and respond appropriately to changes in the workplace. (A.R. 20, 22.) Plaintiffs first argument, accordingly, is unpersuasive.
To be sure, Plaintiff contends that she also suffers from "severe anxiety." The record, however, does not support that contention. In the absence of medical findings, see 20 C.F.R. § 416.928(a) (2004), Plaintiff's statements alone cannot establish that her alleged anxiety is severe.
2. Subjective Complaints of Pain
Plaintiffs second argument — that the ALJ failed to give full weight to her subjective complaints of pain which, she claims, were supported by the findings of her treating physicians — can also be disposed of in relatively short order. In effect, Plaintiff maintains that the ALJ impermissibly failed to support his conclusion that her testimony as to pain was "not [credible] to the extent alleged." (A.R. at 19.)
In Avery v. Sec'y of Health Human Servs., 797 F.2d 19 (1st Cir. 1986), the First Circuit established a road map for evaluating a claimant's subjective complaints of pain. As the court observed, "[p]roper consideration of the effect of pain . . . on an individual's ability to work is an important part of the disability evaluation process." Id. at 27 (quoting POMS T00401.570). The policy is grounded in the requirement that "there must be a clinically determinable medical impairment that could reasonably be expected to produce the pain claimed." Id. at 21-22. In essence, an administrative law judge must "obtain detailed descriptions of daily activities by directing specific inquiries about the pain and its effects to the claimant, his/her physicians from whom medical evidence is being requested, and other third parties who would be likely to have such knowledge." Id. at 23 (citations and internal quotation marks omitted). The court also requires the administrative law judge to then consider the following criteria: (1) the nature, location, onset, duration, frequency, radiation and intensity of pain; (2) any precipitating and aggravating factors; (3) the type, dosage, effectiveness and adverse side-effects of any pain medication; (4) any treatment, other than medication, for the relief of pain; (5) functional restrictions; and (6) the claimant's daily activities. See id. at 29 (citing POMS Dl T00401.570); Musto v. Halter, 135 F. Supp.2d 220, 226-27 (D. Mass. 2001).
The First Circuit has long acknowledged, however, that an administrative law judge is not required to take a claimant's subjective allegations at face value. See Bianchi v. Sec'y of Health Human Servs., 764 F.2d 44, 45 (1st Cir. 1985) (citing Burgos Lopez v. Sec'y of Health Human Servs., 747 F.2d 37, 40 (1st Cir. 1984)). It is also well established that a court must generally defer to credibility determinations made by an administrative law judge. See Frustaglia v. Sec'y of Health Human Servs., 829 F.2d 192, 195 (1st Cir. 1987); Brown v. Sec'y of Health Human Servs., 740 F. Supp. 28, 36 (D. Mass. 1990). Still, a court must review an administrative law judge's determination to see if it comports with the law.
In making his credibility determination, the ALJ first noted that Plaintiff had not produced any medical evidence of muscle wasting, neurological deficits or marked limitations in any area of mental functioning. (A.R. at 19.) The ALJ then used Plaintiff's own testimony to evaluate her RFC, e.g., she stated that: the pain in her neck was "low grade"; she used Motrin, MS Contin, Ritalin and ice to manage her symptoms and did not suffer any adverse side effects; she was able to grocery shop, but needed help carrying the bags; and, on "good days," she could walk one quarter of a mile and sit for about one half hour. (Id.) In short, the ALJ's findings with respect to Plaintiffs subjective complaints of pain were supported by the substantial evidence of record and sufficiently specific to make clear the weight the ALJ gave to Plaintiff's testimony. See generally Social Security Ruling 96-7p (July 2, 1996). Accordingly, the court rejects Plaintiffs second argument.
3. Conclusions of Treating Physician
Finally, Plaintiff contends that the ALJ failed to give controlling weight to the conclusion of her treating physician, Dr. Larkin, that she is "disabled" from work. As the Commissioner correctly points out, however, Dr. Larkin was not entitled to make the ultimate determination as to whether Plaintiff is "disabled." See generally Social Security Ruling 96-5p (July 2, 1996). Rather, such a judgment was properly reserved to the Commissioner. See 20 C.F.R. § 416.927(e)(1)(2004) ("We are responsible for making the determination or decision about whether you meet the statutory definition of disability. . . . A statement by a medical source that you are `disabled' or `unable to work' does not mean that we will determine that you are disabled."). See also Arroyo v. Sec'y of Health Human Servs., 932 F.2d 82, 89 (1st Cir. 1991) (finding ALJ not required to accept conclusions of treating physician on ultimate issue of disability); Sitar v. Schweiker, 671 F.2d 19, 22 (1st Cir. 1982) (similar). Further, to the extent Dr. Larkin's conclusion could be considered a medical opinion, it is neither well-supported by clinical and laboratory diagnostic techniques nor consistent with the record as a whole and, therefore, could properly have been rejected by the ALJ on those grounds as well. See 20 C.F.R. § 416.927(d) (2004).
IV. CONCLUSION
For the foregoing reasons, the court finds that the Commissioner's decision is based on substantial evidence and not predicated on errors of law. Accordingly, Plaintiff's motion to reverse or remand the Commissioner's decision is DENIED and the Commissioner's motion to affirm is ALLOWED.
IT IS SO ORDERED.