Opinion
5:22-CV-00159-M
03-07-2023
Dawn Prince, Plaintiff, v. Kilolo Kijakazi, Acting Commissioner of Social Security, Defendant.
MEMORANDUM & RECOMMENDATION
Robert T. Numbers, II United States Magistrate Judge
Plaintiff Dawn Prince challenges an Administrative Law Judge's decision to deny her application for social security income. Prince claims that the ALJ erred in reaching that decision by failing to properly consider the medical opinion evidence from a consultative examiner. Both Prince and Defendant Kilolo Kijakazi, Acting Commissioner of Social Security, have moved for a judgment on the pleadings in their favor. D.E. 15, 18.
After reviewing the parties' arguments, the undersigned has determined that the ALJ reached the appropriate determination. The ALJ properly evaluated the consultative examiner's assessment and offered sufficient reasons to conclude it was not persuasive. So the undersigned recommends that the court grant Kijakazi's motion, deny Prince's motion, and affirm the Commissioner's determination.
The court has referred this matter to the undersigned for entry of a Memorandum and Recommendation. 28 U.S.C. § 636(b).
I. Background
Because Prince's motion concerns matters related her physical health, the undersigned will forgo a recapitulation of her mental health history, symptoms, and treatment.
Prince has a history of physical and mental impairments. In January 2018, Dr. Peter Morris conducted a consultative physical examination. Tr. at 409-13. Prince reported pain in her back, right hip, and right knee. Tr. at 409. Sitting, standing, and walking for a long time were difficult, as were squatting, kneeling, bending, and lifting or carrying items. Id. But Prince could cook, wash dishes, and perform self-care independently, although she sometimes needed help with shoes and socks. Id.
Prince had a slow, antalgic gait. Tr. at 411. Dr. Morris noted that Prince used a cane, but it was not prescribed to her. Id. She retained a normal range of motion in her spine but a diminished range of motion in her hips. Id. Prince also displayed tenderness in her lumbar spine, right hip, and right knee. Tr. at 412. She demonstrated full strength, bulk, and tone with no spasms, effusions, or trigger points. Id.
Dr. Morris assessed chronic back pain without radiculopathy, chronic right hip and right knee pain, reportedly because of degenerative joint disease, asthma, and probable hypertension. Id. He found that she had mild limitations in sitting, standing, and walking as well as reaching. Tr. at 412-13. Dr. Morris also concluded that she had moderate limitations in lifting, carrying, pushing, and pulling. Id. And her ability to squat, stoop, kneel, and crawl were severely limited. Id.
Two weeks later, Prince was in a motor vehicle accident and sought emergency care for back pain. Tr. at 444-46. The next month, she reported pain in her left hip and leg. Tr. at 24, 46771. An examination noted only tenderness, and providers prescribed her medication. Tr. at 24.
In April 2018, Prince reported right hip and leg pain with bilateral foot tingling. Id. An examination revealed pain with range of motion in her right hip. Id. At a community health visit a month later, Prince did not complain of right hip pain. Tr. at 25. But the next week, she visited the emergency department for right hip pain, which increased with movement and weight-bearing. Tr. at 757-62. An examination noted a painful range of motion. Tr. at 25. Providers prescribed medication and referred her to orthopedics. Id. Although Prince complained of discomfort in her right hip at an August 2019 mental health visit, she did not seek follow-up care with orthopedics. Id.
In January 2018, Dr. Stephen Levin, a state agency reviewer at the initial level, found that Prince could perform work at the medium exertional level with limitations in crouching, stooping, and climbing. Tr. at 94. At the reconsideration level six months later, Dr. Martin Rubinowitz concluded that light work with similar postural limitations better suited Prince's abilities and limitations. Tr. at 106.
Prince testified that because of her pain, she could walk for about two minutes and sit for five to seven minutes. Tr. at 47-48. She uses a cane to ambulate. Tr. at 49. Cold weather aggravates her hip pain. Tr. at 27. Her provider recommended that she walk to relieve her pain, but it exacerbated it. Id. She also experiences tingling in her hands. Id.
B. Procedural
In March 2017, Prince applied for supplemental security income alleging a disability that began four years earlier. After the Social Security Administration denied her claim at the initial level and upon reconsideration, Prince appeared before an ALJ for a hearing to determine whether she was entitled to benefits. The ALJ determined that Prince had no right to benefits because she was not disabled. Tr. at 18-30.
The ALJ found that Prince lived with several severe impairments. Among these were degenerative disc disease, obesity, diabetes mellitus, asthma, depressive disorder, and anxiety disorder. Tr. at 19. The ALJ also found that Prince's impairments, either alone or in combination, did not meet or equal a Listing impairment. Tr. at 21.
Next, the ALJ determined that Prince had the residual functional capacity (RFC) to perform light work with other limitations. Tr. at 22. Prince can occasionally climb ramps and stairs but she cannot climb ladders, ropes, or scaffolds. Id. She can occasionally stoop and crouch. Id.
Prince can occasionally work around unprotected heights, moving mechanical parts, and pulmonary irritants (dust, odors, fumes, etc.) but she cannot work in extreme cold. Id. She is limited to understanding, remembering, and carrying out instructions by performing simple, routine, repetitive tasks but not at a production-rate pace (e.g., assembly line work). Id. Prince can have no more than frequent interaction with supervisors and only occasional interaction with co-workers and the public. Id.
Then the ALJ concluded that Prince had no past relevant work. Tr. at 28. But considering her age, education, work experience, and RFC, the ALJ found that other jobs existed in significant numbers in the national economy that Prince could perform. Tr. at 29. These include cafeteria attendant, laundry folder, and electronics worker. Id. These findings led the ALJ to conclude that Prince was not disabled. Tr. at 30.
After unsuccessfully seeking review by the Appeals Council, Prince began this action in April 2022. D.E. 5. Both parties have asked the court to issue a judgment in their favor. D.E. 15, 18.
II. Analysis
Prince challenges the ALJ's evaluation of a medical opinion. But the undersigned finds that the ALJ properly considered this evidence and sufficiently explained his reasons for finding its conclusions unpersuasive. So Prince has not stated a viable basis to remand her claim.
A. Standard for Review of the Acting Commissioner's Final Decision
When a claimant appeals the Commissioner's final decision, the district court considers whether, based on the entire administrative record, there is substantial evidence to support the Commissioner's findings. 42 U.S.C. § 405(g); Richardson v. Perales, 402 U.S. 389, 401 (1971). Substantial evidence is “evidence which a reasoning mind would accept as sufficient to support a particular conclusion.” Shively v. Heckler, 739 F.2d 987, 989 (4th Cir. 1984) (quoting Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966)). The court must affirm the Commissioner's decision if it is supported by substantial evidence. Smith v. Chater, 99 F.3d 635, 638 (4th Cir. 1996).
B. Standard for Evaluating Disability
Under the Social Security Act, a claimant is disabled if they are unable “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. § 423(d)(1)(A). ALJs use a five-step, sequential process when considering disability claims. 20 C.F.R. § 404.1520.
First, at step one, the ALJ considers whether the claimant is engaged in substantial gainful activity. Id. § 404.1520(a)(4)(i). If so, the claim is denied. Id.
Then, at step two, the ALJ looks at whether the claimant has a severe impairment or combination of impairments that significantly limit him from performing basic work activities. Id. § 404.1520(a)(4)(ii). If not, the claim is denied. Id.
Next, at step three, the ALJ compares the claimant's impairments to those in the Listing of Impairments. Id. § 404.1520(a)(4)(iii). If the impairment appears in the Listing or if it is equal to a listed impairment, the ALJ must find that the claimant is disabled. Id.
But if the ALJ concludes that a presumption of disability is not warranted, the ALJ must then assess the claimant's residual functional capacity (RFC). A claimant's RFC “is the most work-related activity the claimant can do despite all of her medically determinable impairments and the limitations they cause.” Arakas v. Comm'r, Soc. Sec. Admin., 983 F.3d 83, 90 (4th Cir. 2020). Determining the RFC requires the ALJ to “first identify the claimant's ‘functional limitations or restrictions' and assess the claimant's ‘ability to do sustained work-related' activities ‘on a regular and continuing basis'-i.e., ‘8 hours a day, for 5 days a week, or an equivalent work schedule.'” Id. (quoting SSR 96-8p, 1996 WL 374184, at *1 (July 2, 1996)). The ALJ will then “express the claimant's Residual Functional Capacity ‘in terms of the exertional levels of work[:] sedentary, light, medium, heavy, and very heavy.'” Id. (alteration in original).
After assessing the claimant's RFC, the ALJ, at step four, considers whether the claimant can perform his past work despite his impairments. Id. § 404.1520(a)(4)(iv). If the claimant can, the ALJ will deny the claim. Id. If the claimant cannot, the analysis moves on to step five.
This final step considers whether the claimant, based on his age, work experience, and RFC, can perform other substantial gainful work. Id. § 404.1520(a)(4)(v). If so, the claimant is not disabled; if so, they are considered disabled. Id.
The burden of proof shifts between the Commissioner and the claimant during the evaluation process. The claimant has the burden of proof on the first four steps, but the Commissioner bears it on the last one. Pass v. Chater, 65 F.3d 1200, 1203 (4th Cir. 1995).
C. Medical Opinion Evidence
Prince contends that the ALJ failed to address the supportability and consistency of Dr. Morris's assessment before concluding that it was unpersuasive. But the Acting Commissioner asserts that the ALJ's decision reflects sufficient reasons for declining to endorse Dr. Morris's findings. The undersigned finds no error the evaluation of this evidence.
The Regulations direct the ALJ to consider each medical opinion in the record. 20 C.F.R. §§ 404.1520c, 416.920c. A medical opinion is a statement from a medical source about what you can still do despite your impairment(s) and whether you have one or more impairment-related limitations or restrictions in the [following] abilities ...
(A) Your ability to perform physical demands of work activities, such as sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical functions (including manipulative or postural functions, such as reaching, handling, stooping, or crouching);
(B) Your ability to perform mental demands of work activities, such as understanding; remembering; maintaining concentration, persistence, or pace; carrying out instructions; or responding appropriately to supervision, co-workers, or work pressures in a work setting;
(C) Your ability to perform other demands of work, such as seeing, hearing, or using other senses; and
(D) Your ability to adapt to environmental conditions, such as temperature extremes or fumes.Id. §§ 404.1520(a)(2), 416.913(a)(2).
The Regulations provide that the ALJ “will not defer or give any specific evidentiary weight, including controlling weight, to any medical opinion(s) or prior administrative medical finding(s), including those from [claimant's] medical sources.” Id. §§ 404.1520c(a), 416.920c(a).Instead, the ALJ must evaluate each medical opinion and articulate the “persuasiveness” of all medical opinions by considering five factors:
Because Prince filed his application after March 27, 2017, the revised rules for the assessment of medical opinion evidence govern how the ALJ considers the medical opinions in this case.
(1) supportability, meaning that “[t]he more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion(s) ... the more persuasive the medical opinions or prior administrative medical finding(s) will be”; (2) consistency, meaning that the more consistent an opinion is with other evidence in the record, the more persuasive the medical opinion will be; (3) the medical source's relationship with the claimant, which considers the length of the treating relationship, frequency of examinations, purpose of the treating relationship, extent of the treatment relationship, and whether the medical source examined the claimant; (4) specialization, meaning that “a medical source who has received advanced education and training to become a specialist may be more persuasive”; and (5) other factors that tend to support or contradict a medical opinion.”Id. §§ 404.1520c(c)(1)-(5), 416.920c(c)(1)-(5).
Supportability and consistency are the “most important” factors, and the ALJ must discuss how they considered these factors in the written opinion. Id. §§ 404.1520c(b)(2), 416.920c(b)(2). The ALJ may explain their consideration of the other factors but need only do so when contrary medical opinions are equally persuasive in terms of both supportability and consistency. Id. §§ 404.1520c(b)(3), 416.920c(b)(3). In that situation, the ALJ must then articulate the remaining factors and their application to the persuasiveness of the medical opinion. Id.
The Regulations require the ALJ to “articulate in [her] determination or decision how persuasive [she] find[s] all of the medical opinions and all of the prior administrative medical findings in [the] case record.” Id. §§ 404.1520c(b), 416.920c(b). But when a medical source provides multiple opinions, the ALJ may use a single analysis to evaluate all the opinions from a single source, and the ALJ is “not required to articulate how [she] considered each medical opinion or prior administrative medical finding from one medical source individually.” Id.
Dr. Morris's medical source statement found that Prince had no limitations with handling, fingering, and feeling but she was mildly limited in reaching. Tr. at 412-13. Her abilities to sit, stand, and walk were also mildly restricted. Id. Prince had moderate limitations in lifting, carrying, pushing, and pulling. Id. And she had severe limitations in postural movements like squatting, stooping, kneeling, and crawling. Id.
The ALJ discussed Dr. Morris's consultative examination. Tr. at 24. He noted that Dr. Morris observed Prince's moderate difficulty in heel, toe, and tandem walking as well as with squatting and kneeling. Id. The ALJ remarked that the examination found tenderness to palpitation in the lumbar spine, right hip, and right knee. Id. But there were no spasms, crepitus, effusions, deformities, or trigger points. Id. The bilateral extremities retained normal strength, bulk, tone, and reflexes. Id.
The ALJ did not list Dr. Morris's conclusions about Prince's functioning. But he determined that Dr. Morris's medical source statement was not persuasive “because it is not presented in vocationally relevant terminology[.]” Id. So the assessment was vague, as Dr. Rubinowitz remarked. Id.
Prince argues that the ALJ's evaluation of Dr. Morris's assessment is insufficient because he failed to discuss the conclusions the consultative examiner reached. She also contends that the ALJ's reasons for finding this medical opinion unpersuasive do not withstand scrutiny. The undersigned disagrees.
First, an ALJ need not discuss every piece of evidence or every finding. See Reid v. Comm'r of Soc. Sec., 769 F.3d 861, 865 (4th Cir. 2014). The ALJ not only reviewed Dr. Morris's medical source statement but he discussed it in detail. Tr. at 24-26, 28. That he did not list Dr. Morris's findings does not suggest that the ALJ ignored them. Nor has Prince identified any authority to support a claim that the ALJ's failure to cite a consultative examiner's conclusions about one's functional abilities constitutes reversible error.
Second, Prince challenges the ALJ's characterization about the vocational relevance in Dr. Morris's findings. The ALJ did not state that Dr. Morris's conclusions were not vocationally relevant, as Prince appears to argue. Instead, he determined that the opinion did not express its findings in vocationally relevant terms. No doubt the abilities it assessed-sitting, standing, walking, reaching, lifting, carrying, pushing, pulling, and postural movements-are work-related. But the problematic terms are not those functions but the limitations Dr. Morris placed on those abilities-mild, moderate, and severe.
As noted above, these terms are not defined by examiner nor have widely accepted meanings that are quantifiable in terms of time, weight, or frequency. Understandably, the ALJ could not know whether, for instance, Dr. Morris believed that Prince could reach for three hours in an eight-hour workday or occasionally lift and carry twenty pounds. So his assessment, as written, offers limited enlightenment into Prince's functional abilities.
The ALJ's determination that Dr. Morris's statement was vague, given the unquantified and unmeasured restrictions he assessed, is well-founded. Dr. Rubinowitz, too, found that the assessment was “too vague” and did not evaluate Dr. Morris's findings against his own. Tr. at 107.
Prince cites a decision from this court to support her argument. In Jones v. Saul, the ALJ declined to give substantial weight to a medical opinion, in part because it was vague and not expressed in vocationally relevant terms. No. 5:18-CV-177-BO, 2019 WL 2884279, at *2 (E.D. N.C. July 3, 2019). The court remarked that the opinion limited the claimant to lifting or carrying ten pounds, standing or walking less than two hours a day, and sitting less than six hours a day. Id. The court noted that the opinion about the claimant's abilities to sit, stand, lift, carry, push, and pull were “directly relevant to the inquiry into whether a claimant can perform substantial gainful activity.” Id. So it remanded the matter for further consideration. Id. at * 3.
But Kijakazi contends that Jones is distinguishable from the fact here. The undersigned agrees. In Jones, the medical opinion specified how much the claimant could lift and carry and how long she could sit, stand, and walk. Id. at * 2. Yet Dr. Morris's assessment does not quantify Prince's restrictions as to these functions. Instead, he finds she had mild, moderate, and severe limitations in these work-related functions. But neither the ALJ nor a reviewing court know how these terms translate into restrictions on her ability to perform work tasks: Can she sit, stand, and walk for six hours? Can Prince frequently lift and carry ten pounds? Is she able to reach for three hours a day?
Because the limitations that Dr. Morris found were undefined, the ALJ committed no error in declining to find it persuasive to the disability analysis. Prince has identified only disagreement, not error, with the ALJ's consideration of Dr. Morris's opinion. But it is not the role of the reviewing court to weigh evidence or make findings in the face of conflicting evidence. See Johnson v. Barnhart, 434 F.3d 650, 653 (4th Cir. 2005) (reviewing court should not seek to reweigh conflicting evidence, make credibility determinations, or substitute its judgment for that of the ALJ). So the undersigned recommends that the court reject his argument on this issue as it lacks merit.
III. Conclusion
For these reasons, the undersigned recommends that the court grant Kijakazi's motion (D.E. 18), deny Prince's motion (D.E. 15), and affirm the Acting Commissioner's determination.
The Clerk of Court must serve a copy of this Memorandum and Recommendation (M&R) on each party who has appeared in this action. Any party may file a written objection to the M&R within 14 days from the date the Clerk serves it on them. The objection must specifically note the portion of the M&R that the party objects to and the reasons for their objection. Any other party may respond to the objection within 14 days from the date the objecting party serves it on them. The district judge will review the objection and make their own determination about the matter that is the subject of the objection. If a party does not file a timely written objection, the party will have forfeited their ability to have the M&R (or a later decision based on the M&R) reviewed by the Court of Appeals.