Opinion
CIVIL NO. 98-CV-4819 (JBS)
November 1, 1999
Alan H. Polonsky, Esquire, Polonsky Polonsky, Audubon, New Jersey. Attorney for Plaintiff.
Faith S. Hochberg, United States Attorney, By: Anthony J. LaBruna, Assistant United States Attorney, Newark, New Jersey, Attorney for Defendant.
OPINION
This matter comes before the court pursuant to section 205(g) of the Social Security Act ("Act"), as amended, 42 U.S.C. § 405(g), to review the final decision of the Commissioner of the Social Security Administration ("Commissioner"), denying the plaintiff's claim for Disability Insurance Benefits under Title II and Supplemental Security Income ("SSI") benefits under Title XVI of the Act. For the reasons stated below, this court affirms the Commissioner's final decision.
I. Background
A. Procedural History
The plaintiff, Antonio Cuevas, filed an application for Social Security Disability Benefits on September 22, 1995, alleging disability due to a nervous problem, back problems and high blood pressure. (Joint Stipulation of Facts at 1.) His application was denied both initially and on reconsideration. Id. The plaintiff subsequently requested a hearing before an Administrative Law Judge ("ALJ"). Id. On June 24, 1997, the plaintiff, represented by counsel, appeared before the Honorable Alfred K. Tyminski in Voorhees, New Jersey. (R. 15.)
The plaintiff testified at the hearing that he can sit for one hour before he has to stand up. (R. 57.) He stated that he can lift up to twenty pounds once, and ten pounds repeatedly for about five minutes. (R. 57.) He further testified that he has thoughts of suicide and that he does not go any where by himself. (R. 53-56.)
In a written opinion dated August 28, 1997, the ALJ determined that the plaintiff was "not disabled" within the meaning of the Act, and was therefore not entitled to benefits. (R. 22.) In applying the regulation's five-step sequential evaluation analysis, see infra, the ALJ found at step one that the plaintiff had not engaged in substantial gainful activity since June 20, 1995. (R. 16, 21.) At steps two and three, the ALJ found that the plaintiff suffered from degenerative disc disease at L3-L4, L4-L5 and L5-S1, as well as anxiety disorder and dependent personality. (R. 18.) The ALJ found these impairments to be severe, but that they did not equal an impairment listed in Appendix 1 to Subpart P ( 20 C.F.R. § 404.1520(d) and 416.920(d)). (R. 18, 21.) At step four, finding that the plaintiff has the physical residual functional capacity to do medium work, and that the plaintiff's mental residual functional capacity was not significantly limited, the ALJ concluded that these impairments did not preclude the plaintiff from returning to his past relevant work as a janitor. (R. 18, 21.) The ALJ's decision that the plaintiff was not disabled became final when the Appeals Council denied the plaintiff' request for review. (Joint Stipulation of Facts at 1.)
Medium work is defined by the Code as the capacity to lift no more than fifty pounds at a time with frequent lifting or the carrying of objects weighing up to twenty five pounds, which also includes the ability to perform the exertional requirements of light and sedentary work. See 20 C.F.R. § 404.1567(c) and 416.967(c).
On October 22, 1998, the plaintiff timely filed this action in the United States District Court, claiming that the Commissioner's finding that his is "not disabled" was not based upon substantial evidence.
B. Personal and Medical History
The plaintiff stated in the Disability Report completed in connection with his application that he last worked in June of 1995, when he was employed for twenty years as a janitor at a factory in Puerto Rico. (R. 16.) He claims that he has not engaged in any substantial gainful employment since coming to the United States, approximately twenty months before the hearing. (R. 16.) He claims that his family doctor in Puerto Rico, a Dr. Gonzales, instructed him to discontinue working when he fell from a ladder at the factory in June of 1995. (R. 50-51.) When he came to New Jersey, the plaintiff sought the treatment of Dr. Udom Suvansri on July 1, 1995 for pain in his right leg and lower back. (R. 52.)
The plaintiff was examined by six doctors besides Dr. Gonzales, including Dr. Seth L. Jaffe and Dr. Mark J. Reiner, who are orthopedic specialists, as well as Dr. Stephen J. Zionts and Dr. Willa M. Greenberg. Moreover, the plaintiff visited the Hispanic Counseling and Family Services of New Jersey on at least eleven different occasions, and was examined by Dr. Young B. Lee, a psychiatrist. A summary of the medical findings regarding the plaintiff's physical and mental conditions follow.
1. The Plaintiff's Physical Condition
Between July 1, 1995 and April 8, 1996, Dr. Suvansri, the plaintiff's treating physician, examined the plaintiff on at least nineteen different occasions for complaints ranging from back and leg pain to anxiety. (R. 160-184.) On the second visit, December 5, 1995, Dr. Suvansri diagnosed the plaintiff as suffering from hypertension and osteoarthritis. (R. 193-196). A CT scan of the lumbar spine was performed on the same day, which gave the impression of lumbar spondylosis resulting in mild spinal stenosis at the L4-L5 and L5-S1 levels. (R. 173).
On January 2, 1996, Dr. Jaffe and Dr. Reiner, orthopedists at Cherry Hill Orthopedic Surgeons, examined the plaintiff at the request of Dr. Suvansri. The doctors observed that the plaintiff could walk normally, that his reflexes were normal and symmetrical, and that the muscle strength in his lower extremities was full. (R. 198.) Doctor Jaffe advised Dr. Suvansri that the CAT scans of the plaintiff's back showed evidence of herniated discs at L4-L5 and L5-S1 but ordered an MRI to be performed on the plaintiff the same day. (R. 198.)
On January 24, 1996, Dr. Stephen J. Zionts completed a consultative physical examination of the plaintiff at the request of the Social Security Administration. (R. 215-16.) In his report, Dr. Zionts noted that it was "almost impossible to obtain an accurate [medical] history." (R. 215). Doctor Zionts found that the plaintiff was in no acute distress, was ambulating without difficulty, and was able to get up on his heels and toes. (R. 215.) Doctor Zionts found that the plaintiff's lumbar range of motion was "slight," while he enjoyed a full range of motion of, inter alia, hips, cervical regions the spine and ankles. (R. 216.) Notably, Dr. Zionts found that the plaintiff's deep tendon flexes to be equal and active and that there was no gross muscle wasting in the lower extremities. (R. 216.) Finally, Dr. Zionts opined that the plaintiff is suffering from degenerative joint disease primarily affecting his lumbosacral spine. (R. 216.)
On January 30, 1996, Drs. Jaffe and Reiner re-examined the plaintiff following receipt of an MRI performed on January 15, 1996. The MRI, conducted in order to confirm the doctors' initial suspicion that the plaintiff's discs were herniated, revealed that the discs were not, in fact, herniated. (R. 217.) Doctor Jaffe advised Dr. Suvansri that the plaintiff suffered from degenerate disc disease at L3-L4, L4-L5, and L5-S1, and that the plaintiff should undergo EMG testing and epidural steroid injections. (R. 217.)
Subsequently, Dr. Suvansri referred the plaintiff to Dr. Willa M. Greenberg for EMG testing. On March 22, 1996, Doctor Greenberg examined the plaintiff, which included an electrodiagnostic study. (R. 219-221.) A physical examination revealed that the plaintiff's "[b]ilateral upper and lower extremities have full strength and range of motion." (R. 219.) Doctor Greenberg found electrodiagnostic evidence suggestive of right L5 radiculopathy as well as right S1 radiculopathy, with no evidence of peripheral neuropathy. (R. 220.)
Neuropathy is a general term denoting functional disturbances or pathological changes in the peripheral nervous system. See Sloane-Dorland Annotated Medical-Legal Dictionary 376 (1987). Peripheral neuropathy rests on symptoms of sensory abnormalities. See Elam v. Alcolac, Inc . , 765 S.W.2d 42, 101, 107 (Mo.App. 1988).
On April 29, 1996, the plaintiff was reevaluated at the office of Cherry Hill Orthopedic Surgeons, where the diagnosis of degenerative disc disease was affirmed. (R. 223.) That examination revealed that straight leg raising and other physical tests were negative, and that the plaintiff's distal, sensory motor vascular and strength exam were normal. (R. 223.)
Meanwhile, the plaintiff continued to see his treating physician, Dr. Suvansri. On April 3, 1996, following examinations conducted by Drs. Jaffe, Reiner and Greenberg, Dr. Suvansri indicated that there had been no significant changes in the plaintiff's condition since the December 5 visit, and that the plaintiff suffered from herniated discs at L4-L5 and L5-S1, and right renal calculus and hypertension. (R. 222.) On May 14, 1996, Dr. Suvansri indicated in a letter that the plaintiff was under his care due to hypertension and disc herniation. (R. 224.) On July 18, 1996, Dr. Suvansri expressed in another letter that the plaintiff was under his care due to severe low back pain due to disc herniation, and opined that the plaintiff was unable to work at the time. (R. 225.) This diagnosis was reaffirmed in another letter on January 31, 1997, as well as office notes dated January 26, 1997. (R. 229, 237.)
2. The Plaintiff's Mental Condition
The plaintiff was under the care of the Hispanic Counseling and Family Services of New Jersey from November of 1995 to February of 1997. He was treated for generalized affective disorder and depressive disorder with a variety of medications including Paxil, Xanax, Klonopin, Atclazine and Risperdal. (R. 185-86, 200-211.)
"Depressive disorder" is mood disorder. See Diagnostic Statistical Manual of Mental Disorders 375-80 (4th ed. 1995) ("DSM-IV"). A major depressive disorder is characterized by one or more "Major Depressive Episodes," which is "at least two weeks of depressed mood or loss of interest accompanied by at least four additional symptoms of depression." DSM-IV at 320. A Major Depressive Episode is qualified by an episode "specifier" — mild, moderate or severe — which indicates the severity of the symptoms and the degree of functional disability and distress. Id . at 376. "Mild episodes are characterized by the presence of only five or six depressive symptoms and either mild disability or the capacity to function normally but with substantial and unusual effort." Id .
Doctor Lee conducted an examination of the plaintiff on January 9, 1996, at the request of the Social Security Administration Division of Disability Determinations. (R. 212-13.) Doctor Lee found that the plaintiff's affect was appropriate to his thought process, and his mood was mildly depressed and somewhat anxious, but not to a significant degree. (R. 213.) Notably, Dr. Lee assessed the plaintiff "able to follow directions," that his "interpersonal relationship is moderately impaired," and that the plaintiff's "subjective symptoms are not entirely substantiated by the objective findings." (R. 213.) Doctor Lee diagnosed the plaintiff as suffering from mild anxiety order and dependent personality. (R. 213.)
3. The Plaintiff's Residual Functional Capacity
Doctor Suvansri completed two assessments of the plaintiff's residual functional capacity, relating to the plaintiff's mental and physical capacities. In the plaintiff's physical assessment, Dr. Suvansri expressed that the plaintiff's ability to sit, stand and walk is limited to one-half hour in an eight hour day, and only for one-half of an hour at one time. (R. 235.) Doctor Suvansri expressed that the plaintiff is capable of squatting, lifting one to four pounds, using his hands for pushing and pulling, doing simple grasping, and undertaking fine manipulations only occasionally. (R. 236.) Doctor Suvansri expressed that the plaintiff had no ability to push and pull leg controls, bend, reach, climb, push, pull and crawl. (R. 236.)
In Dr. Suvansri's assessment of the plaintiff' mental capacity, he rated the plaintiff as having a fair ability to function in following work rules, relating to co-workers, dealing with the public, using judgment in public, interacting with a supervisor, dealing with work, functioning independently, maintaining attention, concentrating, understanding, remembering and carrying out job instructions, behaving in an emotionally stable manner, relating predictably in social situations and demonstrating ability. (R. 232-233.) Doctor Suvansri indicated that the plaintiff had poor to no ability to maintain personal appearance. (R. 223.)
In an assessment dated May 15, 1996, the State Agency, non-examining physician made findings of fact that the plaintiff can lift and carry up to fifty pounds frequently and twenty-five occasionally, stand or walk for up to six hours in an eight hour work day, sit for up to six hours in an eight hour work day, and that the plaintiff has no postural or environmental limitations. (R. 72.) The assessment further expressed that the plaintiff's memory is adequate and that his concentration is fair, and that the plaintiff is able to understand, remember, and follow simple instructions. (R. 69.)
II. Discussion
A. "Disability" Defined and Burdens of Proof
The Social Security Act defines "disability" for purposes of plaintiff's entitlement to benefits as the inability "to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 1382c(a)(3)(A). Under this definition, a the plaintiff qualifies as disabled "only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work." 42 U.S.C. § 1382c(a)(3)(B).
The Commissioner has promulgated regulations for determining disability applicable to Disability Insurance cases. See 20 C.F.R. § 404.1501-404.1599. Under these regulations, substantial gainful activity is defined as "work that — (a) involves doing significant and productive physical or mental duties; and (b) is done (or intended) for pay or profit." 20 C.F.R. § 404.1510. Importantly, this definition presupposes a regular, continuing, and sustained ability to perform such work. Kangas v. Bowen, 823 F.2d 775, 778 (3d Cir. 1987).
The Commissioner has promulgated regulations that determine disability by application of a five-step sequential analysis codified in 20 C.F.R. § 404.1520. The Commissioner evaluates each case according to a five-step process until a finding of "disabled" or "not disabled" is obtained. 20 C.F.R. § 404.1520(a). This five-step process is summarized as follows:
1. If the plaintiff currently is engaged in substantial gainful employment, he will be found "not disabled."
2. If the plaintiff does not suffer from a "severe impairment," he will be found "not disabled."
3. If the severe impairment meets or equals a listed impairment in 20 C.F.R. Part 404, Subpart P, Appendix 1 and has lasted or is expected to last for a continuous period of at least twelve months, the plaintiff will be found "disabled."
4. If the plaintiff can still perform work he has done in the past ("past relevant work") despite the severe impairment, he will be found "not disabled."
5. Finally, the Commissioner will consider the plaintiff's ability to perform work ("residual functional capacity"), age, education and past work experience to determine whether or not he is capable of performing other work which exists in the national economy. If he is incapable, a finding of disability will be entered. On the other hand, if the the plaintiff can perform other work, he will be found not to be disabled.20 C.F.R. § 404.1520(b)-(f). Entitlement to benefits is dependent upon a finding that the plaintiff is incapable of performing some other type of work in the national economy.
This analysis involves a shifting burden of proof. Wallace v. Secretary of Health Human Servs., 722 F.2d 1150, 1153 (3d Cir. 1983). In the first four steps of the analysis, the burden is on the plaintiff to prove every element of her claim by a preponderance of the evidence. In the final step, however, the Commissioner bears the burden of proving that work is available for the petitioner: "Once a the plaintiff has proved that he is unable to perform his former job, the burden shifts to the Commissioner to prove that there is some other kind of substantial gainful employment he is able to perform." Kangas, 823 F.2d at 777. See Olsen v. Schweiker, 703 F.2d 751, 753 (3d Cir. 1983).
B. Standard of Review
A reviewing court must uphold the Commissioner's factual decisions if they are supported by "substantial evidence." 42 U.S.C. § 405(g), 1383(c)(3); Williams v. Sullivan, 970 F.2d 1178, 1182 (3d Cir. 1992),cert. denied, 507 U.S. 924 (1993). "Substantial evidence" means more than "a mere scintilla." Richardson v. Perales, 402 U.S. 389, 401 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). "It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Id. The inquiry is not whether the reviewing court would have made the same determination, but, rather, whether the Commissioner's conclusion was reasonable. See Brown, 845 F.2d at 1213. Thus, substantial evidence may be slightly less than a preponderance. See Hanusiewicz v. Bowen, 678 F. Supp. 474, 476 (D.N.J. 1988).
The reviewing court, however, does have a duty to review the evidence in its totality. See Daring v. Heckler, 727 F.2d 64, 70 (3d Cir. 1984). In order to do so, "a court must `take into account whatever in the record fairly detracts from its weight.'" Schonewolf v. Callahan, 972 F. Supp. 277, 284 (D.N.J. 1997) (quoting Willbanks v. Secretary of Health Human Servs., 847 F.2d 301, 303 (6th Cir. 1988) (quoting Universal Camera Corp. v. NLRB, 340 U.S. 474, 488 (1951))). The Commissioner has a corresponding duty to facilitate the court's review: "[w]here the [Commissioner] is faced with conflicting evidence, he must adequately explain in the record his reasons for rejecting or discrediting competent evidence." Ogden v. Bowen, 677 F. Supp. 273, 278 (M.D.Pa. 1987) (citing Brewster v. Heckler, 786 F.2d 581 (3d Cir. 1986)). As the Third Circuit has held, access to the Commissioner's reasoning is indeed essential to a meaningful court review:
Unless the [Commissioner] has analyzed all evidence and has sufficiently explained the weight he has given to obviously probative exhibits, to say that his decision is supported by substantial evidence approaches an abdication of the court's duty to scrutinize the record as a whole to determine whether the conclusions reached are rational.Gober v. Matthews, 574 F.2d 772, 776 (3d Cir. 1978). Nevertheless, the district court is not "empowered to weigh the evidence or substitute its conclusions for those of the fact-finder." Williams, 970 F.2d at 1182.
The ALJ must analyze all of the evidence in the record and provide an adequate explanation for disregarding evidence. Adorno v. Shalala, 40 F.3d 43 (3d Cir. 1994). The ALJ must set out a specific factual basis for each finding. Baerga v. Richardson, 500 F.2d 309 (3d Cir. 1974),cert. denied, 420 U.S. 931 (1975); Root v. Heckler, 618 F. Supp. 76, 79 (D.Del. 1985). Simply referring to the "record" is insufficient. Abshire v. Bowen, 662 F. Supp. 8 (E.D.Pa. 1986).
III. Analysis
The plaintiff challenges the Commissioner's final decision denying him SSI and Disability Insurance benefits by arguing that the ALJ's decision was not supported by substantial evidence. Specifically, the plaintiff alleges that the ALJ erred in three instances. First, the plaintiff claims that the ALJ rejected the plaintiff's treating physician's medical opinion without offering an adequate explanation. Second, the plaintiff alleges that the ALJ's finding that he possessed the residual functional capacity to perform a limited range of work activity is not supported by substantial evidence. Finally, the plaintiff alleges that the ALJ failed to consider the plaintiff' physical impairments in combination with his mental impairments, thereby denying the ALJ's findings from substantial evidence support. (Pl. Br. at 7-27.)
For the following reasons, this court holds that the ALJ's determinations were based upon substantial evidence and affirms the Commissioner's final decision.
A. The ALJ Adequately Explained Why it Gave the Treating Physician Little Evidentiary Weight
The plaintiff's first argument is that the ALJ erred in rejecting the treating physician's medical opinion without offering an adequate explanation. (Pl. Brf. at 7-20.) The plaintiff's second argument is that the ALJ's finding that the plaintiff possessed the residual functional capacity to perform a limited range of medium work is not supported by substantial evidence. Because addressing the plaintiff's contention that the ALJ failed to adequately explain why he did not give controlling weight to the treating physician necessarily includes a discussion on the plaintiff's residual functional capacity, the plaintiff's arguments will be discussed together.
The ALJ found that the plaintiff was severely impaired but that the plaintiff failed to carry his burden in demonstrating that he is unable to perform his past relevant work. (R. 20-21.) Therefore, the plaintiff's challenges are limited to the ALJ's determination to accord little controlling weight to the treating physician's assessment of the plaintiff's mental and physical residual functional capacity.
In his decision, the ALJ states that he
considered Dr. Suvansri's opinions in accordance with 20 C.F.R. § 404.1527, 416.927 and SSR 96-2p, and adjudges that, because his conclusions are not well supported by the preponderance of the credible evidence of record and are inconsistent with other medical opinions of record, his opinions are entitled to little evidentiary weight. . . .
. . . .
After a thorough review of the record, including the claimant's testimony, it is concluded that, although the claimant may have some physical discomfort which may interfere with his functional capacity, the degree of such limitation would not preclude the performance of medium work. . . . As to his mental residual capacity, the Administrative Law Judge concludes that the claimant does not have any significant limitation on his ability to understand, remember, and carry out simple instructions and to respond appropriately to supervision[,] co-workers and work pressures in a work setting.
(R. 20.)
The Social Security Administration regulations regarding the evaluation of evidence from treating physicians are found in 20 C.F.R. § 404.1527. In explaining the nature of a treating physician's relationship with a patient and the weight given to their opinions, the regulations provide that the Social Security Administration will
give more weight to opinions from your treating sources, since these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of your medical impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations, such as consultative examinations or brief hospitalizations.20 C.F.R. § 404.1527(d)(2). Generally, the regulations provide that the opinion of a treating physician will be given controlling weight if it is "well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record." Id. and 416.927(d)(2) (1995).
The Third Circuit has long held that "[a] court considering a claim for disability benefits must give greater weight to the findings of a treating physician." Mason v. Shalala, 994 F.2d 1058, 1067 (3d Cir. 1993). See Kane v. Heckler, 776 F.2d 1130, 1135 (3d Cir. 1985). This is particularly true "`when the opinion reflects an expert judgment based on a continuing observation of the patient's condition over a prolonged period of time.'" Rocco v. Heckler, 826 F.2d 1348, 1350 (3d Cir. 1987) (quoting Podedworny v. Harris, 745 F.2d 210, 217 (3d Cir. 1984)).
The ALJ cannot reject a treating physician's testimony in the absence of strong contradictory medical evidence. See Jones v. Sullivan, 954 F.2d 125, 128-29 (3d Cir. 1991). "Absent persuasive contradictory evidence, the validity of the plaintiff's symptoms can be conclusively established by the opinion of the treating physician." Smith v. Sullivan, 720 F. Supp. 62, 64 (E.D.Pa. 1989). However, the ALJ is not bound to accept the opinion of a treating physician without weighing it against the other medical evidence of record. Kent v. Schweiker, 710 F.2d 110, 115 n. 5 (3d Cir. 1983). An ALJ may reject the opinion of a treating physician if he or she explains on the record the reasons for doing so. See Allen v. Bowen, 881 F.2d 37, 41 (3d Cir. 1989); Brewster v. Heckler, 786 F.2d 581, 585 (3d Cir. 1986); Schonewolf v. Callahan, 972 F. Supp. 277, 285 (D.N.J. 1997).
However, an ALJ may not make speculative inferences from medical reports. Smith v. Califano, 637 F.2d 968, 972 (3d Cir. 1981). Moreover, an ALJ's own medical analysis which is contrary to medical evidence, especially from treating physicians, is invalid. Allen v. Bowen, 881 F.2d 37, 41 (3d Cir. 1989). Therefore, the ALJ must indicate the basis for conclusions that a the plaintiff's testimony or doctor's report is not credible. Cotter v. Harris, 642 F.2d 700 (3d Cir. 1981).
An ALJ's findings concerning a plaintiff's residual functional capacity must be supported by the medical evidence. Doak v. Heckler, 790 F.2d 26, 29 (3d Cir. 1986). Although the diagnosis of a treating physician is considered as to whether a the plaintiff is "disabled," it is not dispositive, as the ALJ has the final responsibility to determine the plaintiffs' residual functional capacity to perform past relevant work.See 20 C.F.R. § 404.1527(e)(2); Castellano v. Secretary of Health Human Servs., 26 F.3d 1027, 1029 (10th Cir. 1994); Davis v. Apfel, 40 F. Supp.2d 1261, 1266 (D.Kan. 1999).
Regarding his mental condition, the plaintiff asserts that because Dr. Suvansri had the benefit of observing the plaintiff over a matter of years, his opinion should be given greater weight than that of Dr. Lee, the psychiatrist who examined the plaintiff at the request of the Administration. (Pl. Brf. at 18-19.) In determining whether the ALJ had a reasonable basis to defer to Dr. Lee's assessment, it must first be noted that Dr. Suvansri is not a mental health professional, whereas Dr. Lee is. In reviewing Dr. Suvansri's clinical notes, this court could not uncover any diagnostic evaluation, examination, or similar test performed by the doctor that supports his conclusion that the plaintiff suffers from debilitating mental impairments. It is thus difficult for this court, as it was for the ALJ, to find that the Dr. Suvansri's conclusions are reasonably supported with any diagnostic tests conducted by him.
Moreover, this court disagrees with the plaintiff's contention that Dr. Suvansri's opinion is substantiated by reports provided by the Hispanic Family Counseling Center. ( See Pl. Brf. at 18.) In fact, this court finds the severity of the clinic's diagnoses of generalized affective disorder and depressive disorder to be consistent with those Dr. Young B. Lee, namely that of anxiety disorder and dependent personality. See supra , note 3.
For example, the January 4, 1995 report from the Hispanic Counseling Services diagnosed the plaintiff as suffering from "major depression mild" ( See R. at 200). The episode specifier of "mild" identified in the report is consistent with Dr. Lee's assessment that the severity of the plaintiff's symptoms are mild, and indicates that he has the capacity to function normally but with substantial and unusual effort. See DSM-IV at 316. Thus, nothing in the Hispanic Counseling Services records of treatment suggests that the plaintiff's generalized affective disorder and depressive disorder were other than mild, and certainly not that these conditions were disabling.
Doctor Lee opined that the plaintiff was mildly depressed, that the plaintiff's affect was appropriate to his thought process, and that the plaintiff was able to follow directions. (R. 213.) In concluding that the plaintiff is not significantly limited in his ability to understand, remember, and follow simple instructions, it was proper for the ALJ's to adopt the conclusions reached by Dr. Lee, a mental health specialist.
Regarding the plaintiff's physical condition, the plaintiff reads two Social Security Rulings ("SSR") together, 96-2p and 96-6p, in arguing that the ALJ erred as a matter of law by declining to give controlling weight to the treating physician's opinion concerning the plaintiff's residual functional capacity. (Pl. Brf. at 8, 11-15.)
Social Security Rulings are interpretive rules of the Social Security Administration with the purpose of guiding agency adjudicators. See Lauer v. Apfel, 169 F.3d 489, 492 (7th Cir. 1999); Young v. Apfel, 1999 WL 354776 *1, *5 (N.D.Ill. 1999). Although the SSR's do not carry the force of law, they are "binding on all components of the Social Security Administration." Lauer, 169 F.3d at 492 (quoting 20 C.F.R. § 402.35(b)(1)).
The provision of SSR 96-2p that the plaintiff relies upon, which incorporates the language in 20 C.F.R. § 404.1527(d)(2) and 146.927(d)(2), states that
If a treating source's medical opinion is well-supported and not inconsistent with the other substantial evidence in the case record, it must be given controlling weight; i.e., it must be adopted.
SSR 96-2p ( 61 Fed. Reg. 34490 (July 2, 1996)). The ruling further explains that when according controlling weight to a treating physician
The adjudicator cannot decide a case in reliance on a medical opinion without some reasonable support for the opinion. . . .
It is an error to give an opinion controlling weight simply because it is the opinion of the treating source if it is not well-supported by medically acceptable clinical and laboratory diagnostic techniques or it is inconsistent with the other substantial evidence in the case record.Id.
The provision of SSR 96-6p upon which the plaintiff relies provides that
[T]he opinion of the State agency medical or psychological consultant . . . may be entitled to greater weight than a treating source's medical opinion if the State agency medical or psychological consultant's opinion is based on a review of a complete case record that includes a medical report from a specialist in the individual's particular impairment which provides more detailed and comprehensive information than what was available to the individual's treating source.
SSR 96-6p ( 61 Fed. Reg. 34466 (July 2, 1996)). A provision from 96-6p concerning an ALJ's examination of a claimant's residual functional capacity not addressed by the plaintiff, but which this court finds relevant, states
[T]he administrative law judge and the Appeals Council must consider and evaluate any assessment of the individual's RFC by a State agency medical or psychological consultant and by other program physicians or psychologists.Id.
The ALJ's opinion states: "[T]he undersigned has considered the program physician's findings of fact in accordance with SSR 69-6p and concludes that, because the conclusions are well supported by a preponderance of the credible evidence of record, the program physician's findings are entitled to considerable weight in this matter." (R. 20.)
The plaintiff challenges this determination, asserting that Dr. Suvansri's opinion is entitled to controlling weight under SSR 96-2p on the premise that the doctor used medically acceptable clinical and laboratory diagnostic techniques, and the doctor's opinion is not inconsistent with other substantial evidence of record. (Pl. Brf. at 8-9, 11-15.) The plaintiff supports this assertion by contending that the only contradictory evidence of record regarding the plaintiff's residual functional capacity, the non-examining State Agency, medical reviewer's opinion, is not properly supported, because by stating that the plaintiff does not suffer from neurologic deficits, it ignores the fact that the plaintiff suffers from right L-5 and S-1 radiculopathy. (Pl. Brf. at 7, 13-14.) The plaintiff then asserts that because this opinion is not properly supported, SSR 96-6p prevented the ALJ from according controlling weight to it because it was not reached with the aid of additional medical information from a specialist that Dr. Suvansri was not privy to. (Pl. Brf. at 13.)
In reviewing the ALJ's decision, the analysis must begin by noting that there were credibility issues with respect to both the treating physician's assessment of the plaintiff, as well as the plaintiff's subjective complaints of pain. It is within the ALJ's discretion "`to evaluate the credibility of a claimant and to arrive at an independent judgment, in light of medical findings and other evidence, regarding the true extent of the pain alleged by the claimant.'" Brown v. Schweiker, 562 F. Supp. 284, 287 (E.D.Pa. 1983) (quoting Bolton v. Secretary of Health Human Servs., 504 F. Supp. 288, 291 (E.D.N.Y. 1980)). The ALJ pointed out that Dr. Suvansri continued to diagnose the plaintiff as suffering from herniated discs despite the fact that the orthopedic specialists, to whom Dr. Suvansri referred the plaintiff, reported to Dr. Suvansri in two letters that the plaintiff's discs were not herniated as originally suspected. (See R. 16.) Moreover, the ALJ found the plaintiff's own testimony at the hearing regarding his physical limitations to be inconsistent with his treating physician's assessments. (R. 18.) The ALJ also found the plaintiff's lack of muscle atrophy in his lower extremities to be significant. (R. 19.) Specifically, the January 1, 1996, examination conducted by Dr. Zionts, revealing that there was no gross muscle wasting in the plaintiff's lower extremities, further contradicted the treating physician's assessments. (R. 216.) These are clear and specific reasons for finding that the doctor's reports were not entitled to much weight. See Cotter v. Harris, 642 F.2d 700 (3d Cir. 1981).
Upon reviewing the evidence in its totality, see Daring, 727 F.2d at 70, this court finds that other examinations of record are inconsistent with Dr. Suvansri's assessment of the plaintiff's strength and range of motion. Rather, these reports are in accord with the State Agency reviewer's assessment. For example, Drs. Jaffe and Reiner, in their examination of January 2, 1996, report that the plaintiff's strength was full. (See R. 198). In an April 29, 1996 subsequent exam, that office reported that the plaintiff exhibited normal strength, reflexes, and sensory capacity. (R. 223.) In a March 22, 1996 exam, Dr. Greenberg reported that the plaintiff's "[b]ilateral upper and lower extremities have full strength and range of motion."
Thus, Dr. Suvansri's opinion that the plaintiff could only occasionally lift up to four pounds and that he can sit, stand or walk for one-half hour in an eight-hour work day seems to be unrealistically restrictive. This is especially so as the plaintiff himself testified that he can do more than that. This court therefore concludes that the ALJ's findings that Dr. Suvansri's assessments were not reasonably supported and not wholly credible were properly warranted, (See R. 18), in view of strongly contradictory findings upon examination and testing, and given that the ALJ had the opportunity to observe the plaintiff first-hand. See Wier v. Heckler, 734 F.2d 955, 962 (3d Cir. 1984) (recognizing that great deference is given to ALJ's determination of credibility).
The plaintiff's argument that the ALJ erred in giving controlling weight to the State Agency reviewer's opinion under SSR 96-6p would have merit if the ALJ based his determinations solely on the State Agency reviewer's opinion, and there was no substantial confirmatory evidence. However, the plaintiff fails to recognize that the ALJ based his findings not only on the opinion of the State Agency reviewer, but on the opinions of other examining doctors of record as well. The ALJ concluded that the plaintiff can perform medium work "[a]fter a complete review of the record." (R. 20). This review included the plaintiff's own testimony and the reports of other examining physicians including Dr. Zionts (R. 19), who opined that the plaintiff has a full range of motion in the upper and lower extremities and that the plaintiff does not suffer any sensory deficits. (R. 215-16.)
As a collateral matter, this court cannot agree with the plaintiff's contention that the State Agency medical reviewer's opinion is not properly supported because by stating that the plaintiff does not suffer from neurologic deficits, it ignores the plaintiff's radiculopathy. Radiculopathy is defined as a "disease of the nerve roots." Sloane-Dorland Annotated Medical-Legal Dictionary 601 (1987). A neurologic deficit is defined as "the existence of a problem in the neurological system (brain, spine, and nerves) that results in decreased neurologic function. Examples include inability to speak, decreased sensation, and loss of balance." HealthCentral (visited Sept. 28, 1999)http://www.healthcentral.com/mhc/top/002267.cfm (emphasis added). Thus, although radiculopathy is a condition that may cause a neurologic deficit, it does not follow that the presence of the condition necessarily manifests into a neurologic deficit. See Miller v. Heckler, 1985 WL 1641 *1, **3-4 (N.D.Ill. 1985) (reasoning that radiculopathy may often manifest itself long before, or even without, becoming so severe as to be disabling). Contrary to the plaintiff's implication, the record does not disclose evidence of a neurologic deficit, as the majority of examining physicians opine that the plaintiff does not suffer from severe sensory or motor impairments.
Reading the two Social Security rulings in tandem reveals that the ALJ followed the rulings' guidance appropriately. Social Security Ruling 96-2p required the ALJ to find some reasonable support for the opinion before giving it controlling weight. See supra. Finding the treating physician's opinion not credible, the ALJ afforded it little evidentiary weight. Social Security Ruling 96-6p required the ALJ to weigh the State agency reviewer's opinion regarding the plaintiff's residual functional capacity. See supra. The ALJ, after reviewing the complete record including the opinions of other examining treating physicians, accorded significant evidentiary weight to the State agency reviewer's assessment. Based on the foregoing, and upon the fact that the responsibility for determining the plaintiff's residual functional capacity rests with the ALJ, see 20 C.F.R. § 404.1546 and 416.946, this court holds that substantial evidence supports the ALJ's finding that the plaintiff has the capacity to perform medium work.
As a subsidiary argument, the plaintiff asserts that the ALJ, by analyzing Dr. Suvansri's clinical notes, improperly substituted his own medical opinion for that of the treating physician's in contravention of this court's decision in Schonewolf v. Callahan, 972 F. Supp. 277 (D.N.J. 1997). (Pl. Brf. at 15 and Pl. Reply Brf. at 1.) The plaintiff's reliance on Schonewolf, however, is misplaced. In that case, this court specifically stated that "an ALJ can reject the opinion of a treating physician if he or she explains on the record the reasons for doing so."Id. at 285 (citing Allen v. Bowen, 881 F.2d 37, 41 (3d Cir. 1989);Brewster, supra, 786 F.2d at 585). In that case, the ALJ did not adequately explain why certain medical evidence was not deserving of more probative weight. Id. at 286. Because the ALJ ignored objective medical testing relied upon by doctors of record, and offered no explanation as to why it found a treating physician's medical opinion unreliable, see id. at 287, this court had little choice but to conclude that the doctor invalidly substituted his medical conclusions for those of the physician ("[i]t is almost impossible for this court to determine whether the ALJ based his decision on substantial evidence if the ALJ does not explain the reasons for his decision."). Id. at 286. Such is not the case here.
Here, the ALJ provides a clear explanation as to how Dr. Suvansri's opinions are discredited by conflicting medical evidence. See id.;Willbanks, 847 F.2d at 301. Regarding the plaintiff's mental capabilities, the ALJ gave more deference to mental health specialist and found that the treating physician's conclusions were not, at a minimum, reasonably supported. (R. 19.) Regarding the plaintiff's physical capabilities, the ALJ specifically found the plaintiff's subjective complaints of pain to be inconsistent with his own testimony at the hearing, (R. 18), that the treating physician's diagnosis of the plaintiff's back to be inconsistent with the opinions of specialists, (R. 16), and that the treating physician's assessment of the plaintiff's strength and range of motion to be contradicted by the weight of other doctor's assessments of record. (R. 16, 18-20.) Therefore, because the ALJ details its reasons for giving little evidentiary weight to the opinion of the treating physician, and because the ALJ's findings are supported by the opinions of other examining physician's of record, the plaintiff's contention is without merit.
B. The ALJ Considered the Plaintiff's Physical and Mental Impairments in Combination
The plaintiff's final argument is that the ALJ failed to consider the plaintiff's physical impairments in combination with his mental impairments, thereby rendering the ALJ's findings deficient of substantial evidence support. (Pl. Brf. at 20.) The plaintiff disputes the ALJ's conclusion that the plaintiff can return to a supervised work setting by arguing that the ALJ's finding that the plaintiff often has deficiencies of concentration to be inconsistent with the ALJ's conclusion that the plaintiff's mental residual functional capacity is not severely impaired. (Pl. Brf. at 20, 24-25.)
An individual with multiple impairments will not be found disabled when the cumulative effect of his medically determinable impairments is not of the severity required under the Act. See 20 C.F.R. § 404.1523 and 416.923; Wheeler v. Heckler, 784 F.2d 1073, 1076 (11th Cir. 1986); Olsen v. Schweiker, 703 F.2d 751, 755 (3d Cir. 1983). It is the extent and severity, not the mere existence, of a medical condition or combination of conditions which is controlling in a decision to grant or deny disability benefits. Armstead v. Chater, 892 F. Supp. 69, 73 (E.D.N.Y. 1995).
It is clear from his decision that the ALJ considered whether the plaintiff's impairments in combination amounted to a disability under the Act. The ALJ determined that "[t]he combination of impairments . . . do not meet or equal the severity requirements of any impairment listed in Appendix 1 to Subpart P (20 C.F.R. § 404.150(d) and 416.920(d))." (R. 18.) The ALJ then considered whether the plaintiff's mental and physical residual functional capacities in combination prevented the plaintiff from returning to his past relevant work: "[h]aving established that the claimant has the residual functional capacity for medium work and has no significant limitations on his mental capacity, it is concluded that the claimant is able to do his past relevant work." (R. 21.)
Moreover, the plaintiff's contention that the ALJ's finding concerning the plaintiff's concentration deficiency is inconsistent with the ALJ's conclusion that the plaintiff has no severe mental impairments is unfounded. The regulations provide a five point scale — never, seldom, often, frequent and constant — for evaluating, inter alia, concentration. See 20 C.F.R. § 404.1520a and 416.920a. "The last two points for each of these scales represent a degree of limitation which is incompatible with the ability to perform the work-related function." §§ 404.1520a(3) and 416.920a(3). Thus, the finding that the plaintiff often is unable to concentrate (as opposed a finding that the plaintiff frequently or constantly is unable to concentrate) is consistent with the conclusion that the plaintiff does not suffer from a severe mental impairment.
This court finds that the ALJ demonstrated sufficient consideration of the combined effects of the plaintiff's impairments since each was examined separately, see Browning v. Sullivan, 958 F.2d 817, 821 (8th Cir. 1992); Smith v. Chater, 959 F. Supp. 1142, 1147 (W.D.Mo. 1997), as well as in combination. Accordingly, the ALJ's findings that the plaintiff's impairments in combination did not prevent the plaintiff from returning to his relevant work is based upon substantial evidence.
V. Conclusion
For the reasons discussed, this court holds that: (1) the ALJ adequately explained on the record why it gave the treating physician little evidentiary weight, (2) the ALJ's finding that the plaintiff was capable of performing medium work is supported by substantial evidence, and (3) the ALJ properly considered the plaintiff's physical and mental impairments in combination. Thus, this court affirms the Commissioner's final determination that the plaintiff is not disabled within the meaning of the Act.
The accompanying order is entered.
ORDER
This matter having come before the court upon plaintiff Antonio Cuevas' application to review the final decision of the Commissioner of the Social Security Administration denying plaintiff's application for Disability Insurance benefits under Title II of the Social Security Act; and this court having considered the entire record and all submissions on behalf of the parties; and for the reasons stated in the Opinion of today's date; and for good cause shown;
It is on this day of ______, 1999, hereby ORDERED that the plaintiff's appeal be, and hereby is DENIED and the final decision of the Commissioner be, and hereby is, AFFIRMED.