Opinion
EP-22-CV-00120-FM-RFC
12-05-2022
GLENDA CERNA MORALES, Plaintiff, v. COMMISSIONER OF THE SOCIAL SECURITY ADMINISTRATION, Defendant.
REPORT AND RECOMMENDATION OF THE MAGISTRATE JUDGE
ROBERT F. CASTANEDA UNITED STATES MAGISTRATE JUDGE
Plaintiff Glenda Cerna Morales (“Plaintiff” or “Morales”) appeals from the decision of the Commissioner of the Social Security Administration (“Commissioner”), denying her claim for disability insurance benefits (“DIB”) under Title II of the Social Security Act. For the reasons set forth below, this Court recommends that the Commissioner's decision be AFFIRMED.
I. PROCEDURAL HISTORY
On November 15, 2019, Morales filed a DIB application alleging disability beginning on May 15, 2015, due to arthritis, liver lesion, depression, anxiety, bilateral hand joint pain, swelling, and migratory rash. (R:36, 109-10.) Morales's application was initially denied on January 6, 2020 (R:109-21) and again upon reconsideration on September 3, 2020 (R: 122-34). On April 8, 2021, an Administrative Law Judge (“ALJ”) conducted a hearing. (R:88-108.) The ALJ issued an unfavorable determination on May 14, 2021. (R:30-58.) The Appeals Council denied Morales's request for review on December 21, 2021. (R:9-17.)
II. DISCUSSION
A. Standard of Review
This Court's review of the Commissioner's final decision is limited to a determination of (1) whether the Commissioner's final decision is supported by substantial evidence on the record and (2) whether the Commissioner applied the proper legal standards. See 42 U.S.C. § 405(g); Copeland v. Colvin, 771 F.3d 920, 923 (5th Cir. 2014). Substantial evidence is more than a scintilla but less than a preponderance and is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Perez v. Barnhart, 415 F.3d 457, 461 (5th Cir. 2005) (citations omitted). “A finding of no substantial evidence is appropriate only if no credible evidentiary choices or medical findings support the decision.” Boyd v. Apfel, 239 F.3d 698, 704 (5th Cir. 2001) (internal quotes and citations omitted)
In applying the substantial evidence standard, the court may not reweigh the evidence or try the issues de novo. Masterson v. Barnhart, 309 F.3d 267, 272 (5th Cir. 2002). Conflicts in the evidence are for the Commissioner, not the courts, to resolve. Spellman v. Shalala, 1 F.3d 357, 360 (5th Cir. 1993). If the Commissioner's findings are supported by substantial evidence, they are conclusive and must be affirmed. Martinez v. Chater, 64 F.3d 172, 173 (5th Cir. 1995) (per curiam).
A finding of legal error may require either automatic reversal or harmless error analysis, depending on the circumstances. See, e.g., Keel v. Saul, 986 F.3d 551, 556 (5th Cir. 2021). Error is harmful when it affects a party's substantial rights. Mays v. Bowen, 837 F.2d 1362, 1364 (5th Cir. 1988). By contrast, harmless error “exists when it is inconceivable that a different administrative conclusion would have been reached even if the ALJ did not err.” Keel, 986 F.3d at 556. Courts apply the harmless error rule “to preserve judgments and avoid waste of time.” Mays, 837 F.2d at 1364 (“Procedural perfection in administrative proceedings is not required.”).
B. Evaluation Process
Under the Social Security Act, disability is defined as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment . . . 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). The ALJ evaluates disability claims according to a five-step sequential process: (1) whether the claimant is currently engaged in substantial gainful activity; (2) whether the claimant has a severe medically determinable impairment; (3) whether the claimant's impairment meets or equals the severity of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1; (4) whether the impairment prevents the claimant from performing past relevant work; and (5) whether the impairment prevents the claimant from doing any other work. 20 C.F.R. § 404.1520(a)(4).
Between steps three and four, the ALJ determines the claimant's “residual functional capacity” (“RFC”). Id. The RFC “is the most [a claimant] can still do” despite the limitations caused by her physical and mental impairments. Id. § 404.1545(a)(1). The ALJ then considers the RFC to make the step four and step five determinations. Id. § 404.1520(a)(4).
At the first four steps, the claimant bears the burden of proving that she is disabled. Selders v. Sullivan, 914 F.2d 614, 618 (5th Cir. 1990). If the claimant meets this burden, at step five the burden shifts to the Commissioner “to show that there is other substantial gainful employment available that the claimant is able to perform.” Id. If the Commissioner satisfies this burden, “the burden then shifts back to the claimant to prove that [s]he is unable to perform the alternate work.” Id. (quoting Fraga v. Bowen, 810 F.2d 1296, 1302 (5th Cir. 1987)).
C. The ALJ's Findings
In this case, at step one, the ALJ found that Morales “did not engage in substantial gainful activity during the period from her alleged onset date of May 15, 2015 through her date last insured of December 31, 2020.” (R:38.) At step two, the ALJ found that Morales “had the following severe impairments: asthma, dermatitis, obesity, major depressive disorder, and anxiety disorder.” (Id.) At step three, the ALJ found that Morales “did not have an impairment or combination of impairments that met or medically equaled the severity” of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. (R:43.)
For Morales's residual functional capacity, the ALJ determined that Morales could “perform light exertion work as defined in 20 [C.F.R.] 404.1567(b) except as follows: avoid even moderate exposure to dust, odors, fumes, and other pulmonary irritants; understand, remember, and carryout simple instructions; occasional interaction with the public; and, occasional[ly] adapt to changes.” (R:44.)
At step four, the ALJ found that Morales was unable to perform past relevant work. (R:51.) At step five, the ALJ found that despite her impairments, Morales could successfully adjust to “other work that existed in significant numbers in the national economy.” (R:52.) Based on the step five finding, the ALJ concluded that Morales was not disabled, as defined in the Social Security Act, from May 15, 2015, through December 31, 2020, the date last insured. (R:53.)
D. Analysis
Morales alleges that the ALJ erred by (1) failing to sufficiently evaluate the “supportability” and “consistency” of certain opinions offered by Nurse Practitioner Ricardo Gonzalez (“NP Gonzalez”) and the Disability Determination Services (“DDS”) doctors regarding Morales's social limitations; (2) failing to consider Morales's husband's third-party statement; (3) substituting the ALJ's lay opinion for medical opinions; and (4) failing to otherwise establish a “logic bridge” between the evidence and the ALJ's RFC conclusion. (ECF No. 16:9.)
The ALJ determines the RFC by examining “all of the relevant medical and other evidence.” 20 C.F.R. § 404.1545(a)(3). When using medical opinions as evidence, the ALJ must assess persuasiveness. Id. § 404.1520c(a). Persuasiveness is based on a number of factors, but most importantly, the ALJ must always articulate “supportability” and “consistency.” Id. § 404.1520c(b)(2). “Supportability” means that a medical source's opinion is “more persuasive” when it is supported by relevant objective medical evidence and explanations provided by the source. Id. § 404.1520c(c)(1). “Consistency” means that medical opinions are “more persuasive” when they coincide “with the evidence from other medical sources and nonmedical sources in the claim.” Id. § 404.1520c(c)(2). In other words, “supportability looks internally to the bases presented by the medical opinion itself” while “consistency is an external inquiry that juxtaposes a medical opinion to other evidence in the record, including opinions of other medical professionals.” Sharon H. v. Kijakazi, No. 5:21-CV-167-H, 2022 WL 3951488, at *3 (N.D. Tex. Aug. 31, 2022).
“Not all statements by medical providers are considered medical opinions.” William T. v. Comm'r of Soc. Sec., No. 6:18-CV-0055-BU, 2020 WL 6946517, at *3 (N.D. Tex. Nov. 25, 2020). “A medical opinion is a statement from a medical source about what [the claimant] can still do despite [the claimant's] impairment(s) and whether [the claimant has] one or more impairment-related limitations or restrictions” in the ability to perform physical, mental, or other demands of work, or to adapt to environmental conditions. 20 C.F.R. § 404.1513(a)(2). By contrast, “[o]bjective medical evidence is medical signs, laboratory findings, or both.” Id. § 404.1513(a)(1). And “other medical evidence” includes “judgments about the nature and severity of” the claimant's impairments, medical history, “clinical findings, diagnosis, treatment prescribed with response, or prognosis.” Id. § 404.1513(a)(3).
The ALJ's explanation of persuasiveness must “enable[] the court to undertake a meaningful review of whether his finding with regard to the particular medical opinion was supported by substantial evidence.” Cooley v. Comm'r of Soc. Sec., 587 F.Supp. 3D 489, 499 (S.D.Miss. 2021). On the other hand, the ALJ does not need to articulate a persuasiveness finding for statements from nonmedical sources. 20 C.F.R. § 404.1520c(d).
1. Supportability and Consistency of NP Gonzalez's Opinion
First, Morales contends that the ALJ violated 20 C.F.R. § 404.1520c by failing to sufficiently explain the supportability and consistency of NP Gonzalez's March 2021 opinion regarding Morales's social limitations. (ECF Nos. 16:11, 20:2-4.) As Morales notes, NP Gonzalez found that Morales had a “marked [limitation] in the ability to interact appropriately with supervisors” and “moderate [limitation] in interacting with co-workers.” (ECF No. 16:14) (alterations in original) (quoting R:51, which in turn cites R:1129). The ALJ found that NP Gonzalez's assessment was “not entirely consistent with other examination[s] or supported by [NP] Gonzalez's examinations, which are essentially unremarkable.” (Id. at 15) (quoting R:51). Morales argues that this “consistency” analysis is insufficient because the comparison record citations do not “relate to the Plaintiff's abilities to interact with others, nor do they specifically address the issue of whether the Plaintiff can adequately interact with co-workers and supervisors.” (Id.) Morales also argues that the “supportability” analysis is insufficient because the ALJ does not specify how NP Gonzalez's other examinations fail to support the March 2021 opinion. (Id. at 15-16.)
NP Gonzalez signed his opinion on March 18, 2021, but listed October 16, 2019 as the date when he first observed the limitations discussed in the opinion. (R:1129-30.)
As defined on NP Gonzalez's opinion form, “marked” means a “serious limitation in this area” with “a substantial loss in the ability to effectively function.” (R:1128.) “Moderate” means “more than a slight limitation in this area but the individual is still able to function satisfactorily.” (Id.)
In response, the Commissioner argues that the ALJ sufficiently articulated the supportability and consistency of NP Gonzalez's opinion. (ECF No. 18:6-9.) The Court agrees. The ALJ cites to examinations by other providers that a reasonable mind could find conflicting with NP Gonzalez's opinion. See (R:51) (citing R:724, which notes that Morales was “alert and cooperative” with “normal mood and affect”; R:861, which notes that Morales was “alert and had good eye contact and fluent speech,” with “appropriate” mood and “clear thought processes”; R:1077, noting “[c]ooperative, appropriate mood and affect”; R:1113, noting “cooperative, appropriate mood and affect”); Webster v. Kijakazi, 19 F.4th 715, 719-20 (5th Cir. 2021); Cooley, 587 F.Supp.3d at 496, 499. The ALJ also cites to mental status notes from other examinations by NP Gonzalez that a reasonable mind could find to be unsupportive of NP Gonzalez's March 2021 opinion. See (R:51) (citing R:851, 854, 982, 986, 997, 1001, 1003-04); Webster, 19 F.4th at 719-20; Cooley, 587 F.Supp.3d at 496, 499. The Court is able to follow this persuasiveness determination and finds that it is supported by substantial evidence. Therefore, the Court finds that the ALJ met the 20 C.F.R. § 404.1520c requirements on this point.
2. Supportability and Consistency of DDS Doctors' Opinion
Morales also contends that the ALJ violated 20 C.F.R. § 404.1520c by failing to sufficiently explain the supportability and consistency of the DDS doctors' initial opinion that Morales's “ability to accept instructions and respond appropriately to criticism from supervisors” was “moderately limited.” (ECF No. 16:24) (quoting R:118). The Court agrees. See (R:51) (indicating that the DDS doctors' initial opinion is “not entirely consistent” with objective evidence provided by the DDS doctors but failing to cite evidence from other medical sources); Sharon H., 2022 WL 3951488, at *3.
However, the Court finds that such error is harmless. Keel, 986 F.3d at 556. The DDS doctors' opinion itself says that the listed rating questions, including the question at issue, are informative but do not constitute the opinion itself. (R:116-17.) Rather, “the actual mental residual functional capacity assessment is recorded in the narrative discussion(s)” following the listed rating questions. (R:116.) The DDS doctors' narrative discussion states that Plaintiff can, inter alia, “carry out simple instructions” and “interact with others.” (R:118.) Both of those assessments are subsumed in the ALJ's RFC determination, which includes responding to simple instructions and “occasional interaction with the public.” (R:44.)
3. Consideration of Plaintiff's Husband's Third-Party Statement
Morales also contends that the ALJ erred by failing to “expressly consider the third-party function report” submitted by her husband. (ECF No. 16:26.) Morales argues that such error is not harmless because “Plaintiff's husband provided insight and observations into the Plaintiff's paranoia and ‘serious aggression,' which is particularly relevant in this case where the ALJ failed to properly account for Plaintiff's limitations in the ability to interact with co-workers and supervisors in the RFC.” (Id.) In response, the Commissioner argues that the ALJ did consider the report submitted by Morales's husband. (ECF No. 18:11) (citing R:43-44.) The Court notes that the ALJ cited to the report from Morales's husband marked as Exhibit 9E (R:352-60), while Morales's argument concerns another report from Morales's husband, marked as Exhibit 5E (R:320-27). See (ECF Nos. 16:26; 18:11.) The Court also notes that the ALJ only discussed Exhibit 9E at step three and does not reference it in his RFC discussion. See (R:43-51.)
As part of the RFC assessment, the ALJ considers “descriptions and observations of your limitations from your impairment(s) . . . provided by you, your family, neighbors, friends, or other persons.” 20 C.F.R. § 404.1545(a)(3). However, the ALJ need not articulate his consideration of nonmedical opinions to the same extent as for medical opinions. Id. § 404.1520c(d). Further, “RFC determinations are ‘inherently intertwined with matters of credibility,' and the ALJ's credibility determinations are generally entitled to great deference.” Acosta v. Astrue, 865 F.Supp.2d 767, 790 (W.D. Tex. 2012) (quoting Outlaw v. Astrue, 412 Fed.Appx. 894, 897 (7th Cir. 2011)).
Here, the ALJ stated that he considered all of the evidence and included Exhibits 5E and 9E in the List of Exhibits attached to his decision. (R:37-38, 44, 56.) He also prefaced his RFC discussion by stating that he “considered all symptoms and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence.” (R:44-45.) At step three, he cited Exhibit 9E's indication that Morales's “social interaction is limited to [her] husband and daughter” and that “she has mood swings and has problems getting along with others.” (R:43.) In the same paragraph, the ALJ stated that “[m]ental status exam[s] indicate [Morales] is cooperative with normal behavior” and “[s]he does not demonstrate any significant issues interacting with her providers.” (R:43-44.) That reasoning is consistent with the ALJ's RFC reasoning, even absent specific reference to Exhibits 5E or 9E in the RFC discussion. See (R:45, 50) (citing the same parts of the record regarding Morales's mental status exams). Ultimately, the Court finds that the ALJ adequately considered Morales's husband's input.
Even if the ALJ erred as Morales alleges, Morales has not shown such error to be prejudicial. Gutierrez v. Barnhart, No. 04-11025, 2005 WL 1994289, at *8 (5th Cir. Aug. 19, 2005) (“[T]his Court has generally held that to obtain reversal for an ALJ's failure to fully develop the record, a plaintiff must demonstrate prejudice.”); Ripley v. Chater, 67 F.3d 552, 557 (5th Cir. 1995); Mays, 837 F.2d at 1364. Morales challenges the ALJ's RFC determination, and the RFC informs the ALJ's assessments at steps four and five. At step five, the ALJ determined that Morales was not disabled based on the vocational expert's (“VE”) testimony that Plaintiff could work as a Marker (DOT [Dictionary of Occupational Titles] 209.587-034), Mailroom Clerk (DOT 209.687-026), or Office Helper (DOT 239.567-010), all of which are jobs available in significant numbers in the national economy. (R:52.) Other courts have affirmed ALJs' decisions that claimants could work as a Marker or a Mailroom Clerk with an RFC that limits contact with supervisors and coworkers. See, e.g., Coscarelli v. Saul, No. SA-19-CA-1219-XR, 2021 WL 8053621, at *1, 3 (W.D. Tex. Jan. 29, 2021) (noting VE's testimony that claimant could perform work as a marker with limitations to “superficial interaction with the public and coworkers”); Grimes v. Berryhill, No. 3:16-CV-3280-BH, 2018 WL 1210533, at *8-9 (N.D. Tex. Mar. 8, 2018) (noting VE's testimony that claimant, who “must avoid more than occasional contact with coworkers, supervisors, and the public,” could work as a retail marker and mail clerk); Hughes v. Berryhill, No. 7:18-cv-00087-BP, 2019 WL 585440, at *4-5 (N.D. Tex. Feb. 13, 2019), aff'd sub nom. Hughes v. Saul, 783 Fed.Appx. 475 (5th Cir. 2019) (discussing viability of a mail clerk position with “no more than incidental, superficial work-related type contact with the general public, coworkers, and supervisors”); see also Finley v. Colvin, No. 14-CV-430-SDD-RLB, 2015 WL 5162476, at *5 (M.D. La. Aug. 12, 2015), report and recommendation adopted, No. 14-CV-430-SDD-RLB, 2015 WL 5162396 (M.D. La. Sept. 1, 2015) (discussing the DOT categorization of job titles, including price marker, with respect to levels of interaction with people). Though it is not clear whether Plaintiff could work as an Officer Helper with stricter social limitations, the Marker and Mailroom Clerk positions would still be available in significant numbers to support a “not disabled” determination. (R:52, 106); see Lirley v. Barnhart, 124 Fed.Appx. 283, 284 (5th Cir. 2005) (per curiam).
In sum, the Court finds that substantial evidence supports the ALJ's RFC determination and subsequent findings. See (R:50) (citing the mental status reports discussed above, as well as other evidence that “claimant's symptoms are situational and intermittent” and that “[a]nxiety and depression have improved with medication”); Webster, 19 F.4th at 719-20. Further, the Court sees no harmful error in how the ALJ reached his decision, including his consideration of the input from Morales's husband.
4. Other Concerns Regarding the ALJ's RFC Determination
Morales makes additional arguments related to her foregoing claims. First, she claims that the ALJ improperly “reject[ed] every medical opinion pertaining to [Morales's] social interactions”-namely, the opinions of NP Gonzalez and the DDS doctors-and instead “substituted his own lay opinion” to establish the RFC. (ECF No. 16:21.) Second, Morales contends that the ALJ “failed to provide a discernible ‘logic bridge' between the evidence and the RFC” by failing to account for Morales's difficulties engaging with coworkers and supervisors and failing to otherwise explain why the RFC was appropriate. (Id. at 16-18); see (ECF No. 20:4-6.)
For the reasons discussed above, equally applicable to these additional arguments, the Court finds that the ALJ's decision was based on substantial evidence and Morales has not demonstrated that she suffered harmful error or prejudice.
III. CONCLUSION
For the foregoing reasons, the Court RECOMMENDS that the decision of the Commissioner be AFFIRMED pursuant to 42 U.S.C. § 405(g).
NOTICE
FAILURE TO FILE WRITTEN OBJECTIONS TO THE PROPOSED FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS CONTAINED IN THE FOREGOING REPORT, WITHIN FOURTEEN DAYS OF SERVICE OF SAME, MAY BAR DE NOVO DETERMINATION BY THE DISTRICT JUDGE OF AN ISSUE COVERED HEREIN AND SHALL BAR APPELLATE REVIEW, EXCEPT UPON GROUNDS OF PLAIN ERROR, OF ANY UNOBJECTED-TO PROPOSED FACTUAL FINDINGS AND LEGAL CONCLUSIONS AS MAY BE ACCEPTED OR ADOPTED BY THE DISTRICT COURT.