United States District Court, S.D. Alabama, Southern Division
July 24, 2015
LATESHA L. ROBINSON, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.
MEMORANDUM OPINION AND ORDER
KATHERINE P. NELSON, Magistrate Judge.
Social Security Claimant/Plaintiff Latesha Robinson ("Robinson") has brought this action under 42 U.S.C. §§ 405(g) and 1383(c)(3) seeking judicial review of a final decision of the Defendant Commissioner of Social Security ("the Commissioner") denying her protective applications for disability insurance benefits ("DIB") under Title II of the Social Security Act, 42 U.S.C. § 401, et seq., and supplemental security income ("SSI") under Title XVI of the Social Security Act, 42 U.S.C. § 1381, et seq. By the consent of the parties ( see Doc. 16), the Court has designated the undersigned Magistrate Judge to conduct all proceedings and order the entry of judgment in this civil action, in accordance with 28 U.S.C. § 636(c) and Federal Rule of Civil Procedure 73. ( See Doc. 18).
Upon consideration of the parties' briefs (Docs. 12, 13) and the administrative record (Doc. 11) (hereinafter cited as "(R. [page number(s)])"),  the Court finds that the Commissioner's decision is due to be AFFIRMED.
I. Procedural Background
On March 11, 2011, Robinson protectively filed applications for DIB and SSI with the Social Security Administration ("SSA"),  alleging disability beginning April 28, 2010. After her applications were initially denied, Robinson requested a hearing on her applications, which was held in Mobile, Alabama, before an Administrative Law Judge ("ALJ") on January 15, 2013. (R. 22).
On March 14, 2013, the ALJ issued an unfavorable decision on Robinson's applications, finding her "not disabled" under the Social Security Act. ( See R. 19-29). Robinson requested review of the ALJ's decision by the Appeals Council for the SSA's Office of Disability Adjudication and Review (R. 17), which denied Robinson's request on July 2, 2014. (R. 8-12).
On August 11, 2014, Robinson filed this action under §§ 405(g) and 1383(c)(3) for judicial review of the Commissioner's final decision. (Doc. 1). See Ingram v. Comm'r of Soc. Sec. Admin., 496 F.3d 1253, 1262 (11th Cir. 2007) ("The settled law of this Circuit is that a court may review, under sentence four of section 405(g), a denial of review by the Appeals Council."); 42 U.S.C. § 1383(c)(3) ("The final determination of the Commissioner of Social Security after a hearing [for SSI benefits] shall be subject to judicial review as provided in section 405(g) of this title to the same extent as the Commissioner's final determinations under section 405 of this title."); 42 U.S.C. § 405(g) ("Any individual, after any final decision of the Commissioner of Social Security made after a hearing to which he was a party, irrespective of the amount in controversy, may obtain a review of such decision by a civil action commenced within sixty days after the mailing to him of notice of such decision or within such further time as the Commissioner of Social Security may allow.").
II. Standard of Review
"In Social Security appeals, [the Court] must determine whether the Commissioner's decision is "supported by substantial evidence and based on proper legal standards. Substantial evidence is more than a scintilla and is such relevant evidence as a reasonable person would accept as adequate to support a conclusion."'" Winschel v. Comm'r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011) (quoting Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004) (per curiam) (internal citation omitted) (quoting Lewis v. Callahan, 125 F.3d 1436, 1439 (11th Cir. 1997))). However, the Court "may not decide the facts anew, reweigh the evidence, or substitute our judgment for that of the [Commissioner].'" Winschel, 631 F.3d at 1178 (quoting Phillips v. Barnhart, 357 F.3d 1232, 1240 n.8 (11th Cir. 2004) (alteration in original) (quoting Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983))). "Even if the evidence preponderates against the [Commissioner]'s factual findings, we must affirm if the decision reached is supported by substantial evidence.'" Ingram, 496 F.3d at 1260 (quoting Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990)).
"Yet, within this narrowly circumscribed role, [courts] do not act as automatons. [The court] must scrutinize the record as a whole to determine if the decision reached is reasonable and supported by substantial evidence[.]" Bloodsworth, 703 F.2d at 1239 (citations and quotation omitted). "In determining whether substantial evidence exists, [a court] must... tak[e] into account evidence favorable as well as unfavorable to the [Commissioner's] decision." Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). Moreover, "[t]here is no presumption... that the Commissioner followed the appropriate legal standards in deciding a claim for benefits or that the legal conclusions reached were valid. Instead, [the court] conduct[s] an exacting examination' of these factors." Miles v. Chater, 84 F.3d 1397, 1400 (11th Cir. 1996) (per curiam) (citing Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990)) (internal citation omitted). In sum, courts "review the Commissioner's factual findings with deference and the Commissioner's legal conclusions with close scrutiny." Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). See also Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005) (per curiam) ("In Social Security appeals, we review de novo the legal principles upon which the Commissioner's decision is based. Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). However, we review the resulting decision only to determine whether it is supported by substantial evidence. Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158-59 (11th Cir. 2004)."). "The [Commissioner]'s failure to apply the correct law or to provide the reviewing court with sufficient reasoning for determining that the proper legal analysis has been conducted mandates reversal.'" Ingram, 496 F.3d at 1260 (quoting Cornelius v. Sullivan, 936 F.2d 1143, 1145-46 (11th Cir. 1991)).
Eligibility for... SSI requires that the claimant be disabled. 42 U.S.C. §... 1382(a)(1)-(2). A claimant is disabled if she is unable "to engage in any substantial gainful activity by reason of a 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. §... 1382c(a)(3)(A).
Thornton v. Comm'r, Soc. Sec. Admin., 597 F.Appx. 604, 609 (11th Cir. Feb. 11, 2015) (per curiam) (unpublished).
The Social Security Regulations outline a five-step, sequential evaluation process used to determine whether a claimant is disabled: (1) whether the claimant is currently engaged in substantial gainful activity; (2) whether the claimant has a severe impairment or combination of impairments; (3) whether the impairment meets or equals the severity of the specified impairments in the Listing of Impairments; (4) based on a residual functional capacity ("RFC") assessment, whether the claimant can perform any of his or her past relevant work despite the impairment; and (5) whether there are significant numbers of jobs in the national economy that the claimant can perform given the claimant's RFC, age, education, and work experience.
Winschel, 631 F.3d at 1178 (citing 20 C.F.R. §§ 404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v); Phillips, 357 F.3d at 1237-39).
"These regulations place a very heavy burden on the claimant to demonstrate both a qualifying disability and an inability to perform past relevant work." Moore, 405 F.3d at 1211 (citing Spencer v. Heckler, 765 F.2d 1090, 1093 (11th Cir. 1985)). "In determining whether the claimant has satisfied this initial burden, the examiner must consider four factors: (1) objective medical facts or clinical findings; (2) the diagnoses of examining physicians; (3) evidence of pain; and (4) the claimant's age, education, and work history." Jones v. Bowen, 810 F.2d 1001, 1005 (11th Cir. 1986) (per curiam) (citing Tieniber v. Heckler, 720 F.2d 1251, 1253 (11th Cir. 1983) (per curiam)). "These factors must be considered both singly and in combination. Presence or absence of a single factor is not, in itself, conclusive." Bloodsworth, 703 F.2d at 1240 (citations omitted).
If, in Steps One through Four of the five-step evaluation, a plaintiff proves that he or she has a qualifying disability and cannot do his or her past relevant work, it then becomes the Commissioner's burden, at Step Five, to prove that the plaintiff is capable-given his or her age, education, and work history-of engaging in another kind of substantial gainful employment that exists in the national economy. Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999); Sryock v. Heckler, 764 F.2d 834, 836 (11th Cir. 1985). Finally, but importantly, although "the [plaintiff] bears the burden of demonstrating the inability to return to [his or] her past relevant work, the Commissioner of Social Security has an obligation to develop a full and fair record." Shnorr v. Bowen, 816 F.2d 578, 581 (11th Cir. 1987) (citations omitted).
"When no new evidence is presented to the Appeals Council and it denies review, then the administrative law judge's decision is necessarily reviewed as the final decision of the Commissioner, but when a claimant properly presents new evidence to the Appeals Council, a reviewing court must consider whether that new evidence renders the denial of benefits erroneous." Ingram, 496 F.3d at 1262.
III. Claim on Judicial Review
The ALJ "reversibly erred in failing to articulate specific reasons for rejecting the opinion of Plaintiff treating physician." (Doc. 12 at 1).
At Step One, the ALJ determined that Robinson had "not engaged in substantial gainful activity since April 28, 2010, the alleged onset date." (R. 24). At Step Two, the ALJ determined that Robinson had the following severe impairment: calcaneal fracture with ORIF ("open reduction, internal fixation") of the right foot, stemming from an automobile accident on April 28, 2010. (R. 24-25). At Step Three, the ALJ found that Robinson did not have an impairment or combination of impairments that meets or equals the severity of the specified impairments in the Listing of Impairments. (R. 25). Robinson does not challenge any of the ALJ's determinations at Steps One through Three, or at Step Five. Her claim of error concerns the ALJ's analysis in Step Four.
At Step Four,
the ALJ must assess: (1) the claimant's residual functional capacity ("RFC"); and (2) the claimant's ability to return to her past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). As for the claimant's RFC, the regulations define RFC as that which an individual is still able to do despite the limitations caused by his or her impairments. 20 C.F.R. § 404.1545(a). Moreover, the ALJ will "assess and make a finding about [the claimant's] residual functional capacity based on all the relevant medical and other evidence" in the case. 20 C.F.R. § 404.1520(e). Furthermore, the RFC determination is used both to determine whether the claimant: (1) can return to her past relevant work under the fourth step; and (2) can adjust to other work under the fifth step... 20 C.F.R. § 404.1520(e).
If the claimant can return to her past relevant work, the ALJ will conclude that the claimant is not disabled. 20 C.F.R. § 404.1520(a)(4)(iv) & (f). If the claimant cannot return to her past relevant work, the ALJ moves on to step five.
In determining whether [a claimant] can return to her past relevant work, the ALJ must determine the claimant's RFC using all relevant medical and other evidence in the case. 20 C.F.R. § 404.1520(e). That is, the ALJ must determine if the claimant is limited to a particular work level. See 20 C.F.R. § 404.1567. Once the ALJ assesses the claimant's RFC and determines that the claimant cannot return to her prior relevant work, the ALJ moves on to the fifth, and final, step.
Phillips, 357 F.3d at 1238-39 (footnote omitted).
The ALJ determined that Robinson had the RFC "to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b)." (R. 25-28).
Robinson's sole claim on judicial review is that, in determining her RFC, the ALJ erred by failing to articulate specific reasons for rejecting the medical opinions of Robinson's treating physician, Dr. Mark Perry, M.D. "Medical opinions are statements from physicians and psychologists or other acceptable medical sources that reflect judgments about the nature and severity of [the claimant's] impairment(s), including [the claimant's] symptoms, diagnosis and prognosis, what [the claimant] can still do despite impairment(s), and [the claimant's] physical or mental restrictions.'" Winschel, 631 F.3d at 1178-79 (quoting 20 C.F.R. §§ 404.1527(a)(2), 416.927(a)(2)). "In assessing medical opinions, the ALJ must consider a number of factors in determining how much weight to give to each medical opinion, including (1) whether the physician has examined the claimant; (2) the length, nature, and extent of a treating physician's relationship with the claimant; (3) the medical evidence and explanation supporting the physician's opinion; (4) how consistent the physician's opinion is with the record as a whole; and (5) the physician's specialization. These factors apply to both examining and non-examining physicians." Eyre v. Comm'r, Soc. Sec. Admin., 586 F.Appx. 521, 523 (11th Cir. Sept. 30, 2014) (per curiam) (unpublished) (internal citations and quotation marks omitted) (citing 20 C.F.R. §§ 404.1527(c) & (e), 416.927(c) & (e)). "[T]he ALJ must state with particularity the weight given to different medical opinions and the reasons therefor." Winschel, 631 F.3d at 1179 (citing Sharfarz v. Bowen, 825 F.2d 278, 279 (11th Cir. 1987) (per curiam)). However, the ALJ "may reject the opinion of any physician when the evidence supports a contrary conclusion." Bloodsworth, 703 F.2d at 1240. Accord, e.g., Anderson v. Comm'r of Soc. Sec., 427 F.Appx. 761, 763 (11th Cir. 2011) (per curiam) (unpublished).
"A treating source' (i.e., a treating physician) is a claimant's own physician, psychologist, or other acceptable medical source who provides, or has provided, [the claimant] with medical treatment or evaluation and who has, or has had, an ongoing treatment relationship with [the claimant].'" Nyberg v. Comm'r of Soc. Sec., 179 F.Appx. 589, 591 (11th Cir. May 2, 2006) (per curiam) (unpublished) (quoting 20 C.F.R. § 404.1502). "Absent good cause, ' an ALJ is to give the medical opinions of treating physicians substantial or considerable weight.'" Winschel, 631 F.3d at 1179 (quoting Lewis, 125 F.3d at 1440). "Good cause exists when the: (1) treating physician's opinion was not bolstered by the evidence; (2) evidence supported a contrary finding; or (3) treating physician's opinion was conclusory or inconsistent with the doctor's own medical records.' With good cause, an ALJ may disregard a treating physician's opinion, but he must clearly articulate [the] reasons' for doing so." Id. (quoting Phillips, 357 F.3d at 1240-41) (internal citation omitted). See also, e.g., Bloodsworth, 703 F.2d at 1240 ("[T]he opinion of a treating physician may be rejected when it is so brief and conclusory that it lacks persuasive weight or where it is unsubstantiated by any clinical or laboratory findings. Further, the Secretary may reject the opinion of any physician when the evidence supports a contrary conclusion." (citation omitted)).
The ALJ summarized Dr. Perry's medical findings and opinions as follows:
In a report dated June 9, 2011, Mark Perry, M.D., a treating physician, noted it had been approximately one year since the claimant's operative treatment. He also referenced that the claimant had been denied for disability twice. Dr. Perry referenced the claimant's report that she still had significant pain when walking or ambulating. The physical examination findings revealed tenderness to palpation of the peroneal tendons, and pain with motion of the subtalar joint. However, x-rays showed good consolidation of the fracture but with decreased posterior heel height. Dr. Perry opined that the claimant was a good candidate for some form of disability (Exhibit 8F). The following year, on May 15, 2012, the claimant presented for follow-up of what Dr. Perry referenced as a "yearly surveillance." Examination findings revealed the right ankle was approximately three-fourths normal. X-rays showed nice consolidation of the fracture, although it was noted the claimant had lost some calcaneal height as well as subsequent dorsiflexion of her talus. Dr. Perry recommended a shoe heel lift to compensate for lost height. He opined that, given the claimant's injury, she would be a good candidate for disability (Exhibit 12F).
On June 12, 2012, Dr. Perry completed a Physical Capacities Evaluation, in which he estimated the claimant was able to sit for a total of 8 hours in an 8-hour workday, and could stand/walk for a total of one hour each in an 8-hour workday. He added the claimant was able to lift and/or carry up to five pounds for one hour. She was unable to use her right leg or foot for repetitive actions. The claimant could reach for two hours, and bend for one hour in an 8-hour workday, but could not squat, crawl, or climb. She was precluded from activities that involved unprotected heights and had moderate restrictions in terms of driving automotive equipment. Dr. Perry opined that the claimant had been impaired for two years, and was unable to work for 8 hours per day, 40 hours per week on a sustained basis within the limitations noted without missing more than two days of work per month (Exhibit 10F). Dr. Perry also completed a Clinical Assessment of Pain form, indicating he had treated the claimant since April 28, 2010 for a right calcaneal fracture. He indicated that pain would distract the claimant from adequately performing daily activities or work. He also indicated that physical activity would greatly increase the claimant's pain and cause distraction from task or total abandonment of task. It was noted that the impact from pain would cause limitations, but not to such degree as to cause serious problems at work. Dr. Perry indicated the claimant needed a heel lift for her shoe, and noted that her pain had been at the level indicated for one year. He reiterated that the claimant had been impaired for two years, and was unable to work for 8 hours per day, 40 hours per week on a sustained basis within the limitations noted without missing more than two days of work per month (Exhibit 11F).
Of note, Dr. Perry, the claimant's treating physician, has provided several medical source statements, including a physical capacity assessment regarding the claimant's pain, in which he noted she has tried several times for disability based on her right foot condition (Exhibits 10F-12F). Interestingly, after a follow-up examination on July 11, 2011, and following a brief, 15-minute evaluation a year later, on May 15, 2012, Dr. Perry determined that the claimant would be a good candidate for disability (Exhibits 8F, 12F)...
Robinson asserts that "[t]he ALJ rejected Dr. Perry's opinion without fully articulating why. Further, she does not explain exactly how much weight is given to Dr. Perry's opinions." (Doc. 12 at 3). Robinson's assertions are without merit. The ALJ expressly assigned "very little weight" to Dr. Perry's opinions, explaining: "[T]he opinion evidence from Dr. Perry, particularly with regard to the Physical Capacity Assessment (Exhibit 10F) and the Clinical Assessment of Pain (Exhibit 11F), are internally inconsistent, as the treating physician does not state what objective findings he relied upon; and his treatment records do not support his assessments." (R. 27-28). The ALJ further noted that his determined RFC was supported by "the claimant's conservative treatment history and reports of her activities of daily living." (R. 28). The ALJ found more credible the objective medical evidence of examining physician Dr. William Crotwell, III, M.D., and assigned his opinions "great weight." (R. 27-28).
The ALJ articulated "good cause" for assigning less than controlling weight to Dr. Perry's opinions, finding that they were not bolstered by the evidence (e.g. Robinson's "conservative treatment history and reports of her daily living"), that evidence supported a contrary finding, and that they were inconsistent with Dr. Perry's own medical records. See Winschel, 631 F.3d at 1179. Robinson, in her brief substantive discussion regarding the ALJ's rejection of Dr. Perry's opinions (Doc. 12 at 2-3), has not attempted to demonstrate why the ALJ's decision to reject those opinions is not supported by substantial evidence, instead asking the Court to simply accept her bare assertion that the ALJ articulated no reasons for doing so. Accordingly, the Court OVERRULES Robinson's lone assignment of error and finds that the Commissioner's decision is due to be AFFIRMED.
In accordance with the foregoing analysis, it is ORDERED that the Commissioner's final decision issued July 2, 2014, denying Robinson's applications for DIB and SSI benefits is AFFIRMED under 42 U.S.C. §§ 405(g) and 1383(c)(3).
Final judgment shall issue separately in accordance with this Order and Federal Rule of Civil Procedure 58.
DONE and ORDERED.