Opinion
Civil Action No. 03-2501-GTV.
March 11, 2005
MEMORANDUM AND ORDER
Plaintiff Beth Garrison brings this action pursuant to 42 U.S.C. §§ 405(g) and D. Kan. Rule 83.7, seeking judicial review of the decision of the Commissioner of Social Security ("Commissioner") to deny her applications for a period of disability and disability insurance benefits under Title II of the Social Security Act. Plaintiff claims that she is disabled because she suffers from Irritable Bowel Syndrome ("IBS") and depression. She has a high school education and her past work experience includes employment as a receiving clerk. This appeal focuses on the Commissioner's determination that Plaintiff's impairments were not disabling. For the following reasons, the Commissioner's decision is affirmed.
I. Procedural Background
On December 6, 1999, Plaintiff filed an application for disability benefits, claiming disability since October 1, 1999. The application was denied both initially and upon reconsideration. At Plaintiff's request, an administrative law judge ("ALJ") held a hearing on August 8, 2000, at which Plaintiff and her counsel were present. On April 23, 2001, the ALJ rendered a decision in which she determined that Plaintiff was not under a "disability" as defined by the Social Security Act. After the ALJ's unfavorable decision, Plaintiff requested review by the Appeals Council. The Appeals Council denied Plaintiff's request for review on August 8, 2003, rendering the ALJ's decision the final decision of the Commissioner.
II. Standard of Review
The Commissioner's findings are binding on this court if supported by substantial evidence. 42 U.S.C. § 405(g); Dixon v. Heckler, 811 F.2d 506, 508 (10th Cir. 1987). The court's review is limited to determining whether the Commissioner's decision is supported by substantial evidence in the record and whether the Commissioner properly applied relevant legal standards. Marshall v. Chater, 75 F.3d 1421, 1425 (10th Cir. 1996) (citingCastellano v. Sec'y of Health Human Servs., 26 F.3d 1027, 1028 (10th Cir. 1994)). "Substantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Castellano, 26 F.3d at 1028 (citations and internal quotation marks omitted). The court may not reweigh the evidence or substitute its judgment for that of the ALJ or the Commissioner. Hamilton v. Sec'y of Health Human Servs., 961 F.2d 1495, 1500 (10th Cir. 1992).
III. ALJ's Findings
In her April 23, 2001, decision, the ALJ made the following findings:
1. Claimant met the special earnings [requirement] of the Act on October 1, 1999, the date claimant stated she became unable to work, and continues to do so through the date of this decision.
2. Claimant has not engaged in substantial gainful activity at any time since October 1, 1999.
3. Medical evidence on file establishes that claimant has IBS and depression/dysthymia, but she does not have an impairment or combination of impairments listed in, or medically equal to one listed in Appendix 1, Subpart P, Regulations No. 4.
4. Claimant's testimony as to the severity of her impairments and attending symptoms is found to be only partially credible inasmuch as such testimony is inconsistent with her ability to perform her past work with the same or very similar symptoms that she currently has, the lack of any documented disabling or adverse side effects from any medications or any adjustment to the medication regimen, the ability of claimant's medication regimen to essentially control her symptoms, the lack of any definitive statement from any physician that claimant has been disabled for a continuous period of 12 months, the lack of objective evidence supporting a disabling severity of symptoms, the lack of any surgical corrective procedure recommended or performed, claimant's daily activities as documented in the record as opposed to those testified to[,] and for the other reasons specifically set forth in the Rationale section of this decision.
5. Claimant has at all times retained a residual functional capacity for a range of sedentary work.
6. Claimant is incapable of performing her past relevant work but she derived skills from that work that are transferable to sedentary work.
7. Claimant is currently 34 years of age, which is defined as a "younger" individual.
8. Claimant has a high school education.
9. Based on an exertional capacity for sedentary work and claimant's age, education and work experience, Section 201.29, Table No. 1, Appendix 2, Subpart P, Regulations No. 4 indicates that a conclusion of not disabled is appropriate.
10. Although claimant does have some non-exertional pain and may be somewhat limited in her ability to work with the public, using the above-cited rules as a framework for decision making, there are a significant number of jobs in the State of Kansas and the national economy that she can nonetheless perform, the numbers and identities of which were specifically set forth by the vocational expert at the time of claimant's hearing.
11. Claimant has not been under a "disability" as defined in the Social Security Act, as amended, at any time through the date of this decision.
IV. Discussion
"The Secretary has established a five-step sequential evaluation process for determining whether a claimant is disabled." Williams v. Bowen, 844 F.2d 748, 750 (10th Cir. 1988). "If a determination can be made at any of the steps that a claimant is or is not disabled, evaluation under a subsequent step is not necessary." Id. Those five steps are as follows:(1) A person who is working is not disabled.
(2) A person who does not have an impairment or combination of impairments severe enough to limit the ability to do basic work activities is not disabled.
(3) A person whose impairment meets or equals one of the impairments listed in the regulations is conclusively presumed to be disabled.
(4) A person who is able to perform work she has done in the past is not disabled.
(5) A person whose impairment precludes performance of past work is disabled unless the [Commissioner] demonstrates that the person can perform other work. Factors to be considered are age, education, past work experience, and residual functional capacity.Reyes v. Bowen, 845 F.2d 242, 243 (10th Cir. 1988) (citing 20 C.F.R. § 416.920(a)-(f)) (internal citations omitted).
Plaintiff contends that the ALJ committed several errors at step four. Specifically, she asserts that the ALJ: (1) did not give controlling weight to her treating physician; (2) failed to properly assess her credibility; and (3) did not link her residual functional capacity determination with specific evidence in the record. Plaintiff also avers that the Commissioner's decision is not supported by substantial evidence because she selectively pieced together evidence to support her decision, rather than weighing the record as a whole.
Claim 1: Weight Given to Treating Physician
First, Plaintiff argues that the ALJ failed to give controlling weight to the opinions of her treating physician, Dr. Scott Ketcher. In particular, Plaintiff cites two letters Dr. Ketcher composed on December 14, 1999, and January 25, 2000, discussing his treatment of Plaintiff's IBS and depression since July 29, 1999. These letters, Plaintiff maintains, should have been given full weight by the ALJ and resulted in a favorable decision for her.
"A treating physician's opinion about the nature and severity of the claimant's impairments should be given controlling weight by the Commissioner if well supported by clinical and laboratory diagnostic techniques and if it is not inconsistent with other substantial evidence in the record." Walker v. Apfel, No. 97-1189-MLB, 1998 WL 928672, at *4 (D. Kan. Sept. 18, 1998) (citing Castellano, 26 F.3d at 1029). If a treating physician's opinion is inconsistent with other evidence, the ALJ must determine whether the other evidence outweighs the treating physician's opinion. Goatcher v. United States Dep't of Health Human Servs., 52 F.3d 288, 290 (10th Cir. 1995). In weighing any medical opinion, the ALJ must consider the following factors: (1) the "length of the treatment relationship and the frequency of examination"; (2) the "nature and extent of the treatment relationship"; (3) the amount of relevant evidence supporting the physician's opinion; (4) how consistent that opinion is with the rest of the record; (5) whether the physician is a specialist; and (6) other factors tending to support or contradict the opinion. 20 C.F.R. § 404.1527(d)(2)-(6). The ALJ cannot disregard a treating physician's opinion that a claimant is disabled without giving legitimate and specific reasons. Goatcher, 52 F.3d at 290 (citing Frey v. Bowen, 816 F.2d 508, 513 (10th Cir. 1987)). But the ultimate responsibility for determining whether a claimant is disabled is reserved for the ALJ, not the treating physician. Castellano, 26 F.3d at 1029 (citations omitted);see White v. Barnhart, 287 F.3d 903, 907 (10th Cir. 2002) (citation omitted) (stating that "a treating physician's opinion is not dispositive on the ultimate issue of disability).
In the two letters cited by Plaintiff, Dr. Ketcher notes that IBS is a common intestinal disorder that causes cramping, bloating, and changes in bowel habits. Although IBS is not diagnosed using a specific lab test, Dr. Ketcher states that Dr. Zachary, a gastroenterologist to whom he referred Plaintiff for consultation, agrees with his diagnosis that Plaintiff suffers from IBS. This diagnosis is partially based on the fact that Plaintiff underwent several tests — including blood work, stool cultures, abdominal x-rays, endoscopys, and colonoscopys — that ruled out the possibility that she suffered from a more serious illness.
Although IBS is ordinarily a "mild annoyance," Dr. Ketcher reported that for Plaintiff, "it is disabling." He observed that Plaintiff states that the "symptoms occur on a daily basis." As of January 25, 2000, Dr. Ketcher prescribed Prozac, Xanax, Tylenol No. 3, and Elavil for Plaintiff, while Dr. Zachary prescribed Pamine for her. Dr. Ketcher's letter notes that these medications "tend to cause drowsiness." He also directed Plaintiff to follow a high fiber diet, to lower her caffeine intake, and to start a low-impact exercise program. Dr. Ketcher observed that the treatment plan should help her symptoms, but would not cure IBS.
Finally, regarding Plaintiff's ability to return to work, Dr. Ketcher's January letter reported:
Beth states the symptoms she is having, such as the abdominal cramping, constipation, diarrhea and bloating, make it difficult for her to feel secure enough to leave her home for any lengthy period of time. Beth also states the stress related to her job as well as the constant standing, lifting and/or bending cause a great deal of discomfort for her. The last few months Beth has been seen and stated some of her symptoms have worsened causing her to miss a lot of work. She is currently on medical leave from work and due to her current condition, I am unable at this time to determine when she will be able to return to her job.
In her decision, the ALJ addressed why she did not follow Dr. Ketcher's conclusion that Plaintiff's IBS was "disabling." Citing the passage quoted above, the ALJ concluded that "[t]his assessment appears to be based largely on the statements of claimant." See Boss v. Barnhart, 67 Fed. Appx. 539, 542 (10th Cir. 2003) (rejecting a treating physician's opinion because it is based on a claimant's subjective complaints is a legitimate reason under the Commissioner's regulations). Nevertheless, at step four, the ALJ agreed with Dr. Ketcher that Plaintiff could not return to her past work as a receiving clerk. The ALJ determined, however, that Dr. Ketcher's letter did not preclude Plaintiff from performing sedentary work. As explained later in this opinion, the ALJ's assessment of Plaintiff's residual functional capacity is supported by substantial evidence. Accordingly, the court rejects Plaintiff's contention that Dr. Ketcher's opinions deserved controlling weight and merited a finding that Plaintiff was disabled for any work.
Claim 2: The ALJ's Credibility Determination
Second, Plaintiff maintains that the ALJ's credibility determination is not specific enough to allow for meaningful review. She also claims that the factors used by the ALJ to assess her credibility are not supported by the evidence in the record. The court disagrees.
Because the ALJ is "`optimally positioned to observe and assess witness credibility,'" Adams v. Chater, 93 F.3d 712, 715 (10th Cir. 1996) (quoting Casias v. Sec'y of Health Human Servs., 933 F.2d 799, 801 (10th Cir. 1991)), the court "may overturn such a credibility determination only when there is a conspicuous absence of credible evidence to support it," Patterson v. Apfel, 62 F. Supp. 2d 1212, 1217 (D. Kan. 1999) (citing Trimiar v. Sullivan, 966 F.2d 1326, 1329 (10th Cir. 1992)). Credibility determinations made by the ALJ are generally treated as binding upon review. Talley v. Sullivan, 908 F.2d 585, 587 (10th Cir. 1990). But an ALJ's "[f]indings as to credibility should be closely and affirmatively linked to substantial evidence and not just a conclusion in the guise of findings."Huston v. Bowen, 838 F.2d 1125, 1133 (10th Cir. 1988).
In assessing a claimant's credibility, the ALJ may consider the following factors:
the levels of medication and their effectiveness, the extensiveness of the attempts (medical or nonmedical) to obtain relief, the frequency of medical contacts, the nature of daily activities, subjective measures of credibility that are peculiarly within the judgment of the ALJ, the motivation of and relationship between the claimant and other witnesses, and the consistency or compatibility of nonmedical testimony with objective medical evidence.Id. at 1132. Nevertheless, "the ALJ is not required to discuss each and every credibility factor in her decision. . . ." Frost v. Barnhart, No. 02-4106-JAR, 2004 WL 2058264, at *7 (D. Kan. Sept. 9, 2004).
The ALJ found Plaintiff's testimony concerning the severity of her complaints and symptoms to be "partially credible." In the "Findings" section of her decision, she stated that: Plaintiff worked for years as a receiving clerk with symptoms very similar to the ones she allegedly suffers from now; the medical evidence did not indicate any disabling effects from the medication she was taking; the medical evidence showed that the medications controlled her symptoms; no physician has stated that she has been disabled for a period of twelve continuous months; the objective medical evidence did not support that her symptoms were disabling; no doctor performed or recommended any surgical procedures to correct her condition; and that inconsistencies existed between the daily activities Plaintiff testified to at the hearing versus the daily activities she claimed to have performed in an earlier document. The court observes that the ALJ elaborated on many of these conclusions in the "Rationale" section of her decision, and therefore rejects Plaintiff's argument that the ALJ did not make a specific enough credibility determination to allow for meaningful review. The court will now address Plaintiff's assertion that the ALJ's reasons for her partial credibility assessment were not supported by the medical evidence in the record.
a. Side Effects of Medication
Plaintiff disputes the ALJ's conclusion that her alleged drowsiness is not a severe, adverse side effect from taking her medications. At the hearing, Plaintiff testified that she is unable to stand in one place for long periods of time because the medications she takes causes drowsiness and dizziness. She also stated that she takes a nap for two or three hours a day. She attributed the need to take a nap to the medications and the IBS symptoms. Overall, Plaintiff testified that her energy level was low due to the medications.
The ALJ's decision acknowledged Plaintiff's testimony concerning drowsiness, but determined that her outpatient treatment records did not reveal any substantial complaints of drowsiness, nor did they show that her doctors tried to change her medications to resolve a problem of drowsiness. Thus, she concluded Plaintiff's drowsiness was not a severe side effect.
To counter the ALJ's conclusion, Plaintiff directs the court to Dr. Ketcher's January 25, 2000, letter in which he states that Plaintiff's "medications do tend to cause drowsiness." This statement does provide evidence that Plaintiff suffers from drowsiness, but it does not establish that she suffers from disabling drowsiness. Not only does the medical record lack evidence of severe drowsiness, but Plaintiff's own testimony indicated that her doctors have not increased the levels of her medication to prevent her from becoming a "total zombie." The ALJ concluded that Plaintiff's testimony regarding drowsiness was partially credible, just not to the extent Plaintiff alleged. The court concludes that the ALJ's assessment is supported by the record.
For example, Dr. Zachary noted in his November 15, 1999, examination of Plaintiff that she complained of some nausea, sinus problems, backaches, headaches, dizziness, and occasional chills. Notably, Plaintiff did not complain of any drowsiness problems from her medications and Dr. Zachary observed that she was alert and oriented.
b. Medications' Ability to Control Symptoms
Next, the ALJ stated that Plaintiff's testimony concerning the severity of her impairments was partially credible to the extent that it was inconsistent with the medications' ability to control her symptoms. Plaintiff contests this finding. Specifically, she argues that Dr. Ketcher's January 25, 2000, letter indicates that despite the prescribed medications, Plaintiff suffers daily from the "debilitating symptoms" of IBS. Thus, Plaintiff argues that no medical evidence demonstrates that her medications control her symptoms of IBS.
After a careful reading of the ALJ's decision, it is apparent that the ALJ was primarily referencing the ability of Plaintiff's medications to control her depression symptoms, not her IBS. The ALJ's decision specifically states that "[w]ith regard to claimant's depression/dysthymia, it appears to be controlled with medication and does not significantly restrict claimant." The medical evidence supports this statement, and furthermore, Plaintiff testified that the Prozac she takes for her depression helps her condition, even though the medicine does not completely get rid of it.
With regard to Plaintiff's IBS, the ALJ's decision briefly notes that Plaintiff's prescription for Pamine has improved her IBS. As Plaintiff correctly points out, Dr. Ketcher's correspondence on January 25, 2000, states that her current treatment plan — emphasizing a high fiber diet, cutting down on her caffeine, starting a low impact exercise program, and taking several prescription medications — will help with her symptoms, but will not cure IBS. This is consistent with Dr. Zachary's statement on November 15, 1999, that he would not be able to cure her symptoms, but that she could receive some symptomatic improvement. On that same day, Dr. Zachary noted that during her time on Pamine, Plaintiff has had a fewer number of bad days. Moreover, he noted that there had been "no significant change" in her symptoms in the past several months.
In sum, the court concludes that the ALJ's statements regarding the effectiveness of Plaintiff's medication for her IBS and depression is well documented by the evidence in the record.
c. Lack of Statement from a Doctor that Plaintiff is Disabled
Plaintiff next challenges the ALJ's statement that the record lacks "any definitive statement from any physician that claimant has been disabled for a continuous period of 12 months." Plaintiff concedes that no such statement exists in the record. Plaintiff, however, cites a note written by Dr. Ketcher on November 10, 1999 stating that Plaintiff is to be "off work until further notice" and Dr. Ketcher's letter dated January 25, 2000 stating that he is unable to determine when Plaintiff can return to her work. From these two pieces of evidence, Plaintiff makes the bald claim that Plaintiff has yet to be released to work, and therefore, Plaintiff's disability lasted for a continuous period of twelve months.
The court concludes that the absence of a physician's opinion stating that Plaintiff has been disabled for a continuous period of twelve months detracts from Plaintiff's subjective complaints. Furthermore, the court is not persuaded by Plaintiff's attempt to equate Dr. Ketcher's opinion that he did not know when Plaintiff would be able to return to her work with a finding that Plaintiff is disabled and unable to work for twelve continuous months.
d. Lack of Surgery
Plaintiff also argues that the ALJ improperly discredited her testimony because no physician had recommended or performed surgery for her IBS. The court determines that the ALJ was entitled to infer that Plaintiff's condition was not as limiting or disabling as she alleged based on a lack of surgery for her IBS. See Wiley v. Chater, 967 F. Supp. 446, 451 (D. Kan. 1997) (stating that the ALJ may discount allegations of disabling pain due to inconsistencies such as minimal medical treatment).
e. Inconsistencies Between Activities
The ALJ also found Plaintiff's testimony partially credible due to inconsistencies between Plaintiff's account of her daily activities when she testified before the ALJ on August 8, 2000, and her written account of her activities on December 14, 1999. The ALJ noted in her decision that Plaintiff's statement of activities in December 1999 indicated that she was relatively active, but that she testified to more restrictions at the hearing. Plaintiff claims that the ALJ should have set forth the specific discrepancies in her decision. Moreover, she attempts to explain the increased restrictions by reasoning that one would expect IBS to become worse over time and that some days are better for Plaintiff than others.
While it would have been helpful for the ALJ to cite the actual differences she was relying on, the court concludes that this omission does not require reversal. At the hearing, Plaintiff testified that on a normal day she takes her medication, feeds her animals, and occasionally does some laundry, dishes, cooking, or makes a trip to Wal-Mart to pick up a prescription or a few groceries. On her activities of daily living form, Plaintiff stated she cares for her personal needs every day, cooks her own meals, shops for groceries, pays bills, shops at Wal-Mart, watches television, reads magazines, goes to the bank, cares for her animals, visits friends and relatives, and does laundry and dishes around the house.
The court agrees with the Seventh Circuit that "[t]he many interviews and forms required to apply for disability benefits should not be viewed as traps for slightly varied accounts of daily activities. . . ." Powers v. Apfel, 207 F.3d 431, 435 (7th Cir. 2000). At the same time, the court determines that the few discrepancies that do exist, in addition to the ALJ's observations of Plaintiff at the hearing, provide support for the credibility assessment. Furthermore, Plaintiff's explanations for the increased restrictions do not change this result. While Plaintiff likely feels better on some days rather than others, the court questions Plaintiff's unsupported statement that her IBS is expected to worsen over time. For example, Dr. Zachary's January 20, 2000 progress note states that Plaintiff "has had no major change in her symptoms of late."
Claim 3: Residual Functional Capacity
Plaintiff next claims that the ALJ failed to link her residual functional capacity ("RFC") determination with specific evidence in the record. Instead, Plaintiff contends that the ALJ's decision merely made a boilerplate statement that "[a]s a consequence of all of the above, . . . claimant retains the residual functional capacity to perform at least a wide range of sedentary work. . . ." Additionally, Plaintiff cites 20 C.F.R. § 404.1545 and Social Security Ruling 96-8p, which requires the ALJ to provide a narrative discussion describing how the evidence of record supports Plaintiff's residual functional capacity. Plaintiff believes that the ALJ did not fulfill this obligation. The court disagrees.
A "claimant bears the burden at step four of proving his inability to return to his particular former job and to his former occupation as that occupation is generally performed throughout the national economy." Andrade v. Sec'y of Health Human Servs., 985 F.2d 1045, 1051 (10th Cir. 1993). "However, in order to make the ultimate finding that a claimant is not disabled at step four, the ALJ is required by SSR 96-8p to make specific and detailed predicate findings" at each of three phases. Winters v. Barnhart, No. 00-2419-DJW, 2002 WL 1286134, at *14 (D. Kan. June 5, 2002). "In the first phase, the ALJ must evaluate a claimant's physical and mental [residual functional capacity], and in the second phase, he must determine the physical and mental demands of the claimant's past relevant work." Winfrey v. Chater, 92 F.3d 1017, 1023 (10th Cir. 1996) (citation omitted). "In the final phase, the ALJ determines whether the claimant has the ability to meet the job demands in phase two despite the mental and/or physical limitations found in phase one." Id; see also 20 C.F.R. § 404.1545 (stating that at step four the ALJ must assess a claimant's RFC based on all the relevant evidence in the record and then use that assessment to determine whether the claimant can return to past relevant work).
At step four, the ALJ concluded that Plaintiff was incapable of performing her past relevant work as a receiving clerk, which the vocational expert classified as a semi-skilled position, requiring light exertion. Nevertheless, the ALJ determined that Plaintiff retained the RFC to perform a wide range of sedentary work. Contrary to Plaintiff's contentions, the ALJ's opinion discussed the specific evidence of record supporting her conclusion.
In assessing Plaintiff's RFC, the ALJ initially considered Plaintiff's "own estimate of her residual functional capacity." To this end, the ALJ reviewed Plaintiff's testimony at the ALJ hearing regarding the physical demands of her prior work and her alleged physical limitations. Plaintiff testified that on October 1, 1999, the date she alleged her disability began, her employer moved her from an office position to a position on the floor that required more strenuous physical activity. In particular, she informed the ALJ that her IBS became worse as a result of the "strenuous lifting, bending, standing" and constant moving that the job entailed. Plaintiff testified that physical movement sometimes disturbed her IBS. Specifically, Plaintiff stated that she occasionally had problems standing or walking for long periods of time, especially in the heat. Plaintiff, however, testified that the only time she had difficulty sitting was when she experienced a severe IBS flare up, which she estimated occurred two to three times per month. Plaintiff stated that her job as a receiving clerk required her to stand four hours a day and sit four hours a day. Plaintiff further testified that she could lift ten to fifteen pounds, and that she did not have difficulty breathing, hearing, seeing, or talking. Finally, the ALJ summarized Plaintiff's testimony concerning her daily activities, which need not be repeated here.
The ALJ did not rely solely on Plaintiff's testimony regarding her physical limitations. The ALJ cited Dr. Ketcher's January 25, 2000 letter, which stated that Plaintiff felt that "the constant standing, lifting and/or bending [at her job] cause[d] a great deal of discomfort for her." The ALJ, however, concluded that Dr. Ketcher's opinion did not preclude Plaintiff from working at a purely sedentary position. She also determined that it was not a medical necessity for Plaintiff to lie down because no treating or examining physician ever recommended that Plaintiff lie down for any purpose.
With regard to her mental impairments, the ALJ cited Plaintiff's testimony that she did not have difficulty thinking, though she believed that her memory was not "great anymore" and that she had difficulty concentrating when her IBS flared up. The ALJ also noted that Plaintiff's Global Assessment of Functioning ("GAF") scores were not consistent with disability.
After reviewing the record and the ALJ's decision, the court concludes that the ALJ fulfilled her obligation to provide a narrative discussion linking Plaintiff's residual functional capacity to specific evidence contained in the record. Moreover, the court determines that Plaintiff's RFC is supported by substantial evidence.
Claim 4: The Commissioner's Decision is not Based on Substantial Evidence
Finally, Plaintiff argues that the Commissioner's decision is not based on substantial evidence, asserting that the ALJ selectively cited pieces of evidence in favor of her decision and ignored the evidence as a whole. Plaintiff challenges the ALJ's statement that Plaintiff has suffered from IBS for many years and that her IBS condition did not appear to have increased significantly in severity. Plaintiff cites the medical records from Dr. Ketcher, Dr. Zachary, and emergency room records to demonstrate that since October 1, 1999, her IBS condition deteriorated. While Plaintiff acknowledges that the ALJ mentioned these records in her decision, Plaintiff again contends that the ALJ failed to give them proper weight. Moreover, Plaintiff disagrees with the ALJ's conclusion that her depression imposes no significant limitations on her. Plaintiff maintains that beginning in August 1999, she missed work due to her depression and that her symptoms have increased to the point that her treating physicians took her off work. Plaintiff also contends that the ALJ's statement that her medications do not cause drowsiness is contradicted by the medical record.
The ALJ's decision that Plaintiff is not disabled because she can perform work that exists in the State of Kansas and the national economy is supported by substantial evidence. It is evident from the ALJ's opinion that she reviewed the entire record in reaching her decision, rather than selectively piecing together evidence, as Plaintiff suggests. The ALJ noted in her decision that she reviewed Plaintiff's medical records from as early as 1994. Based on this review, the ALJ assessed that Plaintiff was able to work for several years with IBS, and that her condition did not appear to have significantly worsened. In support of this statement, the ALJ cited several treatment records contained in Plaintiff's file. She observed that Plaintiff's complaints, as well as her doctors' findings and recommended treatment plans, remained consistent over time.
The ALJ's observations are supported by the record. The approximate date Plaintiff's IBS condition commenced was August 1995, and her problems with depression began in the mid-1980's. A letter from Dr. Romano Delcore from the University of Kansas Medical Center, dated November 27, 1995, observed that since September 1995, Plaintiff "started having significant complaints of severe abdominal bloating, flatulence, and abdominal pain associated with episodes of flushing, dizzy spells, intermittent diarrhea and diaphoreses." Treatment records from 1997 reflect that Plaintiff suffered from chronic severe irritable bowel syndrome and severe manic depressive illness. A treatment note from September 1997 reported that Plaintiff had increasing symptoms of crampy abdominal pain with intermittent severe diarrhea. As of August 1998, Plaintiff was taking Prozac, Xanax, Ubrax and Tylenol 3 for her IBS and depression. By April 1999, Plaintiff's doctors still prescribed her Prozac, Xanax, Tylenol 3 and Librax. Dr. Ketcher noted in August 1999 that Plaintiff complained that her IBS had worsened recently. A treatment note from November 1999 comments that Plaintiff is suffering from prominent abdominal pain, bloating and alterations in bowel habits with diarrhea and constipation. Finally, a December 1999 progress note from Dr. Ketcher indicates that Plaintiff was taking Prozac, Xanax, Tylenol 3, Labrax and Pamine for her IBS and depression. A "plaintiff's impairment cannot be presently disabling without showing there has been a significant deterioration." Noble v. Callahan, 978 F. Supp. 980, 986 (D. Kan. 1997). The ALJ correctly determined that Plaintiff was able to work for several years, despite her impairments, and that her symptoms and treatment had not changed significantly. Even so, the ALJ concluded that Plaintiff's present symptoms prevented her from performing her position as a receiving clerk, but that she was not precluded from performing sedentary work. Again, the court determines that the ALJ properly weighed the opinions of Plaintiff's treating physicians and the effects of her medications in making this assessment.
IT IS, THEREFORE, BY THE COURT ORDERED that the decision of the Commissioner is affirmed.
Copies of this order shall be transmitted to counsel of record.
The case is closed.
IT IS SO ORDERED.