United States District Court, M.D. Pennsylvania
MARTIN C. CARLSON, Magistrate 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, Linda Hearn. In Ms. Hearn's case, this ALJ decision was made against a factual backdrop marked by conflicting evidence relating to the nature, severity and disabling effect of Ms. Hearn's emotional and medical conditions. Much of this evidence, and particularly the testimony of the claimant Ms. Hearn, actually seemed to contradict and undermine this disability claim. Upon consideration of this evidence, 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. Hearn's Medical and Employment History
On February 3, 2010, Linda Hearn applied for Social Security Disability Insurance Benefits ("DIB") under Title II, of the Social Security Act, alleging that she could no longer work any job in the national economy since May 1, 2008, the date when she had been laid off of from her last clerical job. According to Hearn she had become disabled due to the cumulative effects of joint pain in her shoulders, elbows, hips and knees. (Tr. 200-213.) Hearn reported that this pain, coupled with diabetes and an attention deficit disorder, left her wholly disabled. (Id.) At the time the alleged onset of this disability, Hearn was 55 years old, which is defined as a "person of advanced age, " had a high-school diploma and a bachelor's degree in elementary education, and had a significant prior work history in a variety of clerical occupations, a work history that had drawn to a close when she had been laid off from her last job in May, 2008. (Tr. 10, 34-35, 57, 178.)
1. Hearn's Testimony Regarding Her Condition
On July 12, 2011, Hearn appeared and testified at a disability hearing conducted by an Administrative Law Judge (ALJ), who was assigned to assess her disability claim. In this testimony, Hearn confirmed that she suffered from the ailments which she had initially documented in her disability application, but described those ailments in ways which often undermined her claims of total disability. (Tr. 33-56.) Thus, under questioning by the ALJ Hearn explained that she had claimed an onset of disability beginning on the date upon which she was laid off from her last job. (Tr. 35.) When asked about the coincidental timing of this lay-off and her disability application onset date, Hearn acknowledged that if she had not been laid off she would have continued to work at the sedentary, clerical job she had held in the Spring of 2008. (Id.) Thus, Hearn seemed to attest to an ability to continue working at her prior employment even after the claimed date of the onset of her disability, May 1, 2008.
Hearn also described her medical and mental limitations in a fashion which seemed to be less than totally disabling. For example, with respect to her diabetes, Hearn described her condition in terms which disclosed that this condition was controlled to a degree that was nearly optimal and stated that her physicians were pleased with her diabetes control. (Tr. 38-41.) As for her joint pain, while Hearn claimed pain in her shoulders, hips and knees, she acknowledged that she had not yet disclosed the hip pain to her primary treating physicians at the VA. (Tr. 36-39.) Hearn further stated that she treated the pain through Ibuprofen, and periodic cortisone injections in her knees and shoulders every six months. According to Hearn, this treatment, and particularly these injections, helped a lot, and relieved her pain a good bit. (Id.) Furthermore, Hearn stated that she was able to treat her attention deficit disorder through herbal medications like gingko biloba and Hawthorn berry tea, herbal cures which allowed her to concentrate better. (Tr. 42-43.)
Hearn also described a level of physical activity which was not entirely consistent with a finding of complete and total disability, stating that she participated in exercise programs at the VA, (40-41.), was able to lift between 10 and 20 pounds, (Tr. 44.), walk laps for 15 minutes at a time, (Tr. 44.), and perform various household tasks. (Tr. 44-46.)
2. Other Medical Evidence
The other objective medical evidence provided to the ALJ also confirmed in large measure the non-disabling nature of Hearn's medical conditions, casting those conditions in terms similar to those described by Hearn herself in her ALJ hearing. These medical records revealed that Hearn had been receiving on-going treatment at the VA Medical Center for obesity and joint disease since 2009. However, by December 2009, Hearn was able to perform hamstring, quadriceps, and calf stretching exercises for 20 minutes, with 1000 steps at a 5/10 workload. (Tr. 913.) Hearn was also receiving periodic injections in her joints and reported that she was able to get around much better since beginning these injections in her knees. (Tr. 921.)
Throughout 2010, these medical records reveal that Hearn was participating in physical therapy at the VA Medical Center, (Tr. 921.), was making dietary and lifestyle changes to improve her health, (Tr. 905.), and was engaging in a home exercise program. (Tr. 912.) These records also disclosed that Hearn and her care givers were electing to treat her condition conservatively. Thus, on April 12, 2010, Rex Herbert, M.D., an orthopedic surgeon, advised that Hearn did not need knee replacement surgery, (Tr. 898.), since she was receiving injections for her knees, which she said "really helped." (Tr. 897). These findings, coupled with X-rays of Hearn's knees, led to a diagnosis of only mild degenerative joint disease in the bilateral knees. (Tr. 897-98.)
While Hearn continued to periodically complain of shoulder and knee pain in 2010, (Tr. 956.), she tolerated her exercise sessions well (Tr. 956.), had increased motivation, reported having less pain, and made "a vast improvement" throughout 2010. (Tr. 956.) Consequently by November 2010, while Hearn complained of bilateral shoulder pain, she indicated that she did not want any type of surgery on her shoulder, (Tr. 1015.), and displayed only some mild pain on range of motion with fairly decent rotator cuff strength when abducting the arms against resistance. (Tr. 1015.)
Throughout 2011, Hearn's medical records continued to document an ability to engage in some gainful activity. Thus, in January 2011, Hearn reported attending the Harrisburg Farm Show for approximately eight hours. (Tr. 999.) Hearn's liver enzymes were reported as normal. (Tr. 988.) A neurological examination was also essentially normal, with maximum motor strength throughout. (Tr. 989.) An MRI of the brain showed only age-related changes, (Tr. 988.) and Hearn was diagnosed with mild diabetic polyneuropathy. (Tr. 989.)
Hearn continued to receive periodic joint injections, which provided good relief for about six or seven months each time, during 2011. (Tr. 1093.) An examination of plaintiff's shoulders in May 2011 showed no erythema, warmth, swelling, or deformity, with only slight pain upon active and passive forward flexion and abduction in both shoulders, and good rotator cuff strength when abducting her arm against resistance. (Tr. 1083.) By June 2011, Hearn reportedly had lost a good deal of weight. (Tr. 1073.) While she experienced pain with exercise, she was able to perform all of her exercises, and reported feeling stronger with some decrease in overall pain. (Tr. 1073.)
3. Opinion Evidence
In addition to Hearn's own equivocal testimony, and the medical records which reflected conservative and generally successful treatment of her medical conditions, the ALJ was provided with medical opinion evidence to consider. This evidence also presented an equivocal and contradictory picture of Hearn's physical condition, with substantial opinion evidence supporting the conclusion that she was not disabled. Thus, on June 3, 2010, a state agency physician conducted an evaluation of Hearn's medical condition based upon her documented treatment records. This evaluation concluded that Hearn could lift 20 pounds occasionally and 10 pounds frequently; could stand or walk for about six hours, and sit for about six hours, in an eight-hour workday; could push and pull with no further limitations; could occasionally climb ramps and stairs, kneel, crouch, and crawl; could frequently balance and stoop; and but should never climb ladders, ropes, or scaffolds. (Tr. 835) Hearn could also occasionally reach above shoulder level bilaterally. No other limitations were noted. (Tr. 836-37.) Likewise, a psychiatric review technique form (PRTF) completed by a state agency psychologist indicated no medically determinable mental impairments. (Tr. 842.)
In contrast, two physician assistants who were treating Hearn provided more guarded assessments of Hearn's capabilities. On June 29, 2011, Karen A. Rogers, a physician's assistant, submitted a medical source statement in which she opined that Hearn could lift less than 10 pounds, stand or walk for at least two hours in an eight-hour workday (Tr. 1124.); had unspecified limitations in sitting and pushing and pulling due to her impairments (Tr. 1125.); could never perform any postural movements (Tr. 1125.); and had some manipulative and environmental limitations. (Tr. 1126-27.) These physician assistant medical findings, in turn, were contradicted in some respects by a second medical source statement from another physician's assistant, dated July 11, 2011, (Tr. 1129-32.), which indicated that Hearn could lift 10 pounds occasionally, less than 10 pounds frequently; could stand or walk for less than two hours in an eight-hour workday, but must periodically alternate sitting and standing to relieve pain; (Tr. 1129.) had no pushing and pulling limitations; (Tr. 1130.); had some postural limitations (Tr. 1130.); and had no manipulative or environmental limitations. (Tr. 1131-32.)
C. The ALJ Hearing and Decision
It was against the backdrop of this equivocal record regarding Hearn's physical condition that the ALJ conducted a hearing on July 11, 2011. (Tr. 29-68.) At this hearing, Hearn testified, providing a mixed and equivocal account of the degree to which her medical conditions were wholly disabling. (Tr. 33-56.) A vocational expert (VE) also testified. (Tr. 57-68.) In this VE testimony, the expert addressed a series of hypothetical questions posited by the ALJ, hypotheticals which incorporated various of the medical conditions and limitations identified by Hearn. In only one of the scenarios presented by the ALJ, the severe set of limitations identified by Physician Assistant Rogers, did the VE opine that ...