Opinion
Cause No. NA00-0213-C-H/S
August 20, 2001
ENTRY ON JUDICIAL REVIEW
Plaintiff Beverly A. Bennett seeks judicial review of the final decision by the Commissioner of Social Security denying her 1998 application for disability insurance benefits pursuant to the Social Security Act. An administrative law judge ("ALJ") found that Mrs. Bennett's rheumatoid arthritis and asthma were severe physical impairments, but that she had no severe mental impairments. He further found that Mrs. Bennett was capable of performing her past relevant work as a data processing clerk despite physical limitations related to her rheumatoid arthritis and asthma. As a result the ALJ found that Mrs. Bennett was not disabled within the meaning of the Social Security Act.
Mrs. Bennett contends the ALJ erred by rejecting the reports of her rheumatologist, therapist, and physician in favor of his own conclusions about her physical and emotional condition, and by not making adequate findings about the demands of her prior work. As explained below the court finds that the ALJ's denial of benefits is supported by substantial evidence in the record. The Commissioner's denial of benefits is therefore affirmed.
Background
Mrs. Bennett was born July 5, 1942. She is a high school graduate and worked for a telephone company from 1979 until her retirement on March 22, 1994. Her work primarily involved keying checks into a computer. She retired due to her fear of being "downsized." Since her retirement she has worked part-time as a companion for special education children, working four hours per day, four days per week.
Mrs. Bennett first applied for benefits on September 14, 1998. She contends she is unable to work due to a combination of physical and mental impairments. She amended her benefits application to change the date of onset from March 22, 1994 (the date of her retirement) to July 5, 1997 (her 55th birthday). The record includes medical evidence from before and after the onset of her alleged disability.
After Mrs. Bennett's application for benefits was denied, she requested an administrative review of this application. On December 17, 1999, Mrs. Bennett and her representative appeared at a hearing before Administrative Law Judge Patrick Kimberlin. ALJ Kimberlin found that Mrs. Bennett was not disabled under the standard set forth in the Social Security Act because she could perform sedentary work which does not require her to lift more than ten pounds and which does not expose her to environmental irritants. Since her past work did not require her to perform activities beyond these limitations, the ALJ found that she was capable of performing the same type of work. The Appeals Council initially denied Mrs. Bennett's request for further review. After receiving new evidence, the Appeals Council again denied review of the ALJ's decision, leaving the ALJ's decision as the Commissioner's final decision.
Because the Appeals Council denied review, this court may not consider 2 the new evidence that was not presented to the ALJ. See Eads v. Secretary of Dep't of Health and Human Services, 983 F.2d 815, 817 (7th Cir. 1993).
Definition of Disability
To be eligible for benefits, a claimant must establish that she has a disability within the meaning of the Social Security Act. The Act itself defines disability to mean, in pertinent part:
[an inability] to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than [twelve] months. . . .42 U.S.C. § 423(d)(1)(A). The Act further describes the relevant standard for disability:
[A]n individual shall be 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 kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work.
. . .
42 U.S.C. § 423(d)(2)(A). This standard is a stringent one. A claimant is not necessarily entitled to benefits even if she has substantial impairments. Before tax dollars — including tax dollars paid by others who work despite severe physical and mental impairments and pain — are available to support someone applying for benefits, it must be clear that she has a severe impairment and that she cannot perform virtually any kind of work. Benefits are thus available only as a matter of nearly last resort.
The statutory standard is applied through a five-step analysis set forth in the regulations:
(1) Is the claimant engaging in substantial gainful activity? If so, he or she is not disabled.
(2) If not, does the claimant have an impairment or combination of impairments that are severe? If not, he or she is not disabled.
(3) If so, does the impairment(s) meet or equal a listed impairment in the appendix to the regulations? If so, the claimant is disabled.
(4) If not, can the claimant do his or her past relevant work? If so, he or she is not disabled.
(5) If not, can the claimant perform other work given his or her residual functional capacity, age, education, and experience? If so, then he or she is not disabled. If not, he or she is disabled.
See 20 C.F.R. § 404.1520. The burden of proof is on the claimant for the first four steps and on the Commissioner for the fifth step if the analysis proceeds that far. Young v. Secretary of Health and Human Services, 957 F.2d 386, 389 (7th Cir. 1992).
In this case, the ALJ found at step one that Mrs. Bennett's part-time employment as a teacher's assistant was not substantial gainful activity. He found at step two that Mrs. Bennett had severe physical impairments from a history of asthma and rheumatoid arthritis, but that none of those impairments met or equaled a listed impairment at step three of the analysis. At step two, the ALJ also found that Mrs. Bennett's mental impairments — post-traumatic stress disorder, anxiety, and panic attacks — were not severe. The ALJ then determined under step four that Mrs. Bennett's asthma and rheumatoid arthritis were not incapacitating and that she had the residual functional capacity to perform her past work, which did not require her either to lift more than 10 pounds or to be exposed to environmental irritants. R. 27.
Standard of Review
The Social Security Act provides for judicial review of the Commissioner's denial of disability insurance benefits. 42 U.S.C. § 405(g). The court reviews the Commissioner's (here the ALJ's) factual findings to determine whether they are supported by substantial evidence in the record as a whole. Angevine v. Sullivan, 881 F.2d 519, 521 (7th Cir. 1989). Substantial evidence is "that quantum of evidence which `a reasonable mind might accept as adequate to support a conclusion.'" Id. If the record contains such support, the court must affirm the decision of the Commissioner unless he has made an error of law. Wolfe v. Shalala, 997 F.2d 321, 322 (7th Cir. 1993).
Although the task before the court is not to decide the facts anew, to reweigh the evidence, or to substitute its judgment for that of the Commissioner, the court will not simply rubber stamp the decision without critically reviewing the evidence as a whole. Bauzo v. Bowen, 803 F.2d 917, 923 (7th Cir. 1986). In considering the record as a whole, the court must look at all the relevant evidence, not just the evidence that supports the Commissioner's conclusion. Ray v. Bowen, 843 F.2d 998, 1002 (7th Cir. 1988). Thus, the court must consider "whatever in the record fairly detracts from [the] weight" of the Commissioner's determination. Bauzo, 803 F.2d at 923. Ultimately, however, "where conflicting evidence allows reasonable minds to differ," the court must defer to the Commissioner's resolution of that conflict. Angevine, 881 F.2d at 521.
Discussion
Mrs. Bennett argues that the ALJ erred (1) by substituting his own interpretation of the medical evidence for that of the treating physicians; and (2) by not comparing the duties of her past work with her functional capacity as supported by the record. Neither argument is persuasive.
I. ALJ's Interpretation of the Medical Evidence
The plaintiff argues that the ALJ erred by "playing doctor," substituting his own opinions for those of the doctors, and by failing to clarify the record when it was unclear. In an application for disability benefits, both the ALJ and the claimant share responsibility for establishing a clear record. The ALJ must develop the record fully, see Thompson v. Sullivan, 933 F.2d 581, 585 (7th Cir. 1991), but this responsibility does not relieve the claimant of her burden of proving disability under the first four steps of the disability analysis. Young v. Secretary of Health and Human Services, 957 F.2d 386, 389 (7th Cir. 1992). Furthermore, no record is ever complete, and requiring a complete record can be a formula for paralysis. Kendrick v. Shalala, 998 F.2d 455, 456-57 (7th Cir. 1993). The record is considered complete when there is enough evidence for the ALJ to make a fully informed decision. Id.
A. Mental Impairments
Mrs. Bennett first raised the asserted mental infirmities with Dr. Anna Fisher on August 30, 1999, more than two years after her alleged onset date. See R. 211. Dr. Fisher diagnosed Mrs. Bennett with post-traumatic stress syndrome, anxiety, and depression stemming from an incident of molestation that occurred when she was a child. Id. Dr. Fisher gave her a prescription for Xanax and suggested she seek counseling. Id. On September 16, 1999, Mrs. Bennett met with Dr. Carol Dougherty.
The record indicates that a prescription for Zoloft was also given to Mrs. Bennett. It appears Dr. Ehsan prescribed it — perhaps without Mrs. Bennett's knowledge of what it was — for a short time. R. 110. At other points, the record is unclear whether the prescription was given by Dr. Ehan [sic], R. 157, or by Dr. Fischer [sic]. R. 124.
Carol Dougherty's professional credentials are unclear from the record. Her signature appears to read, "Carol Dougherty, MS, Psy. D." R. 206-09.
Dr. Dougherty diagnosed post-traumatic stress disorder brought about by an incident of childhood molestation, and exacerbated by Mrs. Bennett's granddaughter reaching the same age that Mrs. Bennett was when the abuse occurred. R. 207. After the initial interview Dr. Dougherty attributed to Mrs. Bennett a Global Assessment of Functioning ("GAF") of 35. R. 207. Over the next few months Mrs. Bennett met with Dr. Dougherty on two more occasions. R. 206, 208.
The ALJ found the evidence was sufficient to determine that Mrs. Bennett's mental condition was not severe enough to impair her ability to do work. He based this finding on several considerations. See R. 25-26. First, because the plaintiff had had memories of sexual abuse since her childhood, which had not affected her ability to work during most of her life, the memories should not impair her ability to continue working. Second, he found that the memories had not impaired her ability to function normally in her daily life. Third, Dr. Fisher's prescription of fairly mild drugs had controlled most of the symptoms, as evidenced by the lack of further prescriptions or recommendations for prescriptions, so plaintiff was able to work. Fourth, the ALJ found that the facts that (a) the plaintiff had not sought counseling until recently, (b) she had gone for counseling only a few times, and (c) she had not attended counseling regularly were not consistent with a severe mental impairment. Fifth, the ALJ determined that the determinations made by Dr. Dougherty about the plaintiff's conditions did not comport with her own observations, and that she did not show any evidence to back up her diagnosis. Finally, the ALJ found the plaintiff's own testimony — that she was feeling fine — and her ability to compose herself at the hearing to be persuasive. R. 26.
Section 404.1521 of the regulations defines a "severe" impairment to be 5 one that "significantly limit[s] your physical or mental ability to do basic work activities."
The plaintiff argues the ALJ erred in dismissing her mental limitations as non-severe. She claims the diagnoses of Dr. Anna Fisher and Dr. Dougherty should carry controlling weight in the absence of any other expert opinion to the contrary, and that the ALJ, by disregarding their opinions, was "playing doctor." The court disagrees.
Dr. Fisher diagnosed Mrs. Bennett with post-traumatic stress syndrome, anxiety, and depression. R. 211. Dr. Fisher did not indicate any medical evidence to support any of her diagnosis other than her notes. Id. There are no medical tests, measurements, or diagnostic tools. Id. Dr. Fisher also identified no work-related limitations resulting from Mrs. Bennett's condition.
Dr. Dougherty assessed Mrs. Bennett with a current GAF of 35. According to the DSM-IV this indicates either "impairment in reality communication" or "major impairment in several areas such as work or school, family relations, judgment, thinking, or mood." Diagnostic and Statistical Manual for Mental Disorders, 34 (4th ed. rev. 2000). A person who truly has a GAF of 35 is unable to function normally. For example the DSM-IV states that a person who is so obsessed with substance abuse that he has lost his job and friends would have a GAF of 40 or lower, and that a person with schizophrenia who hears hallucinations once a week, but accepts them as part of her schizophrenia might have a GAF of 39 or 40. Id. at 33.
The evidence before the ALJ showed that Mrs. Bennett was able to hold a part time job with working with children with special needs. She attended church regularly, attended Bible study weekly, and ushered in church every few months. She also visited nursing homes with her husband, babysat for her granddaughters, played bunco, and did a range of household tasks. She also had not raised concerns about her mental condition with any doctor until August or September 1999, more than two years after her alleged onset date. Dr. Fisher had prescribed some medication and counseling but identified no work-related limitations. Mrs. Bennett had attended only a few counseling sessions. The ALJ quite reasonably concluded that the overall evidence could not possibly be reconciled with a GAF of 35.
The ALJ's task is not to question or disagree with the medical findings of doctors in favor of his own medical opinion. Rohan v. Chater, 98 F.3d 966, 970 (7th Cir. 1996. But it is the ALJ's responsibility to weigh all of the applicable evidence to determine the plaintiff's limitations and abilities. Diaz v. Chater, 55 F.3d 300, 309 (7th Cir. 1995). Weighing such evidence is not "playing doctor." It is objectively weighing the legal merits of several contradicting factors to determine the outcome. Id.
The Commissioner argues that Dr. Dougherty is a counselor (the plaintiff 6 refers to her as a "therapist"), and that, because counselors are not on the list of authoritative medical sources in 20 C.F.R. § 404.1513(a), her opinion need not be afforded strong weight. See Ornellas v. Chater, 1996 WL 539852, at *5 n. 4 (S.D.N Y Sept. 23, 1996) (because chiropractors are not listed in 20 C.F.R. § 404.1513(a), their opinions are not given authoritative weight but may be useful as evidence from "other sources" in what is now codified as 20 C.F.R. § 404.1513(d)), citing Diaz v. Shalala, 59 F.3d 307, 314 (2d Cir. 1995). The Commissioner argues further that since Dr. Fisher is not a mental health professional, her opinion on mental health issues should not be given much weight. It is not clear from the record whether Dr. Dougherty could be deemed an authoritative source or whether Dr. Fisher's opinions deal with issues beyond her qualifications. It is clear that Dr. Dougherty's opinion is contrary to the manifest weight of all other evidence, including the evidence of Mrs. Bennett's past and current activities. Dr. Fisher's opinion does not reflect or support a finding of severe impairment that imposes limitations on Mrs. Bennett's capacity to do work.
The plaintiff interprets SSR 96-5p to mean that when a doctor's conclusions need clarification, it is the ALJ's responsibility to request further information. In particular, the plaintiff argues that the ALJ erred when he did not request clarification after finding that the evidence did not support Dr. Dougherty's conclusions. Clarification is warranted when there is insufficient evidence, not when the evidence and the findings are contradictory. When the plaintiff offers no evidence, "or offers no corroboration for [her] story the ALJ need not even start the psychological examination process." Kendrick v. Shalala, 998 F.2d 455, 458 (7th Cir. 1993).
"For treating sources, the rules also require that we make every reasonable 7 effort to recontact such sources for clarification when they provide opinions on issues reserved to the Commissioner and the bases for such opinions are not clear to us." SSR 96-5p at 2 (July 2, 1996).
Here, the ALJ found no evidence to support the doctors' conclusions. The ALJ need not launch a psychological investigation to corroborate or disprove diagnoses with no basis in fact. The opinion of Dr. Dougherty was so much at odds with the behavior of Mrs. Bennett as to justify rejection without further inquiry. Dr. Fisher's opinion simply did not indicate any basis for finding a severe impairment limiting Mrs. Bennett's ability to do work. If ALJs were required to "clarify" such a record, they would be required to "clarify" any record that might otherwise lead to a denial of benefits. The ALJ did not err by finding that Mrs. Bennett did not suffer from an severe mental impairment for purposes of the Social Security Act.
B. Physical Impairments
Mrs. Bennett suffers from asthma and rheumatoid arthritis. R. 25, 72.
She indicates that she began to have problems with asthma in the early 1990s around the age of 50. R. 49. Dr. Gardner diagnosed her with stable asthma in 1994, R. 129, and a pulmonary function test (spirometry) in 1995 was "fairly unremarkable". R. 128. She was admitted to the emergency room for breathing problems and asthma attacks twice in 1996 and again in 1998, R. 131, 138, 153, but otherwise her asthma was largely controlled through inhalers. R. 133. Dr. John Selby diagnosed her in 1999 with asthma. R. 159.
In this action for judicial review, Mrs. Bennett does not take issue with the ALJ's findings on the severity or effects of her asthma. She focuses her challenge instead on the evidence of her rheumatoid arthritis, and especially on Dr. Ehsan's September 20, 1999, evaluation of her condition, which amounted to an opinion that she was completely disabled.
Mrs. Bennett was originally diagnosed with rheumatoid arthritis in the 1970s. She has not been on any continual medication for arthritis since that time. R. 191. According to an examination by Dr. Ehsan in 1994 she did not clinically have rheumatoid arthritis, but she did have mild symptoms indicative of osteoarthritis. R. 126. A 1996 examination by Dr. Howard Pope showed a rheumatoid factor of 91.4. R. 140. In February 1999 Dr. Ehsan measured a rheumatoid factor of 135. R. 146. Mrs. Bennett received Prednisone treatments for asthma, which exacerbated her arthritic condition. R. 129, 191.
In a 1998 exam by Dr. Ehsan, Mrs. Bennett was found to have mild restriction in range of motion of the shoulders and tenderness over her "GH" (gleno-humeral) joints, tenderness of her wrists and hands, but no significant muscle weakness was found. R. 189. There was no active synovitis. Id.
Mrs. Bennett was sent by the Social Security Administration to Dr. Gardner in 1998. He found that there existed asthma and degenerative arthritis of a rheumatoid nature, but that her range of motion was within normal parameters for all categories. R. 147-52.
In other words, the evidence through 1998 and into 1999 did not come close to supporting a finding of disability based on rheumatoid arthritis. On September 20, 1999, however, Dr. Ehsan submitted a report indicating Mrs. Bennett was not able to perform simple grasping, pushing and pulling, fine manipulation, or repetitive motion. R. 198. He also found she should never lift more than ten pounds, squat, crawl, or reach above shoulder level. More important, the report also indicated that Mrs. Bennett could sit for no more than one hour at a time, that during an eight-hour day she could sit for less than one hour, and that she could stand and walk for less than an hour at a time and for less than an hour in an eight-hour day. Id.
If Dr. Ehsan's report of September 20, 1999, were taken at face value, Mrs. Bennett would be totally disabled. The ALJ found that the evidence contradicted Dr. Ehsan's conclusions. Mrs. Bennett argues that the ALJ erred by not giving substantial enough weight to Dr. Ehsan's medical report in favoring the evidence contradicting it.
None of the medical evidence from before September 20, 1999, indicates a condition nearly as severe as Dr. Ehsan reported. The ALJ correctly described her treatment as "highly conservative and somewhat sporadic." R. 23. As for any contention that Dr. Ehsan's September 1999 report showed a severe deterioration in Mrs. Bennett's condition, the ALJ reviewed the evidence of Mrs. Bennett's daily activities at the time of the hearing in December 1999 — her part-time work, her church activities, and her household activities. The ALJ found that Mrs. Bennett exceeded all of Dr. Ehsan's recommended behavioral limits in her work as a teacher's aide, which required her to sit or stand for several hours each day. Furthermore, range of motion tests performed by Dr. Gardner in 1998 did not reveal substantial arthritic limitations. R. 149.
The Seventh Circuit has explained that sometimes the treating physician's opinion can be biased in favor of a patient, so such an opinion may be discounted when it seems unreasonable in light of other evidence. Stephens v. Heckler, 766 F.2d 284, 288-89 (7th Cir. 1985). The ALJ's job is to weigh all legally relevant evidence in determining disability. The opinion of one doctor, even when that doctor is the primary treating physician, does not necessarily override all other evidence. See Clifford v. Apfel, 227 F.3d 863, 870 (7th Cir. 2000) (ALJ need not give controlling weight to the conclusions of a treating physician when the evidence clearly contradicts those conclusions).
Mrs. Bennett describes the ALJ's balancing of the evidence contradicting Dr. Ehsan's report as "playing doctor." As noted earlier, it is the ALJ's responsibility to determine how much credence to give particular pieces of evidence. Diaz v. Chater, 55 F.3d 300, 309 (7th Cir. 1995). It is also up to the ALJ to weigh the applicable evidence to determine the plaintiff's limitations, if any. Id. The ALJ was doing his job, not playing doctor, when he determined that the overall weight of medical evidence and evidence of Mrs. Bennett's activities undermined Dr. Ehsan's conclusions.
Mrs. Bennett also contends the ALJ failed to develop the record fully by not clarifying the opinion of Dr. Ehsan. She argues that when a record is unclear, it is the duty of the ALJ to seek additional evidence to clarify the record.
The plaintiff relies upon Smith v. Apfel, where the Seventh Circuit held 8 that an ALJ erred by finding that an x-ray taken ten years prior and showing the beginnings of degenerative disease was sufficient to find no disease. 231 F.3d 433 (7th Cir. 2000). This case is quite different. The evidence is not out of date — it simply contradicts the conclusions of the treating physician.
First, the record contains medical evidence gathered at the behest of the ALJ that tends to show a lack of physically disabling condition. The plaintiff was sent to Dr. Gardner at the end of 1998 for an evaluation. R. 147. Dr. Gardner found no bronchial spasms, no deformities due to arthritis, and the plaintiff's range of motion to be within normal limits. R. 147-49. These findings were within the claimed period of disability.
Second, if the ALJ were required to gather more information merely because the evidence weighs against a finding of disability, that duty would effectively shift the burden of proof, requiring the agency to disprove the alleged disability. The plaintiff in essence argues that when a physician's conclusions are not supported by his analysis, the ALJ — instead of rejecting the conclusions — must, ask the physician to clarify the conclusions. The Seventh Circuit has not gone so far.
Although an ALJ has a duty to develop the record fully, it is always possible to gather more information. Kendrick v. Shalala, 998 F.2d 455, 456-57 (7th Cir. 1993); see also Stephens v. Heckler, 766 F.2d 284, 287 (7th Cir. 1985) (court reviews the quality not the quantity of the evidence). It is the ALJ's job to determine what amount of evidence is reasonable, and he is not required to gather evidence forever. Kendrick, 998 f2d at 457. The record in this case is sufficient to make a decision. The lack of evidence supporting the plaintiff's claim does not indicate a lack of effort in gathering the records. Sometimes the evidence just isn't there.
II. The ALJ's Interpretation of Past Work
Mrs. Bennett also contends that the ALJ did not address the specific duties and functions of her past work, so that this court should remand for a full determination of these functions. She cites Strittmatter v. Schweiker, 729 F.2d 507, 509 (7th Cir. 1984), where the Seventh Circuit remanded because the court could not determine whether the ALJ ascertained the demands of the claimant's former work and compared them with her present physical capacity. "The administrative law judge [is] required to determine the physical demands of the particular type of sedentary work that [the] claimant [has] done and then [to] compare those demands to her present capabilities." Id.
Here the ALJ properly ascertained the particular nature of Mrs. Bennett's working day — noting that it involved the keying of checks and that it did not require heavy lifting or supervising. R. 22, 26. He further noted that her asthma required her to work in a clean air environment, which her past working environment was. R. 25. In considering these significant characteristics, the ALJ made a reasonable assessment of the plaintiff's past work.
III. The Temporal Aspects of Plaintiff's Conditions
Mrs. Bennett alleges a disability onset of July 5, 1997. She claims that, while the record states that she took an early retirement offer because she feared being "downsized," her decision to retire was really due to illness, which progressed into total disability. At the time of her retirement, the plaintiff was not disabled with respect to the standard for disability set forth in the Social Security Act. The evidence does not show that her conditions worsened to the point of total disability by July 1997. No evidence could support a finding of disability at that time. "[T]he medical evidence serves as the primary element in the onset determination," and the date chosen "can never be inconsistent with the medical evidence of record." Pugh v. Bowen, 870 F.2d 1271, 1274 (7th Cir. 1989), citing Lichter v. Bowen, 814 F.2d 430, 434 (7th Cir. 1987).
The ALJ's finding that Mrs. Bennett could do her job with her current impairments is consistent with the medical evidence of the progression of her conditions. The ALJ's finding that Dr. Ehsan's determination of rheumatoid arthritis in 1999 and asthma attacks in 1996 and 1998 was not sufficient to constitute disability in July of 1997 is reasonable. Furthermore, the findings of Dr. Gardner from 1998, well into the alleged disability period, do not indicate disability.
Finally, Mrs. Bennett claims that the ALJ did not consider whether she could work full time as defined by SSR 96-8p. This is another example of the plaintiff trying to shift the burden of proof. It is the plaintiff's burden to prove — in the first four steps of the analysis — that she is unable to do her past work. It is not up to the ALJ, when he makes a negative finding, to prove that the plaintiff is able to work. By finding that the plaintiff was capable of returning to her old job the ALJ implicitly found that she could work a full 8-hour day. That is not the only way to read the evidence, but it is a reasonable view of the evidence.
Conclusion
For the reasons set forth above the decision of the Commissioner denying disability insurance benefits to plaintiff Beverly A. Bennett is affirmed. Final judgment will issue accordingly.
FINAL JUDGMENT
The court having issued on this day its Entry on Judicial Review in this cause, now ORDERS, ADJUDGES, AND DECREES that the Commissioner's denial of benefits is AFFIRMED. This Entry of Judgment constitutes a final judgment pursuant to the fourth sentence of 42 U.S.C. § 405(g).