Opinion
Case No. 01 Civ. 3486 (SHS)
April 15, 2003
OPINION AND ORDER
Preston Stanton brings this action pursuant to section 205(g) of the Social Security Act (the "Act"), 42 U.S.C. § 405(g), to challenge a final determination by defendant Jo Anne B. Barnhart, Commissioner of Social Security, denying him Social Security Disability Insurance ("SSDI") benefits. Both parties have moved for judgment on the pleadings pursuant to Fed.R.Civ.P. 12(c). As set forth below, defendant's motion is granted because there is substantial evidence in support of her determination.
I. BACKGROUND
A. Administrative Proceedings
On December 18, 1997, Stanton submitted an application to the Social Security Administration for SSDI benefits. (R. 75, 91-100.) The application was denied both initially and upon reconsideration. (R. 56-59, 62-64.) Upon Stanton's request, administrative law judge Thomas P. Dorsey ("the ALJ") held a de novo hearing on May 14, 1999 to determine whether Stanton was entitled to benefits. (R. 65-66.) On May 27, 1999, the ALJ denied Stanton's application. (R. 13-21.) The ALJ's decision became the final determination of the Commissioner on March 6, 2001, when the Appeals Council of the Social Security Administration denied Stanton's request for review. (R. 3-4.)
References to "R.___" are to relevant pages of the record of proceedings prepared by the Commissioner.
B. The Record
1. Stanton's Testimony
Stanton, who was 54 years old at the time of the ALJ's hearing, lives in Monticello, New York with his wife and mother-in-law, and sometimes, with his son. (R. 34, 48.) He completed nine years of school and can read and write English. (R. 35.) Stanton testified that he worked as a bell hop at the Concord Hotel for twenty-two years where he frequently carried up to 25 pounds and sometimes lifted over 100 pounds of luggage in the course of his work. (R. 38-39, 87.) Since leaving that job, he has worked only as a school bus driver, from 1992 until 1997, where he drove, completed trip reports, supervised children, broke up fights, and sometimes lifted children on and off the bus. (R. 50, 85-86, 95.) In a typical day as a bus driver, Stanton would sit for six hours, walk for one hour, and stand for one hour in an eight-hour workday. (R. 86, 96.)
Stanton suffered an acute heart attack on October 7, 1994 and a second heart attack on September 23, 1997. As a result of his coronary disease, Stanton has had several medical procedures requiring his hospitalization, including cardiac catheterizations, angioplasties, and stenting. (R. 347, 351.) He claims that he has been unable to work since his second heart attack. Also, Stanton claims that he suffers from "borderline sugar" problems, pain in his legs and arms, swelling in his hands, and shortness of breath. (R. 39, 41, 52.)
Stanton testified that typically, he passes the day sitting at home, watching television. (R. 45.) At times, he goes outside and walks around. (R. 45.) At home, he sometimes helps his wife wash the dishes and does very light cooking. (R. 47.) He drives a car approximately two or three times a week to run errands and visit his son or friends, and occasionally, he goes out to eat at restaurants. (R. 34-35, 46-47.) Periodically, Stanton goes to the race track to watch horse racing with his son. (R. 46.) In addition, approximately five times a month, Stanton goes fishing. (R. 47.)
With respect to his physical limitations, Stanton testified that he can only walk approximately one to two blocks before becoming short of breath. (R. 42.) After walking, he feels tired. (R. 39.) After ten minutes of standing, he complains of pain in his legs. (R. 42.) In addition, Stanton testified that he generally experiences pain in his legs and arms and has poor circulation. (R. 39, 43, 45.) However, he has no difficulty manipulating his hands and fingers. (R 45.) When he sits for prolonged periods of time, he feels tingling in his extremities and experiences swelling. (R. 43-44.) Stanton stated that he can bend, but complains of blood rushing to his head. (R. 43.) Also, he testified that he can kneel, but finds it hard to stand up. (R. 43.) He testified that he can lift one gallon of milk, but not two gallons, because the additional weight would cause him to experience chest pains. (R. 44-45.) Stanton also described episodes of dizziness and stated that he has "borderline sugar" problems for which he used to take medication but now simply monitors his diet.
Stanton is also obese. He is 5'9" and weighs approximately 260 pounds. (R. 49.) He gained approximately 60 to 80 pounds since he quit smoking after his first heart attack. (R. 49-50.)
2. Medical Evidence
When Stanton suffered his first heart attack, he underwent a coronary angioplasty on October 7, 1994 at Valley Hospital. (R. 200.) The procedure was deemed successful in a report by the treating physician, Dr. Dennis Reison. (R. 201.)
Stanton suffered a second heart attack on September 23, 1997, and was diagnosed with myocardial infraction on September 25, 1997. (R. 287-91.) He received treatment in the form of a right and left cardiac catheterization performed by Dr. Cary Hirsch, which was successful in temporarily removing stenosis from Stanton's right coronary artery. (R. 202, 204.) Stanton claims that his coronary disease and other ailments have prevented him from substantial gainful employment beginning on September 30, 1997. (R. 91.)
From April 1997 through May 1998, Dr. Gary Garfield, Stanton's physician, treated Stanton for various health problems related to coronary disease and other illnesses. (R. 150-77, 237, 301-12.) On April 16, 1997, Dr. Garfield diagnosed Stanton with diabetes after Stanton complained of blurred vision and other hyperglycemic events. (R. 169.) In October 1997, Dr. Garfield diagnosed Stanton with pneumonia and complications stemming from his coronary artery disease. (R. 172-73.) On December 3, 1997, Stanton had a cardiac catheterization performed and a stent was placed in his left anterior descending artery. (R. 180, 207.) The stent placement was described as successful by Dr. Hirsch. (R 182.) On December 18, 1997, Stanton filed for SSDI benefits.
On January 12, 1998, Stanton was examined by Dr. John R. Muccia, who recommended a cardiolite stress test. (R. 211-13.) Dr. Muecia diagnosed Stanton as having coronary artery disease (noting that there had been angioplasty of the right and left coronary artery as well as a stent in the left anterior coronary artery) and hyperglycemia. (R. 213.) In a stress test performed by Dr. Garfield on February 3, 1998 Stanton tested negative for myocardial ischemia. (R. 237-38.) In addition, a thallium stress study and a thallium non-stress test, ordered by Dr. Muccia, showed no evidence of a fixed defect or reversible ischemia. (R. 214.)
On March 10, 1998, Dr. Edward M. Rosenberg, a state agency reviewing physician, recommended that Stanton undergo a pulmonary function test (PFT) and a chest x-ray. (R. 239-40.) The chest x-ray indicated increased cardiac diameter but no active lung disease. (R. 259.) The PFT indicated mild pulmonary restriction. (R. 256-58.)
Dr. Carl Sanchez, the Social Security Administration's consultative examiner, examined Stanton on March 31, 1998. (R. 295-97.) Dr. Sanchez determined that Stanton's physical activities were limited due to coronary artery disease and that he suffered from high blood pressure, diabetes mellitus, hypercholesterolemia, and asthma. (R. 297.) Dr. Sanchez gave Stanton a "guarded" prognosis. (R.297.)
On April 3, 1998, Stanton was admitted to Valley Hospital for unstable anginal symptoms. (R. 242.) Dr. Marc Kirshenbaum, a treating physician, examined him and determined that Stanton had an "unstable angina, coronary artery disease . . . possible stenosis of a left anterior descending lesion." (R. 242.) Dr. Kirshenbaum ordered a cardiac catheterization, angioplasty, and stenting by Dr. Cary Hirsch. (R. 242.) Dr. Hirsch performed a left heart catheterization with left ventriculography and selective coronary arteriography, and an intracoronary stent was successfully placed in Stanton's left anterior descending artery. (R. 251, 254.)
On May 4, 1998 after conducting a paper review of Stanton's medical records including the x-ray and PFT results, Dr. Sanchez's report, and the records from Stanton's hospitalization in April 1998, Dr. Rosenberg recommended a residual functional capacity ("RFC") of light work, assuming that angina was no longer a concern. (R. 298-99.) If angina was still a problem, he recommended a treadmill exercise test. (R. 299.) He also noted that Stanton had good cardiac function, with an ejection factor of 60%, and mild to moderate pulmonary disease. (R. 298-99.)
On May 20, 1998, a cardiolite treadmill stress test was given by Dr. Garfield in consultation with Dr. Muccia. (R. 301.) In the report, Dr. Garfield noted that Stanton complained of chest pains when he lifts objects. Stanton specifically complained that when he lifts his grandchild, he has chest pains and shortness of breath. (R. 301.) Dr. Garfield deemed Stanton's condition negative for myocardial ischemia. (R. 302.) After five minutes on the treadmill, Stanton did not complain of chest pain, but Dr. Garfield noted that he was "markedly short of breath and complain[ing] of fatigue and leg pain." (R. 302.) The next day, a Thallium non-stress test was performed at the direction of Dr. Muccia and Dr. Garfield. (R. 300.) The result was a matching pattern of activity in the post-stress and resting studies with no evidence of reversible ischemia. (R. 300.)
Dr. Rosenberg reviewed Stanton's medical record again on June 4, 1998 after the stress and non-stress tests. (R. 320.) Noting that Stanton complained of chest pains when lifting his grandchild, Dr. Rosenberg concluded that the chest pains were "probably noncardiac [and that] [a]n RFC of light [work] previously proposed is appropriate." (R. 320.)
In a letter to the Office of Temporary and Disability Assistance dated June 3, 1998, Dr. Muccia stated that while there was no evidence of reversible ischemia from the performed stress tests, "it is advisable that the patient does not drive a school bus with children given the possibility of an acute closure while he is driving a school bus." (R. 351-352.)
On June 9, 1998, Dr. Judith Rodnar, a state agency reviewing physician, concluded that Stanton could occasionally lift and/or carry 20 pounds, frequently lift and/or carry 10 pounds, stand and/or walk with normal breaks for approximately six hours, sit with normal breaks for approximately six hours, and push and/or pull with unlimited ability. (R. 337.) This opinion was based on some of Stanton's subjective complaints and on medical records that did not contain a treating or examining source statement regarding Stanton's physical capabilities. (R. 337, 342.) Dr. Rodnar also concluded that Stanton could occasionally climb, balance, stoop, kneel, crouch, and crawl. (R. 338.) Dr. Rodnar also determined that no manipulative, visual, communicative, or environmental limitations were established. (R. 339-340.)
On October 5, 1998, Dr. Susan Wagenheim, a state agency reviewing physician, reviewed both the medical report by Dr. Rodnar as well as a psychiatric report by Dr. Leslie Helprin. (R. 327-43.) With respect to the psychiatric report, Dr. Wagenheim concluded that Stanton did not suffer from any severe psychiatric impairment. (R. 327.) In addition, Dr. Wagenheim concurred with Dr. Rodner's residual capacity assessment and added no new notes. (R. 336-43.)
On December 15, 1998, Dr. Muccia examined Stanton again and prepared a report. (R. 347-48.) The diagnosis contained six findings: dyspnea, tiredness, CAD S/P multiple coronary angioplasties, hyperglycemia, hypertension, and morbid exogenous obesity. (R. 348.) The medications listed for Stanton included Atenolol, Norvasc, Ecotrin, and Zocor. (R. 347.) On December 26, 1998, Dr. Muccia reviewed Stanton's echocardiogram and concluded that there was an insignificant trace mitral regurgitation, moderate left atrial enlargement, satisfactory LV systolic function with an ejection fraction estimated at 46%. (R. 350.)
II. DISCUSSION
A. Standard of Review
This Court's review of the denial of SSDI benefits is limited to a determination of whether there is "substantial evidence" to support the Commissioner's decision. 42 U.S.C. § 405(g) ("The findings of the Commissioner . . . as to any fact, if supported by substantial evidence, shall be conclusive. . . ."); accord Shaw v. Carter, 221 F.3d 126, 131 (2d Cir. 2000); Rosa v. Callahan, 168 F.3d 72, 77 (2d Cir. 1999). Substantial evidence is defined as "`more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" Richardson v. Perales, 402 U.S. 389, 401 (1971) (quoting Consol. Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)); accord Rosa, 168 F.3d at 77. "The substantial evidence test applies not only to findings of basic evidentiary facts but also to inferences and conclusions drawn from such facts." Tillery v. Callahan, 1997 WL 767561 at *2 (S.D.N.Y. Dec. 11, 1997) (citation omitted). Moreover, a court "`may not substitute its own judgment for that of the [Commissioner], even if it might have reached a different result upon a de novo review.'"Jones v. Sullivan, 949 F.2d 57, 59 (2d Cir. 1991) (quoting Valente v. Secretary of Health and Human Servs., 733 F.2d 1037, 1041 (2d Cir. 1984)). "Thus, the role of the district court is quite limited and substantial deference is to be afforded the Commissioner's decision."Jones v. Apfel, 66 F. Supp.2d 518, 536 (S.D.N.Y. 1999) (quotations omitted). Therefore, this Court will not disturb a decision supported by substantial evidence, unless "the decision was the product of legal error." Dumas v. Schweiker, 712 F.2d 1545, 1550 (2d Cir. 1983); accord Jones, 66 F. Supp.2d at 536.
B. The Definition of Disability
In order to establish disability pursuant to the Social Security Act, an individual must demonstrate that he or she was unable "to engage in any substantial gainful activity by reason of a physical or mental impairment that . . . had lasted or could have been expected to last for a continuous period of at least twelve months." 42 U.S.C. § 423(d)(1)(A); see Rosa, 168 F.3d at 77. The impairment must be demonstrated by "medically acceptable clinical and laboratory techniques," 42 U.S.C. § 423(d)(3) and it must be "of such severity that [the claimant] 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." 42 U.S.C. § 423(d)(2)(A); see Rosa, 168 F.3d at 77.
The Commissioner's regulations set forth a five-step procedure for evaluating disability claims. See 20 C.F.R. § 404.1520, 416.920. The U.S. Court of Appeals for the Second Circuit has articulated the procedure as follows:
First, the [Commissioner] considers whether the claimant is currently engaged in substantial gainful activity. If he is not, the [Commissioner] next considers whether the claimant has a "severe impairment" which significantly limits his physical or mental ability to do basic work activities. If the claimant suffers such an impairment, the third inquiry is whether, based solely on medical evidence, the claimant has an impairment which is listed in Appendix 1 of the regulations. If the claimant has such an impairment, the [Commissioner] will consider him disabled without considering vocational factors such as age, education, and work experience. . . . Assuming the claimant does not have a listed impairment, the fourth inquiry is whether, despite the claimant's severe impairment, he has the residual functional capacity to perform his past work. Finally, if the claimant is unable to perform his past work, the [Commissioner] then determines whether there is other work which the claimant could perform.Rosa, 168 F.3d at 77 (quoting Berry v. Schweiker, 675 F.2d 464, 467 (2d Cir. 1982) (per curiam)).
If the claimant meets his burden of proving the first four steps, then the burden shifts to the Commissioner on the fifth step — to show that there is alternative substantial gainful work in the national economy that the claimant can perform. Id. The Commissioner must consider four factors: (1) the objective medical facts; (2) diagnoses or medical opinions based on such facts; (3) subjective evidence of pain or disability testified to by the claimant or others; and (4) the claimant's educational background, age and work experience. Brown v. Apfel, 174 F.3d 59, 62 (2d Cir. 1999) (citations omitted).
C. The Commissioner's Determination of Plaintiff's Residual Functional Capacity to Perform "Light Work" Is Supported by Substantial Evidence
Applying the five-step procedure, the ALJ determined that Stanton, who has not engaged in any substantial gainful activity since September 30, 1997, suffers from two severe non-listed impairments: coronary artery disease and asthma. (R. 20.) With respect to the fourth step, the ALJ found that Stanton could not perform his past work as a bus driver and bell hop, but that he retained the residual functional capacity to perform light work. (R. 19-20.) Then, the ALJ determined that given Stanton's age, educational background, vocational history, and RFC, he was eligible for other jobs existing in significant numbers in the national economy and that therefore Stanton was not disabled pursuant to the Act. (R. 20.)
There is substantial evidence in the record to support the Commissioner's conclusion that, despite Stanton's coronary artery disease and asthma, Stanton could still perform light work. Light work involves
lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a great deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, [a person] must have the ability to do substantially all of these activities.20 C.F.R. § 404.1567(b). In this evaluation, the ALJ must consider exertional and non-exertional capabilities. 20 C.F.R. Subpart P, § 404.1567.
Stanton challenges the ALJ's finding that his alleged symptoms of chest pain, hand, arm, and leg swelling, and shortness of breath were not wholly credible in light of his daily activities and the medical record. Stanton also contends that because the functional capacity questionnaires, to which the ALJ accorded great weight, were "rubber stamped," there was no indication that Stanton's medical records were reviewed comprehensively by the state agency physicians. Id. at 13-14.
In reaching the conclusion that Stanton could perform light work, the ALJ considered Stanton's testimony, his subjective complaints, and medical evidence on the record. (R. 16-18, 20.) While a claimant need not prove that he is housebound or bed bound, a claimant's subjective symptoms must be supported by medical signs or conditions that reasonably could be expected to produce the disability or alleged symptoms based on a consideration of all the evidence. See 20 C.F.R. § 404.1529.
Despite Stanton's subjective complaints, several physicians determined that Stanton could do light work based on his medical records and on their own evaluations of his test results. Indeed, Dr. Rosenberg undertook two thorough reviews of Stanton's medical records to confirm his opinion that Stanton was capable of performing light work. (R. 298-99, 320.) After reviewing the cardiolite treadmill stress test given by Dr. Garfield and Stanton's subjective complaints about lifting his grandchildren and shortness of breath, Dr. Rosenberg concluded that the RFC of light work was appropriate and that those subjective complaints were probably non-cardiac. (R. 320.) In addition, functional capacity questionnaires filled out by Drs. Rodnar and Wagenheim support Dr. Rosenberg's assessment of light work based on a full review of Stanton's available medical evidence and determinations that Stanton could perform the standing, walking, sitting, and lifting requirements of light work. (R. 327-43.)
Furthermore, Stanton could occasionally climb, balance, stoop, kneel, crouch, and crawl and had no manipulative, visual, communicative, or environmental limitations. (R. 338-340.) The only limiting assessments cited by Stanton is a letter by Dr. Muccia stating that given the possibility of acute cardiac closure, Stanton should not return to his former job as a school bus driver. (R. 352.) The "guarded prognosis" by Dr. Sanchez was given before the cardiac catheterization and stenting on April 3, 1998 and does not account for those ameliorative procedures or new developments in Stanton's medical condition.
Because Stanton presented no contradictory medical opinion regarding his ability to perform light work, the ALJ reasonably relied upon the medical opinions of the state reviewing physicians and this Court finds that their assessments contribute to the substantial evidence in support of the ALJ's conclusion. While Stanton's subjective testimony contradicts the medical opinions of the state reviewing physicians, it is not supported by any medical evidence.
The ALJ must resolve conflicts in the record and make determinations of credibility. See Schaal v. Apfel, 134 F.3d 496, 504 (2d Cir. 1998) (the ALJ weighs the conflicting evidence in the record.) Although Stanton testified that he was unable to walk more than one or two blocks, stand more than ten minutes, and lift only one gallon of milk before becoming fatigued or pained, he also testified to his activities, which include walking around his neighborhood, helping his wife do dishes, driving a car to run errands and visit friends, fishing, visiting the horse track, and dining outside his home. (R. 35, R. 39-47.) In light of that testimony and the medical evidence, the ALJ reasonably found that Stanton's allegations about his limitations were not entirely credible. (R. 18.)
The ALJ also considered Stanton's non-exertional limitations and concluded that these limitations did not significantly affect Stanton's ability to perform light work. (R. 19.) Stanton's age, education, vocational training, and work experience were included in the ALJ's assessment that directed a finding of "not disabled." (R. 19.) The ALJ found that additional limitations preclude Stanton from performing work at heights, work requiring frequent climbing, balancing, stooping, kneeling, crouching and crawling, and work in environments with concentrated exposure to fumes, odors, dust, gases, or poor ventilation. (R. 20.) However, since most job environments do not involve exposure to fumes, odors, dust, gases, or poor ventilation, the ALJ properly concluded that Stanton's nonexertional limitations did not significantly affect his ability to perform work and relied on the medical vocational guidelines to find that Stanton was "not disabled." See Bapp v. Bowen, 802 F.2d 601, 605 (2d Cir. 1986) (if the nonexertional limitations do not significantly alter the limitations in the range of work, then the medical-vocational guidelines may be relied upon).
III. CONCLUSION
For the forgoing reasons, this Court finds that there was substantial evidence supporting the ALJ's determination that Stanton was not disabled and that he could perform light work. Accordingly, the Commissioner's motion for judgment on the pleadings pursuant to Fed.R.Civ.P. 12(c) is granted and the Commissioner's final determination is affirmed.