Opinion
Civil No. 02-3476 ADM/AJB.
July 15, 2003.
Randall J. Fuller, Esq., Midwest Disability, P.A., Anoka, MN, on behalf of Plaintiff.
Lonnie F. Bryan, Assistant United States Attorney, Minneapolis, MN on behalf of Defendant.
MEMORANDUM OPINION AND ORDER
I. INTRODUCTION
Plaintiff Lillie M. Williams ("Williams") is pursuing review of an Administrative Law Judge's ("ALJ") denial of her application for benefits [Docket No. 1]. The matter is now before the undersigned United States District Judge pursuant to Plaintiff's Objection to Magistrate's Report ("Plaintiff's Objection") [Docket No. 11]. In the March 21, 2003 Report and Recommendation ("RR"), Magistrate Judge Arthur J. Boylan recommends that Plaintiff's Motion for Summary Judgment [Docket No. 6] be denied and Defendant's Motion for Summary Judgment [Docket No. 8] be granted. For the reasons to follow, the RR is adopted.
II. BACKGROUND
On September 4, 1996, Williams filed an application for disability insurance benefits ("DIB"). Tr. 92-103 [Docket No. 5]. Williams' request was denied on December 26, 1996. Tr. 87-89. On July 26, 2000, Williams filed a second application for DIB and Social Security Income ("SSI") under the Social Security Act ("SSA"), 42 U.S.C. § 416 (i), 423, which was also denied. Tr. 256-58, 234-36. Williams appealed, but the denial of her claim was deemed "proper under the law." Tr. 244, 246. Following that determination, Williams appealed to ALJ Michael D. Quayle. Tr. 252-55. He held that Williams "is not disabled and not entitled to a period of disability or [DIB] under sections 216(i) and 223, respectively, of the [SSA], and is not eligible for [SSI] under sections 1602 and 1614(a)(3)(A) of the [SSA]." Tr. 44. Williams' appeal to the Social Security Administration Appeals Council was similarly unsuccessful. Tr. 15-16. Thus, the ALJ's decision is the agency's final ruling. Williams appealed the agency's decision to United States District Court where her case was reviewed by Judge Boylan [Docket No. 1]. Further factual background for this matter is adequately set forth in the RR and is incorporated by reference for the purposes of Williams' Objection.
III. DISCUSSION
In reviewing a RR, the District Court "shall make a de novo determination of those portions of the report or specified proposed findings or recommendations to which objection is made." 28 U.S.C. § 636(b)(1)(C) (emphasis added); See also D. Minn. LR 72.1(c)(2). Consequently, a District Judge "may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge." 28 U.S.C. § 636(b)(1)(C); See also D. Minn. LR 72.1(c)(2).
When reviewing an ALJ's denial of benefits, the court is limited to a consideration of whether or not, based on the record as a whole, the decision was supported by substantial evidence. 42 U.S.C. § 405(g); Hutsell v. Sullivan, 892 F.2d 747, 748-49 (8th Cir. 1989). Substantial evidence is "less than a preponderance," but is enough that "a reasonable mind might accept [it] as adequate to support" the decision. Haley v. Massanari 258 F.3d 742, 747 (8th Cir. 2001) (citing Beckley v. Apfel 152 F.3d 1056, 1059 (8th Cir. 1998)); Richardson v. Perales, 402 U.S. 389, 401 (1971) (citing Consolidated Edison Co. v. N.L.R.B., 305 U.S. 197, 229 (1938)). The substantiality of the evidence is determined by an examination of the record, which includes evidence that "fairly detracts from [the ALJ's] decision." Haley, 258 F.3d at 747 (citing Beckley, 152 F.3d at 1059).
In determining the substantiality of the evidence within the record, it is critical that the court not substitute its own judgment or findings of fact. Indeed, as long as the Commissioner's decision is supported by substantial evidence within the record, the court cannot reverse it simply because a different outcome could have resulted initially. Haley, 258 F.3d at 747 (citing Shannon v. Chater, 54 F.3d 484, 486 (8th Cir. 1995)). More importantly, the court will not reverse the decision simply because it "would have decided the case differently." Holley v. Massanari, 253 F.3d 1088, 1091 (8th Cir. 2001) (citing Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir. 1993)).
Williams objects to Judge Boylan's RR on several grounds. First, Williams argues that the "Magistrate erred in finding that the ALJ properly discounted the opinions of the Plaintiff's treating physician." Pl.'s Objection at 2-5. Second, Williams contests the Magistrate's "finding that the ALJ properly relied upon the opinions of the Commissioner's experts." Id. at 2, 5-8. Finally, Williams claims that the Magistrate erred in finding substantial evidence for the ALJ's conclusion that Williams' residual functional capacity ("RFC") allowed her to "work at the medium exertional level." Id. at 2-3. Williams asks the District Court to reject the RR and grant her summary judgment.
IV. ANALYSIS
1. ALJ's Treatment of Dr. Anderson's Opinions Was Not Improper
Generally, more weight is given to the opinions of treating physicians, as they are most likely to have a "longitudinal picture" of the patient's impairments. 20 C.F.R. § 404.1527(d)(2) and 416.927(d)(2). The opinion of a treating physician is given more gravity as the number of visits to that person increases. 20 C.F.R. § 404.1527(d)(2)(i) and 416.927(d)(2)(i). The nature of the relationship also influences the weight accorded to the physician's opinions. 20 C.F.R. § 404.1527(d)(2)(ii) and 416.927(d)(2)(ii). But the quality of the physician's analysis must also be considered: if "a treating physician's opinion is . . . unsupported by medically acceptable clinical or diagnostic data," deference is not required. Kirby v. Sullivan, 923 F.2d 1323, 1328 (8th Cir. 1991). Plaintiff relies on Woolf v. Shalala, 3 F.3d 1210, (8th Cir. 1993), in support of the proposition that treating physicians' opinions should be "accorded controlling weight." Pl.'s Mem. at 10. A close reading of that case, however, qualifies that great weight is given to treating physicians' opinions only so long as those opinions are "supported by medically acceptable or diagnostic data." Woolf, 3 F.3d at 1214 (citing Matthews v. Bowen, 879 F.2d 422, 424 (8th Cir. 1989)). In the Woolf case itself, the treating physician's opinion was discounted by the ALJ even though the doctor had been treating the plaintiff for several years. Woolf, 3 F.3d at 1214.
Dr. A. V. Anderson, M.D.'s RFC questionnaire concluded that Williams was disabled and that she was "not employable." Tr. 454. Dr. Anderson based his conclusion in part on his findings that Williams suffered from spasm of the paraspinal, upper trapezius, rhomboid, and other muscles in and around the neck and lower back. Tr. 402, 404, 407, 409, 411, 416, 449. While such objective evidence might constitute substantial support forWilliams' position, review of the ALJ's findings requires an inquiry into whether or not substantial evidence exists for theALJ's position. It is important, however, that such objective evidence supporting Williams' position is considered.
Substantial evidence in the record supports the ALJ's decision to discredit Dr. Anderson's opinions. The ALJ provided four reasons for disregarding Dr. Anderson's opinion with respect to Williams' RFC and employability. First, he referred to a March 2000 report where Dr. Anderson found "that the claimant's muscle testing is 5/5 in the upper and lower extremities and there were no pathological neurological signs . . . based on a physical examination." Tr. 42. Second, the ALJ noted that Dr. Anderson found "no balance problems." Id. Third, the ALJ was uncomfortable with Dr. Anderson's heavy and uncritical reliance on the subjective symptoms "provided by the claimant." Id. Finally, the primary reason for rejecting Dr. Anderson's opinions was the "minimal objective evidence" in existence "to substantiate the claimant's subjective complaints." Tr. 42. Williams takes exception to the last two reasons — that Dr. Anderson uncritically accepted Williams' subjective complaints and that minimal objective evidence supports her contentions. Pl.'s Objection at 3-5.
The ALJ's criticisms are validated by the record. Though a May 1994 MRI revealed a "small focal hemiation of the L4-5 disk . . . that impinges upon and slightly displaces the right L5 nerve root," there was "no evidence of lateral or recess stenosis." Tr. 149. An MRI a year later revealed no degeneration. Tr. 147. A July 14, 2000 MRI revealed that the hemiation was no longer an issue. Tr. 422. Additionally, there was no "nerve root compression or stenosis." Tr. 422. After that MRI, Dr. Anderson recommended that Williams focus on building strength, endurance, and flexibility through Active Rehab. Tr. 369, 412. Indeed, Dr. Anderson noted in his March 7, 2000 History and Physical of Williams that "[e]xercise will be one of the most important aspects of Lillie's long term recovery." Tr. 417. Williams' ability to participate in these exercises casts doubt on the extent of any disability. Another MRI taken in September 2000 revealed "four true lumbar vertebrae and a transitional L5." Tr. 421. The scan also revealed "very mild disc space narrowing at L4-5." Tr. 421. The remaining disc spaces were, however, normal. Tr. 421. In September 2000, after reviewing the medical records, agency expert Dr. Marlon P. Rimando, M.D., found that Williams' "pain . . . is disproportionate to [the] objective findings . . . RFC: medium work." Tr. 428. Agency psychiatric expert Dr. Thomas Kuhlman, Ph.D., reported that "[p]ain and other physical symptoms have been deemed grossly disproportionate to [the] objective findings." Tr. 447.
The conservative treatment recommended by treating physician Dr. Seth Taylor, D.O., in 1995, and Dr. Anderson's continual recommendation to Williams that she exercise, stands in stark contraposition to the conclusion that Williams is disabled and unemployable as those terms are used in this legal context.See Tr. 153-55, 449-54. An additional factor to be considered is that Williams walks up and down three flights of stairs at least twice per day. Tr. 70. Dr. Anderson's opinions, while supported by some objective findings in the record, are contradicted by some of his own (and other doctors') findings. Thus, the record as a whole provides a reasonable basis for not adopting Dr. Anderson's opinions. Since substantial evidence in the record supports the ALJ's decision to reject Dr. Anderson's opinions, the District Court must adopt the RR on this issue.See Kirby, 923 F.2d at 1328; Haley, 258 F.3d at 747; Tr. 449, 454.
2. ALJ's Reliance on Commissioner's Experts
The ALJ gave the opinions of the state agency medical and psychological consultants "significant weight, because these consultants have substantial program knowledge and their opinion[s] [are] consistent with the objective medical evidence." Tr. 42. As grounds for contesting the reliance on the agency experts, Williams makes four arguments. First, she asserts that since only two agency experts actually examined her, there could not be substantial evidence supporting the ALJ's findings. Pl.'s Objection at 5. Williams' second argument is that the ALJ should be reversed because he did not correlate any particular opinions with "specific objective medical evidence." Pl.'s Mem. at 15. Effectively, Williams claims that the ALJ merely stated that the agency experts' opinions were supported by the record, but that he did not bolster the statement with evidence. Id. Third, Williams argues that the ALJ erred in not explicating which opinions he used. Pl.'s Objection at 7. As a final and corollary argument to the third, Williams argues that the ALJ erred in "treating the agency physical RFC opinions as one." Id.
A. Actual Physical Examination is Just One Factor Among Many to be Considered.
Specifically, Williams points out that one of those exams was a mental exam. Additionally, while the second exam was a physical exam, it was performed in 1996 — "five years before the hearing." Pl.'s Objection at 5.
Williams argues that the ALJ erred in giving the conclusions of the agency examiners great weight because "Dr. Anderson is the only medical expert . . . who had a grasp of all of the medical evidence," and "[k]nowledge of the Social Security system does not render an expert's opinions more credible than those of another expert who is not trained in how the system works." Pl.'s Objection at 7.
When medical opinions in the record are inconsistent, the ALJ is required to evaluate each medical opinion and determine how much weight should be given to that opinion. 20 C.F.R. § 404.1527(d) and 416.927(d). In determining how much weight is to be accorded to any particular opinion, the ALJ should consider whether the medical expert had an examining or treatment relationship, the length of the relationship and the frequency of visits, the nature and extent of the relationship, the supportability of the opinion, whether the opinion is consistent with the record as a whole, and any other factors that the ALJ is aware of including a physician's program knowledge. 20 C.F.R. § 404.1527(d)(1)-(d)(6) and 416.927(d)(1)-(d)(6).
All medical opinions are to be considered by the ALJ. 20 C.F.R. § 404.1527(d) and 416.927(d). Moreover, "[t]he more a medical source presents relevant evidence to support an opinion, particularly medical signs and laboratory findings, the more weight [given to] that opinion." 20 C.F.R. § 404.1527(d)(3) and 416.927(d)(3). Importantly, a medical source's understanding of the "disability programs and their evidentiary requirements" can be a "relevant factor" in assigning weight to that opinion. 20 C.F.R. § 404.1527(d)(6) and 416.927(d)(6). Because the ALJ did not err in discounting Dr. Anderson's opinions, he did not err in relying on the Commissioner's experts. Cf. 20 C.F.R. § 404.1527(d) and 416.927(d). Additionally, as will be seen insupra section 2(B), the ALJ based his decision on the testimony of agency experts to the extent that their opinions were supported by the objective medical evidence.
B. The ALJ's Opinion Was Supported by Objective Medical Evidence.
Williams asserts that the ALJ's failure to correlate particular opinions with specific objective medical findings renders his opinion subject to reversal. See Pl.'s Mem. at 15; Pl.'s Objection at 7. Williams' complaint is not supported by the facts of record. The ALJ did substantiate his findings by referencing numerous medical reports and opinions. For example, a September 1999 examination by Dr. Richard Kyle, M.D., revealed an "essentially normal" right knee and "lateral subluxation of the left patella." Tr. at 37 (citing Dr. Kyle's report, which found "some subluxation of the right patella laterally," but no other "definite significant" abnormalities. Tr at 373-74). In February 2000, an x-ray revealed no injuries to the lumbar or cervical spine. Tr. at 37 (citing Dr. John Bartlett, M.D.'s report stating "x-rays done at the time showed normal C-spine and L-spine." Tr. at 351-52). A July 14, 2000 MRI showed a transitional L5-S1, but "no herniation, nerve root compression or stenosis." Tr. at 37 (citing Dr. William J. Mullin, M.D.'s report. Tr. at 422). A September 2000 MRI of the knees showed "small join[t] effusion in both knees with no evidence of ligamentous derangement or meniscus tear." Tr. at 37 (citing Dr. Cooper R. Gundry, M.D.'s report which did note some chondromalacia of the patella and mild lateral subluxation. Tr. at 161). The ALJ recognized all of these complications, but decided that they were not debilitating. Moreover, there is substantial objective evidence in the record, which supports the ALJ's decision to deny Williams' DIB and SSI requests.
C. The ALJ Based His Decision on the Record as a Whole.
Williams' next complaint is that the ALJ did not reveal which medical opinions he used to formulate his opinion to deny benefits. It is true that the ALJ did not list which opinions he gave "significant weight" to. Tr. 42. But discussion and analysis preceding the ALJ's statement makes it clear that the ALJ relied on the objective medical findings presented by Drs. Kyle, Bartlett, Mullin, Gundry, and Marshall J. Golden, M.D., in addition to the opinions of Drs. Kuhlman, Rimando, and Roger Sandvick, Ph.D. See Tr. 37-43; Tr. 373-74, 375-79, 418-30, 445-47, 455-58; Cf. RR at 31 (stating "[s]everal agency practitioners . . . disagreed with Dr. Anderson . . . their opinions were not unsupported, and the ALJ did not err in relying on them"). Additionally, Williams' argument that the ALJ should be reversed because he treated all of the agency opinions as one is not borne out by the facts. The ALJ did not treat all opinions equally. In fact, the ALJ's discussion clearly set forth which opinions and medical evidence he used. See Tr. 37-42. Additionally, it is within the province of the ALJ to evaluate the credibility of each witness and to assign weight to each opinion accordingly. See 20 C.F.R. § 404.1527(d) and 416.927(d). A court should normally defer to an ALJ's rejection of a claimant's testimony of disabling pain if that rejection is supported by good reasons. Browning v. Sullivan, 958 F.2d 817, 821 (8th Cir. 1992) (citing Dixon v. Sullivan, 905 F.2d 237, 238 (8th Cir. 1990)). Since substantial evidence exists in the record, which supports the ALJ's ultimate determination, the RR must be adopted in regards to that issue.
Specifically, the ALJ noted, "[t]he undersigned gives [the medical opinions expressed in the file by the State Agency Medical and Psychological Consultants] significant weight." Tr. at 42.
3. Williams' RFC
If a person suffers from a "medically determinable physical or mental impairment which . . . has lasted or can be expected to last for a continuous period of not less than twelve months," she may be entitled to Social Security benefits. 42 U.S.C. § 1382c(a)(3)(A); 42 U.S.C. § 1382(a)(1) and 1382(a)(2). The impairment must meet or exceed the disabilities listed in the Appendix to the regulations. 20 C.F.R. § 404.1520(d) and 416.920(d). If an impairment is not as severe as those listed, the second step in evaluating a claimant's request requires a consideration of whether the claimant's impairment(s) significantly limit(s) her ability to perform basic work activities. 20 C.F.R. § 404.1520(c) and 416.920(c). In short, the disabling impairment must prevent the person from doing any kind of "substantial gainful activity." 42 U.S.C. § 1382c(a)(3)(A). In determining whether a person is unable to perform substantial gainful work, the RFC of the claimant — that, which the person can do despite her limitations — is determined. 20 C.F.R. § 404.1545(a) and 416.945(a).
A. Williams' Complications Do Not Meet the Severity of Those in the Appendix.
The ALJ found that Williams suffered from "obesity, myofascial syndrome of the cervical and lumbar spine and patellofemoral syndrome bilaterally." Tr. 38. The ALJ then concluded that those complications did not rise to the level of any of the impairments found in the Appendix to the Social Security Regulations. See Tr. 39. The Appendix provides that a person may be disabled if they lose the ability to ambulate effectively. 20 C.F.R.Pt. 404, Subpt. P, App. 1, 1.00(B)(2)(a). A person's inability to effectively ambulate is characterized by "an impairment(s) that interferes very seriously with the individual's ability to independently initiate, sustain, or complete activities." 20 C.F.R.Pt. 404, Subpt. P, App. 1, 1.00, (B)(2)(b)(1). Ineffective ambulation is characterized by "having insufficient lower extremity functioning to permit independent ambulation without the use of a hand-held assistive device(s) that limits the functioning of both upper extremities." Id. Nerve root impingement and spinal stenosis are examples of back injuries that might be "disabling." 20 C.F.R.Pt. 404, Subpt. P, App. 1, 1.00, (K). It is clear from the record that Williams' injuries do not rise to this level. Substantial evidence exists, which supports the conclusion that Williams does have sufficient lower extremity functioning for self-ambulation. Additionally, while some nerve root impingement was discovered in 1994, more recent MRI's ordered by Dr. Anderson revealed "no herniation, nerve root compression, or stenosis." Tr. 149, 422.
B. Williams' Complications Do Not Significantly Limit Her Ability To Perform Basic Work Activities.
The ALJ found that Williams could sustain activity at a medium exertional level. Tr. 39. Specifically, Williams was found to retain the RFC for "unskilled, 3-4 step instructions, routine repetitive tasks, with brief, infrequent and superficial contacts with coworkers, supervisors, and the public and no special supervision performed at the medium exertional level with occasional stooping, kneeling, crouching, or crawling, and no exposure to hazards such as machinery and heights." Tr. 39. The vocational expert testified that while Williams could not return to work as a nursing assistant, she could perform any one of about 35,000 cleaning jobs in Minnesota. Tr. 74-75. Judge Boylan found that the ALJ's conclusion regarding Williams' RFC was supported by the "record as a whole." RR at 31-32. To support her argument that the ALJ's conclusion was not supported by substantial evidence, Williams refers to a hearing where the ALJ noted the unreasonableness of placing her into the medium exertional level. Pl.'s Objection at 3; Tr. 67. But since the substantial evidence standard requires "less than a preponderance," it is possible that there will be substantial evidence in the record favoring both parties. See Haley, 258 F.3d at 747. The record as a whole contains substantial evidence supporting the ALJ's ultimate finding that substantial evidence suggested that Williams could perform at a medium exertional level. The Magistrate Judge appropriately recommends the approval of the ALJ's findings.
Regarding Williams' mental capacity, Dr. Alford S. Karayusuf, M.D., an examining physician, gave Williams a guarded prognosis. Tr. 210. But, he also concluded that she was "able to understand, retain, and follow simple instructions." Tr. 210. Furthermore, he noted that so long as Williams "maintains attendance and sobriety on the job," she will be "able to maintain pace and persistence." Tr. 210. In September 2000, Dr. Sandvick reported that Williams had a poor ability to relate to others. Tr. 377. Moreover, her demeanor manifested a good deal of "resentment and anger." Tr. 377. Dr. Sandvick believed that her attitude suggested "some fabrication of information relating to her physical pain." Tr. 378. Despite Williams' problems in relating to others, in December 2001, Dr. Sandvick opined that she should still be able to "work in entry level employment carrying out tasks that are simple, easy, straight forward and undemanding." Tr. 457. Dr. Sandvick believed that Williams had a "good" ability to maintain her personal appearance and be reliable. Tr. 458. Dr. Sandvick also thought she would have a "fair" ability to be emotionally stable and "relate predictably in social situations." Tr. 458. Dr. Kuhlman assigned Williams the following mental RFC, which was relied on by the ALJ: "the ability to learn and remember 3-4 step instructions and sustain mental effort to SGA levels of productivity [and] routine and repetitive tasks that do not tax the physical RFC." Tr. 447. Thus, substantial evidence in the record supports the ALJ's decision.
Substantial evidence also exists for the ALJ's findings in regard to Williams' physical capabilities. In 1996, Dr. Eunice A. Davis, M.D., opined that Williams could lift only twenty pounds or less, but she also noted that Williams had an "unlimited" ability to push or pull. Tr. 213. Additionally, Dr. Davis noted that Williams could sit or stand for "6 hours in an 8-hour workday." Tr. 213. Williams underwent arthroscopic surgery in 1997 on her left knee, which had been afflicted with patellofemoral syndrome. Tr. 347. In 1999, an examination of her knees revealed that her left knee had some lateral subluxation and her right knee had "no significant degenerative changes," but did have "some subluxation." Tr. 374. Additionally, she was capable of "full extension and flexion of both knees. Tr. 361. And again, Williams has "no herniation, nerve root compression or stenosis." Tr. 422. It is also important to note that medications have increased Williams' quality of life and have allowed her to resume her daily living activities. Tr. 395. Substantial evidence in the record supports the ALJ's conclusion. Williams is capable of medium exertional activities and could work at a number of jobs that exist in significant numbers in the national economy. Williams' Motion for Summary Judgment is denied, and Defendant's Motion for Summary Judgment is granted.
V. CONCLUSION
Based upon the RR of Judge Boylan, all of the files, records and proceedings herein, and for the foregoing reasons, IT IS HEREBY ORDERED that:
1. The RR [Docket No. 11] is ADOPTED,
2. Plaintiff's Motion for Summary Judgment [Docket No. 6] is DENIED, and
3. Defendant's Motion for Summary Judgment [Docket No. 8] is GRANTED.
LET JUDGMENT BE ENTERED ACCORDINGLY.