United States District Court, M.D. Pennsylvania
MARTIN C. CARLSON, District Judge.
I. Statement of Facts and of the Case
In this case we are asked to evaluate an Administrative Law Judge's (ALJ) decision denying social security disability benefits to the plaintiff, Brian Clark. That ALJ decision was made against a factual backdrop marked by conflicting and inconsistent evidence relating to Clark's visual acuity and medical condition, but a factual record which contained substantial evidence suggesting that Clark, a younger worker, retained the residual functional capacity to perform numerous jobs in the national and regional economies. 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, this decision will be affirmed.
B. Clark's Medical and Employment History
On December 22, 2008, Brian Clark filed applications for Social Security Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") application under Titles II and XVI, respectively, of the Social Security Act. 42 U.S.C. §§ 401 433, 1381-1383c, alleging that he could no longer work any job in the national economy since June 30, 2007 due to blindness in his left eye; vision difficulties in right eye; and stomach problems. (Tr. 115-25, 141, 146.) Clark was 39 years old on the alleged onset date of June 30, 2007, (Tr. 141.), making him a younger individual under Social Security regulations. He had a high school education, and reported past work as an assistant manager, auto mechanic, and electric contractor. (Tr. 51, 147.)
1. Clark's Visual Acuity
With respect to these presenting medical conditions, the record developed during these disability proceedings was mixed and equivocal. For example, with regard to Clark's first medical concern, his limited visual acuity, the evidence before the ALJ showed that on February 21, 2009, Clark was evaluated by consultative examiner Joseph Greene, M.D. (Tr. 217-20.) On examination, Dr. Greene found that Clark's "[v]ision in his right eye is 20/70" and "in his left eye he is blind." (Tr. 218.) Dr. Greene, therefore, diagnosed Clark as suffering from "no vision in his left eye, " (Tr. 219.) but given the remaining vision in his right eye opined that Clark only had "a mild level of limitation in job-related activities and mild level of limitation in [activities of daily living] specifically related to decreased vision in his left eye." (Tr. 219.)
Three months later, on May 28, 2009, a second consultative examiner Allen Elliot, M.D., examined Clark. (Tr. 229-32.) On examination, Dr. Elliot confirmed that Clark's left eye had "[n]o light perception" but found that Clark's vision in his right eye was 20/30 with correction. (Tr. 229.) Accordingly, Dr. Elliot diagnosed Clark as suffering from blindness in left eye with chronic uveitis and myopic astigmatism in his right eye, but opined that Clark's "[d]ecreased vision [in his] right eye" "[s]hould not preclude [him] from doing work related activity requiring good vision in 1 eye only." (Tr. 230.)
This visual acuity assessment was corroborated by another examination conducted in December of 2009 by Randall Peairs, M.D. During this examination, Dr. Peairs found that Clark had "a vision of 20/25 in the right [eye] and no light perception in the left [eye]." (Tr. 404.)
Arrayed against this medical evidence which consistently found that Clark's vision problems did not render him wholly disabled was one thin reed. In late May 2010, at Clark's request, another health care provider, Dr. Schoonover completed a check-off form prepared by Clark's counsel in these administrative proceedings. This one-page form was internally inconsistent, indicating in one place that Clark had remaining vision in his better eye after best correction of 20/200 or less, and then stating at another location that Clark's visual efficiency in his better eye after best correction was "20/50 in right eye." (Tr. 406.)
2. Clark's Other Presenting Medical Concerns
As for Clark's other presenting medical concerns, which included diabetes, shortness of breath, and back pain, the medical record presented to the ALJ was likewise equivocal and mixed. Thus, the record showed that Gautam Dev, M.D., a pulmonologist, examined Clark in December of 2007, for complaints of chest pain and shortness of breath. (Tr. 211, 216.) At that time Clark reported that he worked as an automotive repairman and had often used his mouth to syphon off gasoline. (Tr. 211, 216.) Clark also reported that he smoked heavily. (Tr. 211, 216.) Dr. Dev diagnosed Clark with pneumonia, and also noted a possible infection from inhaling hydrocarbon. (Tr. 211, 216.)
Clark's medical history then contained no examination or treatment records from 2008, but revealed that Clark received a consultative examination from Dr. Joseph Greene in February 2009. While Dr. Greene described Clark as obese and unkempt in appearance and noted that Clark reported that "[m]ost recently he is employed as an auto mechanic, " (Tr. 218), Dr. Greene's medical assessment of the claimant was largely unremarkable. That examination, in part, revealed that Clark reported no lifting limitations with respect to weight or frequency; further reported no problems with activities of daily living, but estimated that he could only stand, walk, or sit for about 10 to 15 minutes before having to move or rest. (Tr. 217.) On examination by Dr. Greene, Clark displayed a full range of motion of all joints, which were minimally tender to palpation. (Tr. 219.) Clark also had a normal station and gait, and no need for an assistive device. (Tr. 218-19) He demonstrated no problems with gross manipulation or grip strength; (Tr. 218), his upper and lower extremity strength was normal; and he was able to rise from a seated position without using his arms. (Tr. 219.)
Following this examination in March 2009, a state agency physician, Lina B. Caldwell, M.D., reviewed Clark's file and noted that no evidence existed to support plaintiff's belief that he had the medically determinable impairments ("MDI's") of stomach problems, back pain, or migraines. (Tr. 227.) Dr. Caldwell further noted the consultative examiner's report, which found that Clark was not limited in the amount of weight he could lift or how frequently he could lift it, (Tr. 227.), and concluded that no objective medical evidence supported Clark's allegation that he was unable to stand, walk, and sit for only 10-15 minutes without having to move or rest. (Tr. 227.)
In August of 2009, Clark underwent a brief hospitalization for complaints of shortness of breath and frequent urination. (Tr. 330.) During this hospitalization Clark was diagnosed with diabetes and received diabetic counseling, which included the need to eat a low carbohydrate diet. (Tr. 290.) During this admission, various studies were conducted and all were normal, including an echocardiogram and chest x-rays to check for heart problems, and a venous ultrasound to check for deep venous thrombosis of the legs. (Tr. 292-94, 324-25, 328, 330.) Accordingly, Clark's condition was treated conservatively. He was placed on a low-carbohydrate diet, and counseled to make lifestyle changes. (Id.) By mid-October 2009, Clark's doctor reported improvements in Clark's conditions stating that his diabetes was now moderately controlled - his blood sugar levels were in the 100-150 range, whereas they had been in the 300-400 range. (Tr. 358.) At follow-up evaluations for diabetes and hypertension in December 2009 and January 2010, Clark reported that he was exercising four times per week and following the recommended diet. (Tr. 337, 343) Clark's hypertension and diabetes seemed to be controlled, and he was taking his medications as prescribed with no side effects. (Tr. 337, 343, 344.)
Clark's physical examinations at this time showed that he was obese, standing 6'0" tall and weighing 285 pounds. (Tr. 338.) His respirations were regular and labored, and he had good airflow with a mild expiratory wheeze. (Tr. 338.) He had full muscle strength and tone, and his straight leg raise test was negative. (Tr. 338, 344.) With respect to diabetes, plaintiff did not want to try insulin; therefore, his doctor recommended diet and exercise along with strict medication compliance. (Tr. 338.)
Clark's medical records also revealed inconsistencies between his clinical treatment findings throughout 2010 and a residual functional capacity report completed by his treating physician, Dr. Guzek, in January 2010. During this period, Clark's clinical findings were largely unremarkable. Thus, examination notes from January, March, and April of 2010, showed that Clark reported exercising four times per week, (Tr. 374, 378, 390, 398.), and was taking his diabetes medication as prescribed. (Tr. 374, 398.) Clark had also undergone a cardiac catheterization, which showed non-obstructing coronary atherosclerosis. (Tr. 374, 378, 392.) While Clark reported low back pain that radiated to his right leg, which was aggravated by activity, bending, lifting, prolonged sitting, and straining, (Tr. 374, 378, 390, 398.), Darvocet alleviated his pain. (Tr. 374, 378, 390, 398) Furthermore, Clark's straight leg raising test was negative; his diabetic foot examination was normal; (Tr. 375, 379-80, 391, 399.); and he had normal posture, no instability, and normal strength and muscle tone. (Tr. 391, 399.)
In marked contrast to these clinical findings was the residual functional capacity questionnaire completed by Clark's treating physician, Dr. Guzek, in January 2010. (Tr. 369-370.) This two page check list document describes a much more severe and dramatic constellation of conditions than were revealed in Clark's treatment records, including a finding that Clark would require 15 minute rest breaks every 10 minutes during an 8 hour work day. (Id.) This finding, which was tantamount to a declaration that Clark could work, on average, less than 30 minutes per hour during an 8 hour work day, appear to be wholly unsupported by an other specific clinical findings or objective evidence.
3. The ALJ Hearing and Decision
It was against the backdrop of this equivocal record regarding Clark's physical condition that the ALJ conducted a hearing on July 6, 2010. (Tr. 46-66.) At this hearing, Clark testified, asserting that "I can't pretty much do nothing, " (Tr. 59.), an assertion that seemed at odds with Clark's exercise regime that he described to his doctors, to whom Clark reported exercising four times per week. (Tr. 374, 378, 390, 398.) A vocational expert (VE) also testified, presenting evidence that a hypothetical individual, with Clark's work history, who had those limitations set forth by the ALJ, could perform jobs that existed in significant numbers in the national economy. (Tr. 61-66.)
On September 21, 2010, the ALJ issued his decision denying Clark's application for benefits. (Tr. 14-25.) After reviewing the conflicting and contradictory medical evidence, (Tr. 20-24.) the ALJ found that Clark suffered from the following conditions that, while severe, did not meet any of the listing criteria which would qualify Clark for benefits at step three of the five step Social Security disability assessment process: chronic obstructive pulmonary disease, blindness in the left eye, ...