Opinion
Civil Action No. 02-CV-6815.
December 19, 2003
REPORT AND RECOMMENDATION
This action was brought pursuant to 42 U.S.C. § 405(g) seeking judicial review of the final decision of the Commissioner of the Social Security Administration ("Commissioner"), who denied the applications of Marian Blocker for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") under Titles II and XVI, respectively, of the Social Security Act ("Act"). Presently before this Court are the parties' cross-motions for summary judgment. For the reasons set forth below, this Court recommends that Plaintiff's motion for summary judgment be DENIED and Defendant's motion for summary judgment be GRANTED.
PROCEDURAL HISTORY
Blocker filed applications for DIB and SSI on February 20, 1998, alleging disability beginning on January 1, 1997, due to pain in her neck, shoulder, back, and legs. (Tr. 99-101, 340-341). These applications were denied initially and upon reconsideration. (Tr. 72-75, 79-81, 343-346, 348-351). Blocker filed an untimely request for a hearing which was denied by the Administrative Law Judge ("ALJ") for failure to show good cause. (Tr. 67-68). The Appeals Council remanded the case to the ALJ to review a letter of explanation which Blocker had submitted with her request for a hearing but which was not forwarded to the ALJ. (Tr. 69-71, 88-89). Upon remand, the ALJ found good cause for the late filing. (Tr. 15). On February 20, 2001, the ALJ conducted a hearing and received testimony from Blocker, who was represented by counsel. (Tr. 25-62). Additional testimony was received from a vocational expert.
The ALJ denied Blocker's claim for benefits in his decision dated July 24, 2001. (Tr. 12-23). The Appeals Council denied Blocker's request for review of this decision, thereby making it the final decision of the Commissioner. (Tr. 6-7). Having exhausted her administrative remedies, Blocker filed a complaint with this Court seeking review of the Commissioner's final decision denying benefits. Blocker and the Commissioner subsequently filed cross-motions for summary judgment.
FACTUAL HISTORY
Blocker was born on March 20, 1955, and was forty-six years old at the time of the hearing. (Tr. 99, 340). She has an eleventh grade education and past relevant work experience as a press technician, machine operator, and packager at a paper box factory. (Tr. 31-34, 117-118, 121).
Under 20 C.F.R. § 404.1563(c), 416.963(c), Blocker is classified as a "younger person," whose age is not considered to affect seriously her ability to adjust to other work.
The vocational expert testified that these jobs are classified as light unskilled work. (Tr. 54).
On January 9, 1997, Blocker slipped and fell on an icy sidewalk. She went to the emergency room with complaints of pain, but was released into the care of her family physician when x-rays revealed no abnormalities. (Tr. 155, 200, 203). In a letter to counsel dated January 21, 1997, Gregory A. Nelson, M.D., stated that he had examined Blocker on January 14, 1997. Dr. Nelson noted that Blocker had spasms and a decreased range of motion of the cervical spine and lumbar spine. X-rays of the cervical spine, thoracic spine, lumbar spine, and pelvis were normal. (Tr. 152). Dr. Nelson diagnosed cervical strain, dorsal strain, and lumbosacral strain and sprain. He recommended treatment with physical therapy, muscle relaxants, analgesics, and anti-inflammatory medication, and opined that her prognosis remained guarded. (Tr. 155-156, 161). On January 15, 1997, Blocker was evaluated by an occupational therapist. (Tr. 200-202). The initial evaluation report indicated that Blocker had "discomfort; no pain" with dressing, bathing, and grooming but was otherwise independent. (Tr. 201).
Blocker was also evaluated by a physical therapist at Northwest Rehabilitation where she began a course of physical therapy which lasted until July 19, 1997. (Tr. 157, 162-163). Treatment notes from that facility reveal that Blocker continued to complain of pain and stiffness in her neck and back throughout the months of treatment. On some visits, Blocker reported that she had no complaints and was feeling better. (Tr. 173-174, 176, 179-180, 183, 185-186, 188-189). Although progress was slower than expected, Blocker's symptoms improved. (Tr. 162-189).
On February 5, 1997, Zohar Stark, M.D., an orthopedic and reconstructive surgeon, evaluated Blocker who complained of pain in her neck radiating to both shoulders increasing with range of motion, and of tingling in the right upper extremity, pain in the lower back, and tingling in her legs. (Tr. 203-204). Upon examination, Dr. Stark noted that Blocker walked with a normal gait, and that there was no sensory or motor deficit to any extremities. Dr. Stark diagnosed sprain/strain of the cervical spine, sprain/strain of the dorsal spine, and sprain/strain of the lumbosacral spine. He recommend physical therapy treatments, modalities in the form of moist heat, ultrasounds, and gentle stretching exercises at least three times a week. (Tr. 204). At a follow-up visit on February 26, 1997, Dr. Stark noted that Blocker was improving, that she should continue with the recommended treatments, and return in a month for follow-up. (Tr. 205-206). A month later, Dr. Stark again noted that Blocker was improving and that she should continue with the treatment and follow-up. (Tr. 209-210).
On February 6, 1997, Blocker underwent MRI's of the lumbar spine and cervical spine. The MRI of the lumbar spine was normal with no sign of HNP or disc bulge. (Tr. 211). The MRI of the cervical spine revealed a bulging disc at C3-4, diffuse straightening of the cervical spine, suggesting spasm, and no sign of HNP. (Tr. 212). On March 27, 1997, a whole body bone scan was performed which identified no abnormalities. (Tr. 213). On November 4, 1997, Blocker underwent x-rays of the thoracic and cervical spine which showed mild thoracic spine degenerative changes and cervical spine straightening. (Tr. 216-218). Later that month, a CT scan of the cervical spine revealed central disc bulging, but no evidence of herniation. (Tr. 218).
On October 16, 1997, David H. Clements, III, M.D., performed an orthopedic evaluation of Blocker at the request of her family physician. (Tr. 214-215). Upon examination and review of the comprehensive objective testing on record, Dr. Clements noted that Blocker had no obvious back deformity; that she had no focal deficits of strength, sensation, or reflexes in her upper or lower extremities; and that she was mildly tender in the paraspinal neck muscles. (Tr. 214). Dr. Clements diagnosed chronic cervical and lumbar strain without evidence of a radicular component, and recommended a home exercise program in cardiovascular fitness. (Tr. 215).
On April 30, 1998, Emil Sfedu, M.D., an internist, examined Blocker at the request of the Commissioner. (Tr. 226-232). Blocker complained of neck, shoulder, back, and leg pain. (Tr. 226). Upon examination, Dr. Sfedu reported that Blocker had marked hand weakness in both hands "upon squeezing" but no sensory changes in any extremities; that she had some spine and extremity range of motion limitations; that she had limited range of motion in her neck; and that her head and neck were entirely normal. (Tr. 227, 231-232). On a medical source statement of claimant's ability to perform work-related physical activities form, Dr. Sfedu opined that because of her neck and leg pain, Blocker could occasionally lift less than ten pounds, stand and walk less than two hours, and sit less than six hours. (Tr. 229). Dr. Sfedu also indicated that Blocker was limited in her ability to reach, to handle, and to be dextrous; and that she could never climb, balance, stoop, kneel, crouch, or crawl. (Tr. 230). Dr. Sfedu gave no supportive medical findings for Blocker's postural and other physical functioning limitations. (Tr. 230).
On June 12, 1998, Raj K. Narayan, M.D., a neurosurgeon, evaluated Blocker at the request of Ronald Cowen, D.O., Blocker's family physician. (Tr. 298-300). Blocker informed Dr. Narayan that her symptoms were fairly well relieved by hot baths and physical maneuvers; that her back pain was not so bad; and that the pain in her lower back was "not debilitating in any way." (Tr. 298). Upon examination, Dr. Narayan found that Blocker had minimally decreased sensation in her right arm, C5 distribution and possibly C6-C7; that her upper left extremity and both lower extremities had normal sensation; that her neck pain was most likely secondary to ligamentous injury; and that her motor exam was significant for her probably not giving full effort. (Tr. 299).
On October 5, 1998, Blocker returned to Dr. Narayan's office and was evaluated by William Young, M.D., also a neurosurgeon. Dr. Young reported that Blocker had shown no improvement since her earlier visit. (Tr. 319). He opined that Blocker's symptoms were of unclear etiology; that objective medical evidence did not show any lesion that could have been attributed to her symptoms; and that because there was no clear understanding of what caused her symptoms, her problem was not "surgically-correctable." (Tr. 319). Dr. Young recommended that Blocker return to her neurologist for further conservative treatment and if unsuccessful, to a pain specialist. (Tr. 319).
In November 1998, Blocker underwent nerve conduction and needle EMG studies on her right upper extremity and right cervical paraspinal muscles. These studies showed mild slowing of the right median mixed sensory distal latency, but were otherwise normal. (Tr. 318). The interpreting neurologist indicated that the tests showed mild medial slowing at the wrist, possibly reflecting mild carpal tunnel compression, but were otherwise normal with no evidence of cervical radiculopathy. (Tr. 318).
On June 23, 1998, Dr. Cowen opined on a welfare application that Blocker was temporarily disabled until January 1999 due to a herniated cervical disc. (Tr. 242). In February 2001, Dr. Cowen completed a Medical Source Statement of Ability to do Work-Related Activities form where he opined that Blocker could occasionally lift/carry less than ten pounds; that she could stand and/or walk for less than two hours in an eight-hour work day; that she needed to alternate periodically between sitting and standing to relieve her pain or discomfort; and that her ability to push and pull ability was limited. (Tr. 295-296).
In May 1998, a state agency reviewing physician completed a physical residual functional capacity assessment form and opined that Blocker could occasionally lift fifty pounds, frequently lift twenty-five pounds, stand/walk for about six hours in an eight hour day, sit for about six hours in an eight hour workday; that she was unlimited in her ability to push and/or pull; and that she had no postural limitations. (Tr. 234-235). In July of that year, a second state agency reviewing physician completed a functional assessment, and also opined that Blocker could occasionally lift fifty pounds; frequently lift twenty-five pounds; sit, stand, and walk for about six hours; and perform unlimited pushing and pulling with no postural, communicative, visual, manipulative, or environmental limitations. (Tr. 243-250). The physician concluded that, "There were no objective findings to correlate to patient's symptoms." (Tr. 249).
DISCUSSION
The role of this Court on judicial review is to determine whether there is substantial evidence in the record to support the Commissioner's final decision. Doak v. Heckler, 790 F.2d 26, 28 (3d Cir. 1986); Newhouse v. Heckler, 753 F.2d 283, 285 (3d Cir. 1985). The factual findings of the Commissioner must be accepted as conclusive, provided that they are supported by substantial evidence. Richardson v. Perales, 402 U.S. 389, 390 (1971) (citing 42 U.S.C. § 405(g)). Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Id. at 401 (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). See also Dobrowolsky v. Califano, 606 F.2d 403, 406 (3d Cir. 1979).
The Social Security Administration has adopted a system of sequential analysis for the evaluation of disability claims for DIB and SSI. This five-step evaluation is codified at 20 C.F.R. § 404.1520, 416.920. The Act provides that a claimant is disabled if she is 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 twelve months." 20 C.F.R. § 404.1505, 416.905. The claimant satisfies her burden by showing an inability to return to her past relevant work. Doak v. Heckler, 790 F.2d at 28; Rossi v. Califano, 602 F.2d 55, 57 (3d Cir. 1979) (citing Baker v. Gardner, 362 F.2d 864 (3d Cir. 1966)). Once this showing is made, the burden of proof shifts to the Commissioner to show that the claimant, given her age, education, and work experience, has the ability to perform specific jobs that exist in the economy. 20 C.F.R. § 404.1520, 416.920. See Rossi v. Califano, 602 F.2d at 57.
These steps are summarized as follows:
1. If the claimant is working or doing substantial gainful activity, a finding of not disabled is directed. If not, proceed to Step 2. 20 C.F.R. § 404.1520(b), 416.920(b).
2. If the claimant is found not to have a severe impairment which significantly limits his or her physical or mental ability to do basic work activity, a finding of not disabled is directed. If there is a severe impairment, proceed to Step 3. 20 C.F.R. § 404.1520(c), 416.920(c).
3. If the impairment meets or equals criteria for a listed impairment or impairments in Appendix 1 of Sub part P of Part 404 of 20 C.F.R. a finding of disabled is directed. If not, proceed to Step 4. 20 C.F.R. § 404.1520(d), 416.920(d).
4. If the claimant retains residual functional capacity to perform past relevant work, a finding of not disabled is directed. If it is determined that the claimant cannot do the kind of work he or she performed in the past, proceed to Step 5. 20 C.F.R. § 404.1520(e), 416.920(e).
5. The Commissioner will then consider the claimant's residual functional capacity, age, education, and past work experience in conjunction with the criteria listed in Appendix 2 to determine if the claimant is or is not disabled. 20 C.F.R. § 404.1520(f), 416.920(f).See also Santise v. Schweiker, 676 F.2d 925, 926-27 (3d Cir. 1982).
In this case, the ALJ determined that Blocker has an impairment or a combination of impairments considered severe but which does not meet or medically equal one of the listed impairments in the Commissioner's regulations for a per se disability. (Tr. 21, Findings No. 3 and 4). The ALJ then found that Blocker's allegations regarding her limitations were not totally credible based on the objective findings made upon examination and the conservative degree of treatment required. (Tr. 22, Finding No. 5). The ALJ determined that Blocker could not return to her past relevant work because she had the residual functional capacity to perform light work entailing occasionally lifting up to twenty pounds and frequently lifting and carrying up to ten pounds with no more than occasional postural activity and a sit/stand option; and that she retained the ability to perform simple, repetitive tasks. (Tr. 22, Finding No. 7). Finally, the ALJ found that because a significant number of jobs existed in the national economy which Blocker could perform, i.e., marker, folder, and assembler, she was not under a disability as defined in the Act. (Tr. 22, Findings No. 13 and 14).
Blocker disagrees with this decision and presents several arguments contending that it is not supported by substantial evidence. Blocker first argues that the ALJ's finding that Blocker had the residual functional capacity to perform light work with certain restrictions is not supported by substantial evidence. Specifically, Blocker contends that because she has a reduced capacity to use her upper extremities, she would not be able to perform the jobs enumerated by the vocational expert. She further contends that the ALJ erred by not incorporating this limitation into the hypothetical question posed to the vocational expert. This Court must disagree.
The regulations provide that an ALJ has the final responsibility in determining a claimant's residual functional capacity. 20 C.F.R. § 404.1527(e)(2), 416.927(e)(2). The ALJ must consider all the evidence of record, including medical signs and laboratory findings, daily activities, medical source statements, and a claimant's medical history. See Social Security Ruling ("SSR") 96-8p; Mullin v. Apfel, 79 F. Supp.2d 544, 548 (E.D. Pa. 2000). However, an ALJ's residual functional capacity findings must be supported by the medical evidence.Doak v. Heckler, 790 F.2d at 29.
Here, in determining Blocker's residual functional capacity, the ALJ provided the following assessment:
The undersigned administrative law judge finds that she retains the capacity to perform light work activity entailing occasionally lifting objects weighing up to 20 pounds and frequently lift and carry objects weighing up to 10 pounds. Giving the claimant the benefit of the doubt, the undersigned finds that because of her musculoskeletal pain, she should be allowed to alternate her positions between sitting and standing and avoid more than occasional postural activity such as climbing and balancing. Once again viewing the evidence most favorably towards the claimant, the undersigned finds that because the claimant experienced personal losses which led to symptoms of depression, she should be limited to simple repetitive tasks, although her depressive symptomatology has resulted in no more than mild to moderate functional limitations.
(Tr. 19).
There is substantial evidence in the record to support the ALJ's determination that Blocker's minimal weakness in the upper extremities would not preclude her from performing substantial gainful activity. For example, notes from Blocker's physical therapy reveal that Blocker had a grip strength of thirty pounds with her left hand (Tr. 255). Dr. Stark opined that there was no sensory or motor deficit in Blocker's extremities. Dr. Clements noted "no focal deficits to strength, sensation, or reflexes in the upper or lower extremities." (Tr. 214). Dr. Young rated Blocker's motor strength in the biceps and grip at 4+/5. (Tr. 319). Additionally, Dr. Narayan opined that Blocker's left upper extremity had normal sensation and that the minimally decreased sensation in her right arm was significant for her not giving full effort. (Tr. 299). Finally, the state agency reviewing physicians opined that Blocker had no manipulative limitations, including reaching, handling, fingering, and feeling. (Tr. 246). After a careful review of the record, this Court finds that substantial evidence supports the ALJ's determination of Blocker's residual functional capacity.
After determining Blocker's residual functional capacity, the ALJ found that she was precluded from performing her past relevant work. To determine whether Blocker was capable of performing other substantial gainful activity, the ALJ relied upon the testimony of a vocational expert. Testimony of a vocational expert constitutes substantial evidence for purposes of judicial review where a hypothetical question considers all of a claimant's impairments that are supported by the medical record. Chrupcala v. Heckler, 829 F.2d 1269, 1276 (3d Cir. 1987). It is not necessary for the ALJ to include facts that are supported by a claimant's subjective testimony only. Id.
First, this Court has already determined that there is substantial evidence in the record to support the ALJ's determination that Blocker's alleged weakness in both upper extremities was not extensive. The record indicates that there was no weakness in her left arm, and only minimal weakness in her right arm. It was therefore not necessary for the ALJ to include that limitation in his hypothetical question. Hypothetical questions need include only those factors that are supported by objective medical evidence contained in the record. Chrupcala v. Heckler, 829 F.2d at 1271.
Second, a careful reading of the transcript belies Blocker's contention that her upper extremity weakness was not considered during the testimony of the vocational expert. At the hearing, the ALJ asked the vocational expert whether work existed for a hypothetical claimant with Blocker's age, education, and vocational profile who was limited to occasionally lifting twenty pounds and frequently lifting ten pounds; who would have to alternate sitting and standing and avoid more than occasional postural activity; and who would be limited to simple repetitive tasks due to mild to moderate functional limitations resulting from depression. (Tr. 55). The vocational expert responded that such a claimant would not be able to perform Blocker's past relevant work because it could not be performed sitting down. (Tr. 55). However, the vocational expert added that a significant number of other light jobs, i.e., marker, folder, and light assembly, existed in the national economy which such a claimant could perform. (Tr. 55-56). He added that a significant number of sedentary jobs also existed in the national economy that the described claimant could perform. (Tr. 56). The vocational expert further testified that a claimant would be precluded from performing any work if she needed to rest for extended periods of time during the day due to pain; or if she could not accept criticism; or if she had no useful ability to concentrate; or if she were unable to complete a normal eight-hour workday on a sustained basis. (Tr. 56-57). Upon cross-examination, the vocational expert explained that the proposed jobs would not be available to someone who was unable to frequently use her hands, especially the dominant right hand (Tr. 57). However, he added that other jobs existed for a claimant with the limitations described above who was also limited to performing frequent reaching and/or handling with their non-dominant hand, such as certain cashier and ticket seller jobs. (Tr. 58). The vocational expert testified that these jobs could be performed as long as one hand was not impaired in any way. (Tr. 58, 60-61). This testimony disproves Blocker's contention that her alleged weakness was not considered as a limitation.
Thus, this Court finds that the ALJ, having properly determined Blocker's residual functional capacity, posed a valid hypothetical question to the vocational expert, and that the testimony of the vocational expert provides substantial evidence to support the ALJ's determination that a significant number of jobs existed in the national economy which Blocker could have performed.
Citing SSR 96-5p, Blocker next argues that the ALJ failed to satisfy his obligation to re-contact Blocker's physicians for clarification of the bases for their opinions. Specifically, Blocker contends that the ALJ should have contacted Dr. Cowen and Dr. Sfedu. This Court does not agree.
SSR 96-5p provides that "because treating source evidence is important, if the evidence does not support a treating source's opinion on any issue reserved to the Commissioner and the adjudicator cannot ascertain the basis of the opinion from the case record, the adjudicator must make `every reasonable effort' to re-contact the source for clarification of the reasons for the opinion."
As discussed above, Dr. Cowen and Dr. Sfedu opined that Blocker had limitations in reaching, handling, lifting, and carrying. (Tr. 229-230, 295-297). Dr. Cowen further opined that Blocker could stand and walk for less than two hours during an eight-hour work day; that she should periodically alternate between sitting and standing to relieve her discomfort; that her ability to push and pull was limited; and that she could occasionally lift/carry less than ten pounds. (Tr. 295-297). Dr. Sfedu further opined that Blocker could stand and walk for less than two hours; sit for less than six hours in an eight-hour work day; and lift/carry up to ten pounds. (Tr. 229-230).
Generally, enhanced weight should be given to the findings and opinions of treating physicians. 20 C.F.R. § 404.1527(d)(2), 416.927(d)(2); Mason v. Shalala, 994 F.2d 1058, 1067 (3d Cir. 1993); Frankenfield v. Bowen, 861 F.2d 405, 408 (3d Cir. 1988). These physicians' reports should be accorded great weight, especially when their opinions "reflect expert judgment over a prolonged period of time." Rocco v. Heckler, 826 F.2d 1348, 1350 (3d Cir. 1987), (quoting Podedwomy v. Harris, 745 F.2d 210, 217 (3d Cir. 1984)). Controlling weight may be given to the opinion of a treating source; however, the ALJ is not bound by a physician's statement of disability and may reject it if: (1) there is a lack of data supporting it, Newhouse v. Heckler, 753 F.2d at 286 (finding ALJ justified in rejecting treating physician's unsupported medical conclusions); or (2) there is contrary medical evidence, Frankenfield, 861 F.2d at 408 (holding treating physician's opinion may be given no weight by ALJ if opinion is contrary to substantial medical evidence). The weight given to a physician's opinion depends upon the extent to which it is supported by clinically acceptable medical data and laboratory medical techniques. Coria v. Heckler, 750 F.2d 245, 247 (3d Cir. 1984).
The ALJ considered the opinions of Dr. Cowen and Dr. Sfedu and concluded that their conclusions are not "well-grounded in the objective findings related to claimant's neck and back, and are not corroborated by anything more than conservative therapy." (Tr. 19). The ALJ also noted that Dr. Cowen's "more restrictive assessment appears based upon the belief that claimant suffers from a herniated disc; however, there are no objective findings showing a herniated disc." (Tr. 19). The ALJ determined that the findings of Dr. Sfedu were also not soundly based upon objective medical evidence, and that his diagnosis "appears largely based upon self-reported symptoms." (Tr. 19).
A careful review of the record supports the ALJ's findings. As discussed above, Dr. Clements performed a physical examination of Blocker and analyzed the available x-rays and MRI reports. His physical examination revealed no focal deficits to strength, sensation, or reflexes in the upper or lower extremities. He described the x-rays of the cervical spine, thoracic spine, and lumbar spine as normal, as was the whole body bone scan. He also described the MRI's of the cervical spine and lumbar spine as normal, aside from a bulging disc. Dr. Clements recommended a home exercise program and suggested that the chronic cervical and lumbar strain would resolve with time.
Dr. Narayan's evaluation also does not support the conclusions of Dr. Cowen and Dr. Sfedu. Dr. Narayan noted that Blocker had slight weakness in both upper extremities and minimal weakness in her right arm; that she had normal sensation in her lower extremities and 2/2 reflexes in all four extremities; and that her motor exam was "significant for her probably not giving full effort." Objective medical tests including an EMG, nerve conduction studies, x-rays, MRI's, CT scans, were also normal, aside from a bulging disc, and do not support the opinions of these physicians.
After a careful review of the record, this Court finds that substantial evidence supports the determination of the ALJ that the restrictive opinions of Dr. Cowen and Dr. Sfedu were inconsistent with the medical findings of other examining and treating physicians discussed above, and that they therefore did not merit controlling weight. In addition, this Court also finds that the ALJ was not required to re-contact these physicians for clarification.
Blocker next argues that the ALJ erred in failing to evaluate Blocker's mental impairment and its resulting functional limitations. Blocker also contends that the ALJ erred by failing to conduct a thorough inquiry into the types and levels of job stresses involved in the jobs identified by the vocational expert. This Court disagrees.
The Commissioner has promulgated regulations dealing specifically with the evaluation of mental impairments. See 20 C.F.R. § 404.1520a, 416.920a; Woody v. Secretary of Health and Human Services, 859 F.2d 1156, 1159 (3d Cir. 1988). In assessing mental disorders to determine disability, the Commissioner is required to consider medical evidence including certain defined clinical signs, symptoms, and/or laboratory or psychological test results. Any impairment found should be analyzed under the categories of mental impairments in the listings consistent with such clinical findings. Id. The Commissioner must also determine the severity of the impairment by assessing the functional limitations resulting from it. 20 C.F.R. § 404.1520a(b)(3) and 416.920a(b)(3).
Blocker sought mental health treatment at the Warren E. Smith Health Center where she underwent a psychiatric evaluation by Biyi Oyefule, M.D., in December 2000, almost three years after she applied for benefits and two months before her administrative hearing. (Tr. 285-288). She reported that she had injured her back lifting heavy items at work two years previous; that she had been unemployed since then; and that she had recently lost her mother. (Tr. 285). Dr. Oyefule diagnosed Blocker with Bipolar Mood Disorder — Type II, opined that her global assessment of functioning (GAF) score was sixty-five, and prescribed Neurontin, Paxil, and Klonopin. (Tr. 288). A psychosocial evaluation performed on the same date reveals that Blocker took a computer class in 1998 which she did not complete because she got bored. (Tr. 289-290). Her strengths were reported to be her cooperativeness, that she had one good friend, that she liked the gym, that she loved to read, that she went to the park to walk, and that she liked bowling. (Tr. 291). Her problems included the loss of her mother and the loss of her brother. (Tr. 291).
After a couple of months of outpatient treatment, Ted Wilf, M.D., Blocker's treating psychiatrist, completed a Medical Source Statement of Ability to Do Work-Related Activities (Mental) form on which he rated Blocker "poor" in the following abilities: understand and remember detailed instructions; carry out detailed instructions; maintain attention and concentration for extended periods; work with or near others without being distracted by them; make simple work-related decisions; complete a normal work day or work week; and accept instructions and respond appropriately to criticism from supervisors. (Tr. 273-274). Dr. Wilf opined that Blocker was "fair" in the ability to: carry out short, simple instructions; perform activities within a schedule, maintain regular attendance, and be punctual; sustain an ordinary routine without special supervision; perform at a consistent pace; get along with co-workers and peers; respond appropriately to changes in work setting; travel in unfamiliar places or use public transportation; and set realistic goals or make plans independently of others. (Tr. 273-274). He rated Blocker "good" in the following abilities: remember locations and work-like procedures; understand and remember short, simple instructions; interact appropriately with the public; and adhere to basic standards of neatness and cleanliness. (273-274). Finally, Dr. Wilf opined that Blocker was rated "excellent" in her ability to ask simple questions and request assistance. (Tr. 274). Dr. Wilf indicated that Blocker's psychiatric evaluation supported his assessment.
The ALJ discounted Dr. Wilf's assessment, finding that it was unsupported by rationale, that it was extremely limiting, and that it would render a person largely incapacitated. (Tr. 19). The ALJ further noted that this assessment was inconsistent with a GAF score of sixty-five. The ALJ also determined that Blocker's symptoms of depression resulted in no more than "mild to moderate" functional limitations. (Tr. 19).
According to the Diagnostic and Statistical Manual of Mental Disorders ("DSM-IV"), a GAF score of sixty-five suggests an individual with "some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, and has some meaningful interpersonal relationships."
There is substantial evidence in the record to support the findings of the ALJ. First, at the hearing, Blocker's counsel conceded that the record does not support the severity of Dr. Wilf's assessment. (Tr. 30). Next, outpatient psychotherapy records mainly reflect Blocker's recent familial losses naturally resulting in depression and grief. Blocker was the primary caretaker for both her terminally ill brother and invalid mother before their deaths. Blocker believed that she was and had to be the "strong one" in her family. She also felt financially pressured from being unemployed. (Tr. 277-278, 281).
The record contains no evidence that Blocker's mental condition resulted in an inability to perform the mental work-related activities of the jobs identified by the vocational expert. The ALJ accommodated Blocker's mental limitation in her residual functional capacity, as follows, "Once again viewing the evidence most favorably towards the claimant, the undersigned finds that because the claimant experienced personal losses which led to symptoms of depression, she should be limited to simple, repetitive tasks, although her depressive symptomatology has resulted in no more than mild to moderate functional limitations." (Tr. 19).
After a careful review of the evidence, this Court finds that substantial evidence supports the ALJ's determination of Blocker's mental impairment. This Court further finds that because the ALJ made sufficient accommodation for Blocker's mental functional limitations, it was not incumbent on the ALJ to conduct a searching inquiry into the types of stresses involved in the jobs enumerated by the vocational expert.
Blocker finally argues that the ALJ's credibility findings are not supported by substantial evidence. This Court disagrees.
Pain may be a disabling condition in itself but only where it is so severe that it precludes an individual from substantial gainful activity. Cancel v. Harris, 512 F. Supp. 69 (E.D. Pa. 1981). A claimant's testimony of subjective complaints is entitled to great weight, particularly when supported by competent medical evidence. Dobrowolsky v. Califano, 606 F.2d 403, 409 (3d Cir. 1979). Where such testimony is reasonably supported by medical evidence, an ALJ may not discount such evidence without contrary medical evidence. Smith v. Califano, 637 F.2d 968 (3d Cir. 1981). Even when not fully confirmed by objective medical evidence, subjective complaints must be seriously considered. Smith v. Califano, 637 F.2d at 972; Green v. Schweiker, 749 F.2d 1066, 1068 (3d Cir. 1984).
Here, Blocker testified at the hearing that she had persistent pain in her neck, shoulder, and back which radiated to her legs. She lived alone and functioned independently on a day to day basis with occasional help from her niece and a girlfriend. (Tr. 30, 42, 49). Blocker often laid down on the sofa throughout the day, but had difficulty sleeping at night; she could read for only ten to fifteen minutes at a time because she had poor concentration and blurry vision; and she rarely went out because people made her nervous. (Tr. 43-44, 49, 50). She was able to drive to the store, straighten up around the house, boil water for light meal preparation, but could do no heavy housework. (Tr. 41-43). A few months before the hearing, Blocker began to experience excruciating headaches several times each week which lasted a couple of hours. (Tr. 53). Her right hand also would get numb "quite often," i.e., three to four times each day, and was exacerbated by constant activity such as writing or cleaning. (Tr. 50-51). Blocker estimated that she could sit for only twenty to thirty minutes, and that she could walk no more than thirty minutes or for two to three blocks. (Tr. 41).
Although the ALJ is required to give great weight to the claimant's testimony of subjective complaints, he has the right, as the fact finder, to reject partially, or even entirely, such subjective complaints if they are not fully credible. Baerga v. Richardson, 500 F.2d 309, 312 (3d Cir. 1974). When considering the subjective complaints, the ALJ is entitled to discredit a claimant's testimony, but must state the facts upon which the conclusion is based, which must be both clear and reasonable. Atkins v. Bowens, 690 F. Supp. 383, 389 (E.D. Pa. 1988). Relevant factors include the claimant's statements, appearance, and demeanor; medical signs and laboratory findings; treatment and response; and physicians' opinions regarding credibility and severity of claimant's subjective complaints. See SSR 96-7p.
The ALJ found that Blocker's allegations of total disability were not credible when considered in conjunction with the objective evidence of record. The ALJ noted:
Claimant's testimony was very non-specific at the hearing. She was very forgetful and a poor historian. She testified inconsistently, for example, when indicating at first that she did no housework and at other times that cleaning and vacuuming exacerbate her symptoms. Her symptoms are not well supported by the fact that she has had no surgery or electrical stimulation, has not gone to physical therapy in many years, engaged in chiropractic care only about three times, uses no assistive device, and is maintained on Motrin.
(Tr. 19-20).
Deference must be given to the ALJ's determination in issues of credibility when reviewing the Commissioner's final decision, so long as the ALJ discusses the issue and his finding is supported by substantial evidence. Alvarez v. Secretary of Health and Human Services, 549 F. Supp. 897, 899-900 (E.D. Pa. 1982); see also Davidson v. Harris, 502 F. Supp. 1208, 1213 (E.D. Pa. 1980).
As discussed above, the objective medical evidence does not support Blocker's subjective complaints of pain. At the onset of the injury, x-rays taken in the emergency room showed no abnormalities. Both Dr. Nelson and Dr. Stark diagnosed strain and sprain and both recommended conservative treatment with physical therapy, analgesics, and anti-inflammatory medication. Physical therapy notes showed that Blocker's symptoms were improving. A whole body scan was considered normal. An MRI of the lumbar spine was normal. Dr. Clements diagnosed chronic cervical and lumbar strain without evidence of a radicular component, recommended home exercise, and opined that Blocker's symptoms would resolve with time. X-rays showed mild degenerative changes in the thoracic spine, and a CT scan of the cervical spine showed central disc bulging at C4-5, but no evidence of herniation. In addition, Blocker reported to Dr. Narayan that her symptoms were fairly well-relieved, and that her back pain was not so bad or "debilitating in any way." (Tr. 298). Further, as the ALJ discussed, Blocker's treatment has not included surgery or electronic stimulation, she has not gone to physical therapy in several years, she uses no assistive devices, and she is maintained on Motrin. These facts are inconsistent with the limitations Blocker alleges.
Finally, this Court notes that, while the medical evidence supports a claim of some pain or discomfort, it does not depict a disabling condition so severe that it would have precluded an individual from performing substantial gainful activity. A claimant need not be completely free from pain for the ALJ to find her not disabled. Welch v. Heckler, 808 F.2d at 270. The fact that a person cannot work without some pain does not necessarily satisfy the test for disability. Cancel v. Harris, 512 F. Supp. 69 (E.D. Pa. 1981); Candelaria v. Weinberger, 389 F. Supp. 613 (E.D. Pa. 1975).
The ALJ stated his reasons for discounting Blocker's allegations and supported his conclusions with the medical evidence discussed above. He further provided the requisite clear and reasonable basis for his finding that Blocker's testimony regarding her subjective complaints was not credible. Because substantial evidence supports this determination, this Court's standard of review demands that it be afforded proper deference.
In conclusion, after an exhaustive review of the record, this Court finds that substantial evidence supports the ALJ's determination that despite her impairments, Blocker retained the residual functional capacity to perform jobs that existed in significant numbers in the national economy and was, therefore, not disabled as defined in the Act.
Accordingly, this Court makes the following:
RECOMMENDATION
AND NOW, this day of December, 2003, IT IS RESPECTFULLY RECOMMENDED that Plaintiff's motion for summary judgment be DENIED and that Defendant's motion for summary judgment be GRANTED.