United States District Court, N.D. Alabama, Western Division
BRUCE L. STINSON, Claimant,
CAROLYN W. COLVIN, ACTING COMMISSIONER OF SOCIAL SECURITY, Respondent.
KARON OWEN BOWDRE, Chief District Judge.
On June 22, 2010, the claimant, Bruce Stinson, applied for disability insurance benefits and supplemental security income under Title II and Title XVI of the Social Security Act. (R. 26). The claimant initially alleged in both applications disability commencing on November 8, 2008 because of a knee injury, a back injury, and nerve damage in his right arm. (R. 26, 179). The claimant amended his alleged onset date to May 28, 2009, during the administrative hearing. (R. 53). The Commissioner denied the claims initially. (R. 26). The claimant filed a timely request for a hearing before an Administrative Law Judge, and the ALJ held a hearing on December 8, 2011. Id.
In a decision dated January 23, 2012, the ALJ found that the claimant was not disabled as defined by the Social Security Act and, thus, was ineligible for supplemental security income. (R. 35). On July 3, 2013, the Appeals Council denied the claimant's request for review; consequently, the ALJ's decision became the final decision of the Commissioner of the Social Security Administration. (R. 1). The claimant has exhausted his administrative remedies, and this court has jurisdiction pursuant to 42 U.S.C. §§ 405(g) and 1631(c)(3). For the reasons stated below, this court AFFIRMS the decision of the Commissioner.
II. ISSUES PRESENTED
The claimant presents the following issues for review:
(1) whether substantial evidences supports the ALJ's finding that the claimant has the residual functional capacity to perform a full-range of light work without the ALJ obtaining a medical source opinion to assess the claimant's limitations; and
(2) whether the ALJ properly included the required "function-by-function" assessment in determining the claimant's residual functional capacity.
III. STANDARD OF REVIEW
The standard for reviewing the Commissioner's decision is limited. This court must affirm the Commissioner's decision if the Commissioner applied the correct legal standards and if the factual conclusions are supported by substantial evidence. See 42 U.S.C. § 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997); Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
"No... presumption of validity attaches to the [Commissioner's] legal conclusions, including determination of the proper standards to be applied in evaluating claims." Walker, 826 F.2d at 999. This court does not review the Commissioner's factual determinations de novo. The court will affirm those factual determinations that are supported by substantial evidence. "Substantial evidence" is "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, 402 (1971).
The court must keep in mind that opinions such as whether a claimant is disabled, the nature and extent of a claimant's residual functional capacity, and the application of vocational factors "are not medical opinions, ... but are, instead, opinions on issues reserved to the Commissioner because they are administrative findings that are dispositive of a case; i.e., that would direct the determination or decision of disability." 20 C.F.R. §§ 404.1527(d), 416.927(d). Whether the claimant meets the listing and is qualified for Social Security disability benefits is a question reserved for the ALJ, and the court "may not decide facts anew, reweigh the evidence, or substitute [its] judgment for that of the Commissioner." Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005). Thus, even if the court were to disagree with the ALJ about the significance of certain facts, the court has no power to reverse that finding as long as substantial evidence in the record supports it.
The court must "scrutinize the record in its entirety to determine the reasonableness of the [Commissioner]'s factual findings." Walker, 826 F.2d at 999. A reviewing court must not look only to those parts of the record that support the decision of the ALJ, but also must view the record in its entirety and take account of evidence that detracts from the evidence relied on by the ALJ. Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir. 1986).
IV. LEGAL STANDARD
Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the person cannot "engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." To make this determination, the Commissioner employs a five-step, sequential evaluation process:
(1) Is the person presently unemployed?
(2) Is the person's impairment severe?
(3) Does the person's impairment meet or equal one of the specific impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1?
(4) Is the person unable to perform his or her former occupation?
(5) Is the person unable to perform any other work within the economy?
An affirmative answer to any of the above questions leads either to the next question, or, on steps three and five, to a finding of disability. A negative answer to any question, other than step three, leads to a determination of "not disabled."
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986); 20 C.F.R. §§ 404.1520, 416.920.
The instant controversy revolves around the ALJ's determination of the claimant's residual functional capacity. Residual functional capacity (RFC) is an assessment, based upon all of the relevant evidence, of a claimant's remaining ability to do work despite his impairments. Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997); see also 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). Residual functional capacity is assessed at both the fourth and fifth stages of the sequential evaluation process. See 20 C.F.R. § 404.1520(e), (f).
The ALJ has a basic duty to develop a full and fair record; that duty, however, does not require the ALJ to secure a medical source opinion regarding the claimant's RFC. See 20 C.F.R. § 404.1546(c). "The failure to include [an RFC assessment from a medical source] at the State agency level does not render the ALJ's RFC assessment invalid." Langley v. Astrue, 777 F.Supp.2d 1250, 1261 (N.D. Ala. 2011); see Green v. Soc. Sec. Admin., 223 F.Appx. 915, 923-24 (11th Cir. 2007). An ALJ's RFC determination is not a medical assessment, but is "based on all the relevant evidence in [the claimant's] case record." 20 C.F.R. § 404.1545(a)(1).
The ALJ's duty to fully develop the record "requires the ALJ to order a consultative evaluation when such an evaluation is necessary to make an informed decision." Smith v. Commissioner, 501 F.App'x, 875, 878 (11th Cir. 2012). The ALJ's duty to order a consultative examination can be triggered when an inconsistency in the evidence exists or the medical record as a whole does not support a determination on the disability claim. 20 C.F.R. §§ 416.903(a), 416.919. However, the ALJ does not err in denying a request for a consultative examination if substantial evidence supports the ALJ's decision. Holladay v. Bowen, 848 F.2d 1206, 1209-10 (11th Cir. 1988); see also Reeves v. Heckler, 734 F.2d 519, 522 n.1 (11th Cir. 1984).
A single decision maker (SDM) assessment is not a medical source, and conclusions of a SDM are not entitled to any weight. Siverio v. Comm'r of Soc. Sec., 461 F.Appx. 869, 871-72 (11th Cir. 2012) ("[T]he SSA's Program Operations Manual System ("POMS") explicitly distinguishes RFC assessments produced by an SDM from those produced by a medical consultant, and states that SDM-completed forms are not opinion evidence at the appeals level.'"); see accord Hall v. Astrue, 2012 WL 2499177, *2-3 (N.D. Ala. Jun. 22, 2012) (finding ALJ erred in "affording any weight, even minimal weight, " to the SDM's assessment). State agency adjudicator opinions are not included in 20 C.F.R. § 404.1513(a), listing acceptable medical sources. Accordingly, SDM opinions are not entitled to any weight.
In assessing the claimant's RFC, if the ALJ finds the claimant can do unlimited types of work at a given exertional level, the law does not require the ALJ to use a vocational expert to determine what kinds of work a claimant can do on the national level. Welch v. Bowen, 854 F.2d 436, 438-39 (11th Cir. 1988). Instead, the ALJ can rely solely on the grids to determine that work exists in significant numbers in the national economy that the claimant is capable of completing. Id. However, the ALJ may not rely on the grids if the claimant has nonexertional impairments that limit basic working skills. Francis v. Heckler, 749 F.2d 1562, 1566 (11th Cir. 1985); see also Broz v. Schweiker, 677 F.2d 1351, 1361 (11th Cir. 1982).
Social Security Ruling 96-8p provides that the RFC assessment
must first identify the individual's functional limitations or restrictions and assess his or her work-related abilities on a function-by-function basis, including the functions in paragraphs (b), (c), and (d) of 20 CFR 404.1545 and 416.945. Only after that may RFC be expressed in terms of the exertional levels of work, sedentary, light, medium, heavy, and very heavy.
1996 WL 374184 (July 2, 1996), at *1. The ALJ must first assess the claimant's functional limitations and restrictions and then expresses his functional limitations in terms of exertional levels. See Castel v. Comm'r of Soc. Sec., 355 F.Appx. 260, 263 (11th Cir. 2009); Freeman v. Barnhart, 220 F.Appx. 957, 959-60 (11th Cir. 2007); see also Bailey v. Astrue, 5:11-CV-3583-LSC, 2013 WL 531075 (N.D. Ala. Feb. 11, 2013).
The ALJ must consider all of the relevant evidence in assessing the claimant's functional limitations, including:
medical history, medical signs and laboratory findings, the effects of treatment, including limitations or restrictions imposed by the mechanics of treatment (e.g., frequency of treatment, duration, disruption to routine, side effects of medication), reports of daily activities, lay evidence, recorded observations, medical source statements, effects of symptoms, including pain, that are reasonably attributed to a medically determinable ...