United States District Court, M.D. Pennsylvania
REPORT AND RECOMMENDATION
MARTIN C. CARLSON, Magistrate Judge.
I. Statement of Facts and of the Case
This case comes before the court for evaluation of an Administrative Law Judge's decision denying social security disability benefits to the plaintiff, John Gattus. That ALJ decision was made against a factual backdrop marked by conflicting and inconsistent evidence relating to Gattus' medical condition, and mental health. Upon consideration, for the reasons set forth below, we conclude that the ALJ's decision is supported by substantial evidence which is adequately explained on the record and, therefore, we recommend that this decision be affirmed.
B. Gattus' Medical and Employment History
On April 22, 2008, John Gattus filed applications for disability benefits alleging that he could no longer work any job in the national economy since July 31, 2007 due to a knee injury and heart disease. (Tr. 221-27, 228-34, 255.) At the time of this application Gattus was 41 years old, making him a younger individual under Social Security regulations, had a high school education, and had prior work experience as a carpenter. (Tr. 20.) In October 2008, Gattus amended his application, advising Social Security that sleep apnea and chronic pulmonary obstructive disease (COPD) also contributed to his inability to work. (Tr. 57, 66.)
With respect to these presenting medical conditions, the record developed during these disability proceedings was mixed and equivocal. For example, with regard to Gattus' first medical concern, his knee injury, the evidence before the ALJ showed that Gattus suffered a displaced right knee cap fracture as a result of a motor vehicle accident. (Tr. 431.)Gattus underwent surgery for this injury, an open reduction and internal fixation, a procedure which entailed implanting two screws into his knee, in early August 2007. (Tr. 431-32, 802.)
Gattus was treated by David J. Caucci, M.D., an orthopedic surgeon, following this surgery. (Tr. 425, 428.) By October 2007, Gattus was reporting to Dr. Caucci that he was in physical therapy and doing well. (Tr. 423.) Subsequent x-rays continued to show the fracture, as well as a broken and a bent internal screw, but Gattus declined to undergo additional surgery proposed by Dr. Caucci. (Tr. 414, 418.) Gattus was last seen by Dr. Caucci in May 2008. (Tr. 438.) At that time Dr. Caucci's medical notes and impressions provided a profoundly mixed and contradictory picture of Gattus' condition. (Id.) Dr. Caucci's objective findings were relatively benign. Thus, Dr. Caucci noted that Gattus had a full extension range of motion of 120 degrees of flexion, and assessed his quadriceps strength at 4 to nearly 5/5. (Id.) The doctor also noted that Gattus' ligaments were stable, and found his hamstring strength to be 5/5. (Id.) Despite these positive objective findings, however, Dr. Caucci stated without further explanation that he did not think that Gattus could work, (id.), while also concluding that Gattus needed no additional on-going treatment. (Id.)
In contrast to these inconsistent observations made by Dr. Caucci in May 2008, a contemporaneous consultative examination of Gattus undertaken in July of 2008 by Dr. Don Henderson, found that Gattus had a normal gait, walked without assistance, and had full motor power in all extremities. (Tr. 298-304.) Dr. Henderson further found that Gattus had the ability to lift 100 pounds occasionally, carry 50 pounds, occasionally, could stand or walk 4 hours during an 8 hour workday, and could occasionally bend, stoop and climb. (Id.)
The evidence relating to Gattus' coronary health was also mixed and equivocal. Thus, in March 2008, Gattus suffered a mild myocardial infarction. He was treated in a hospital emergency department for this condition before leaving the hospital against medical advice. (Tr. 377.) Gattus, a two-pack daily cigarette smoker, returned to the emergency room two days later complaining about additional chest pain and packs of cigarettes a day, was placed on aspirin and beta blockers and was counseled stop smoking, medical advice he declined to follow. (Tr. 377-78.)
Following this episode, in May 2008, Chatla VR Reddy, M.D., performed a cardiac catherization on Gattus. This procedure revealed a complete occlusion of his right coronary artery, but contained no other adverse findings and concluded that Gattus' ejection fraction, a benchmark measure of cardiac efficiency, was 65%. (Tr. 305-06). Dr. Reddy recommended that Gattus, who continued to smoke but was asymptomatic, lose weight and continue to take his medications. (Tr. 317-18.)
For his part, Gattus did not report significant cardiac symptoms for the remainder of 2008 and the majority of 2009, except when he stopped taking his medications in June 2009 and experienced fatigue. (Tr. 368.) Further, a battery of tests, including Holter monitor testing, cardiac echo imaging, and a perfusion scan performed in October 2008 and October 2009 were negative for any significant coronary abnormality. (Tr. 358-59, 362, 571-72.) In November 2009, Gattus sought another opinion from Stafford M. Smith, M.D. (Tr. 574.) Dr. Smith, upon review of the May 2008 catheterization report, recommended elective surgical intervention, insertion of a stent to open the occluded right coronary artery. (Tr. 574.) That surgery was successfully performed in January 2010, (Tr. 587-92), and following surgery Gattus reported to both Dr. Smith and his primary care provider that he was feeling better, with improved breathing and decreased fatigue. (Tr. 482-83.) Gattus, in turn, testified that he received no further cardiac treatment and was not due to be seen by a cardiologist until 2011. (Tr. 17.)
Finally, with respect to Gattus' sleep apnea and COPD Gattus reported that he started to experience fatigue after his accident in July 2007. (Tr. 278.) In May and June 2010, he participated in two studies at the direction of Sean McVeigh M.D. (Tr. 871-75, 900-13, 918.) Those studies measured a basic medical benchmark of pulmonary efficiency, Gattus' forced expiratory volume (FEV1) and found that Gattus had a pre-drug measured FEV1 of 3.00 and post-drug measured FEV1 of 3.44. (Tr. 896.) These ratings fall well above the Social Security thresholds for disability for individuals like Gattus. Consequently, while Dr. McVeigh recommended that Gattus not drive or operate dangerous machinery when sleepy, he did not recommend any other work related restrictions. (Tr. 871.) Furthermore, by October 2009, Gattus stated that he experienced improved energy and breathing with the use of CPAP therapy, (Tr. 68), and reported that he was able to drive between one and two hours per day. (Tr. 69.)
The wholly equivocal nature of the medical evidence amassed by Gattus in support of this disability application was aptly reflected in the medical opinion evidence provided to the ALJ. In this regard, the evidence supporting Gattus' claim consisted largely of Dr. Caucci's opinion that Gattus could not work, an opinion that was contradicted in some respects by the doctor's own objective medical findings. In contrast, three medical professionals found that Gattus' condition was not wholly disabling. This countervailing medical opinion evidence included consultative examination of Gattus undertaken in July of 2008 by Dr. Don Henderson, who found that Gattus had a normal gait, walked without assistance, and had full motor power in all extremities. (Tr. 298-304.) Dr. Henderson further found that Gattus had the ability to lift 100 pounds occasionally, carry 50 pounds, occasionally, could stand or walk 4 hours during an 8 hour workday, and could occasionally bend, stoop and climb. (Id.) In addition, Dr, Leo Potera, the state agency medical consultant, also determined from a review of Gattus' medical records that Gattus retained a residual capacity to work. (Tr. 333-339.) Finally, Dr. McVeigh, who assessed Gattus' sleep apnea and COPD, simply recommended that Gattus not drive or operate dangerous machinery when sleepy, but did not recommend any other work related restrictions. (Tr. 871.)
C. The ALJ Hearing and Decision
It was against the backdrop of this equivocal record regarding Gattus' physical condition that the ALJ conducted hearings on December 22, 2009, April 23, 2010 and November 23, 2010. (Tr. 25-75.) At these hearings, Gattus testified, and a vocational expert (VE) presented evidence that a hypothetical individual, with a work history as carpenter, who had those limitations set forth by the ALJ, could perform jobs that existed in significant numbers in the national economy. (Tr. 71-74).
On November 23, 2010, the ALJ issued his decision denying Gattus' application for benefits. (Tr. 9-22). After carefully reviewing the conflicting and contradictory medical evidence, the ALJ found that Gattus's orthopedic, coronary and pulmonary ailments, while severe, did not meet any of the listing criteria which would qualify Gattus for benefits at step 3 of the five step Social Security ...