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Emenhizer v. Colvin

United States District Court, M.D. Pennsylvania

February 23, 2017



          Martin C. Carlson United States Magistrate Judge

          I. Introduction

         In this case we are called upon to review a decision by a Social Security Administrative Law Judge (ALJ) that engaged in a fundamental form of legal and factual analysis that is commonplace in Social Security appeals: the weighing of competing medical evidence. In the instant case, the ALJ reviewed the medical opinion of the plaintiff's treating physician, which concluded that Ms. Emenhizer was disabled, and the opinions of two state agency medical sources, who found that she retained the residual functional capacity to perform a range of light work.

         The ALJ found that Ms. Emenhizer could perform a limited scope of light work, and concluded that she was not disabled. (Tr. 32-3.) In reaching this conclusion the ALJ carefully considered the opinion of Ms. Emenhizer's treating doctor, but ultimately found that this opinion was unpersuasive for at least five reasons since it was “[1] not supported by the doctor's own clinical findings, [2] [or] with the findings of other physicians, [3][or] with the results of MRI studies, [4] [or] with the claimant's relatively conservative course of treatment . . ., [5][or] with the claimant's activities of daily living, such as watching television, reading romance novels, cooking, driving herself to her psychologist's office, and caring for her 17-year-old son independently.” (Tr. 29.)

         Given the deferential standard of review that applies to Social Security Appeals, which calls upon us to simply determine whether substantial evidence supports the ALJ's findings, we conclude that substantial evidence does exist in this case which justified the ALJ's evaluation of this medical opinion evidence, and the residual functional capacity determination of Emenhizer which flowed from that assessment of the medical evidence. Therefore, for the reasons set forth below, we will affirm the decision of the Commissioner in this case.

         II. Statement of Facts and of the Case

         On November 6, 2012, Debra Lynn Emenhizer applied for disability insurance benefits and supplemental security income under Titles II or XVI of the Social Security Act (Act). 42 U.S.C. §§ 401-434, 1381-1383f, alleging that she had become disabled in July of 2010[1] due to degenerative disc disease, bone spurs in her back, leg problems, high blood pressure, migraines, anxiety, and depression. (Tr. 79.) Emenhizer was forty-seven years old on May 10, 2012, at the time of her amended alleged onset of disability, and was forty-nine years old at the time of the ALJ's October 9, 2014 decision denying her application for benefits. As such, Emenhizer was considered a “younger person” under Social Security Regulations. See 20 C.F.R. §§ 404.1563, 416.963. Emenhizer had a high school education, and an employment history spanning from 2002 through 2012 in a number of fields including waitressing, housekeeping, and working as a cashier and stock clerk. (Tr. 274-75.)

         Emenhizer's disability application was initially denied on July 19, 2013, and she sought a hearing to contest this denial on August 5, 2013. (Tr. 15.) This hearing was conducted by an ALJ on August 8, 2014. (Tr. 39-86.) At this hearing, the ALJ heard testimony from Emenhizer and a vocational expert. (Id.) The ALJ also received and reviewed detailed medical records from multiple medical sources, (Tr. 337-641.), and had the benefit of at least three medical opinions, an opinion from a treating physician for Emenhizer, Dr. Carleton, (Tr. 518-19.), and two state agency medical sources, Dr. Fox and Dr. Ostrich. (Tr. 98-102.)

         These medical sources reached markedly different conclusions regarding Emenhizer's capacity to perform work. For his part, Dr. Carleton opined that Emenhizer was experiencing a series of moderate, marked and extreme limitations in meeting the mental demands of the workplace. (Tr. 515-17.) Dr. Carleton also concluded that that due to spinal stenosis, COPD, hypertension, and migraines, Emenhizer would be limited to sitting 15 minutes at one time and 3 hours total, standing or walking 15 minutes at one time and 3 hours total, lifting or carrying up to 20 pounds occasionally and less than 10 pounds frequently, using her hands and fingers 30 percent of the workday, and using her arms 20 percent of the workday. (Tr. 518-19.) Dr. Carleton further stated that Emenhizer would need to recline or lie down in excess of typical work breaks and shift positions at will; take unscheduled breaks throughout the work day; and would likely be absent once or twice a month due to her impairments and treatment. (Id.) These findings strongly suggested that Emenhizer was fully disabled.

         In contrast, two state agency medical experts, Dr. Fox and Dr. Ostrich, concluded that Emenhizer was capable of performing a limited scope of light work. Thus, Dr. Fox, a state agency physician, assessed Emenhizer's physical limitations, and following a review of the medical evidence of record in May 2013 concluded that Emenhizer was physically capable of lifting and carrying 20 pounds occasionally and 10 pounds frequently; sitting for six hours in an eight-hour workday; standing and walking for six hours in an eight-hour workday; and performing occasional postural activities; but should avoid concentrated exposure to temperature extremes or vibration. (Tr. 98-100.)

         Likewise, Timothy Ostrich, Psy. D, a state agency psychologist, reviewed the medical evidence of record in July 2013 and determined that Emenhizer was able to understand, retain, and follow simple job instructions, and perform simple, routine repetitive work in a stable environment. (Tr. 100.) Dr. Ostrich further concluded that Emenhizer would be able to carry out very short and simple instructions; make simple decisions, and sustain a work routine without special supervision; found that she would be able to maintain socially appropriate behavior, ask simple questions, and accept instruction; determined that she would be able to sustain an ordinary routine without special supervision; function in a production-oriented job requiring little independent decision making; and exercise appropriate judgments in the workplace. (Tr. 100-02.)

         These contrasting medical opinions rested upon a mixed medical record, albeit a record which provided significant factual support for the opinions of those experts who opined that Emenhizer retained the residual functional capacity to perform some light work. For example, objective medical testing done by a number of care-givers did not document the degree of impairment described by Emenhizer. Thus, an MRI of Emenhizer's lumbar spine in September 2012 showed only mild to moderate lumbar spondylosis, increased degenerative disc disease at ¶ 2-L3, slightly increased disc protrusion at ¶ 3-L4, and mild diffuse disc protrusion at ¶ 5-S1, which was unchanged from a previous study in 2006. (Tr. 479-80.) Later, in March 2013, an examination by Jennifer Simmons, M.D., revealed a normal spine to palpation, no abnormal tension of the paraspinal muscles, and no appreciable scoliosis. (Tr. 634.) Likewise in June of 2014 a musculoskeletal examination showed that Emenhizer had a fluid range of motion of the cervical and thoracic spines, with only slight loss of range of motion of the lumbar spine. (Tr. 609.) A neurological examination, in turn, disclosed good motor strength without deficit, intact sensation, and no signs of upper motor neuron pathology. (Tr. 609.) Further, a review of an earlier MRI showed only some mild degeneration in the spine. (Tr. 610.)

         Further, observation of Emenhizer by various other medical professionals indicated that she retained some physical capabilities and had responded well to conservative medical treatment in the past. For example, Emenhizer began treatment with Upendra Thaker, M.D., a pain management specialist, in December 2012. (Tr. 401-04.) At that time Emenhizer reported that she had been employed part-time as a waitress for two years. (Tr.402.) Emenhizer was prescribed pain medication, which she later reported was minimally helpful, (Tr. 401-04, 588.), and was treated with epidural steroid injections in September and October of 2013. (Tr. 583-84, 586-87, 588-89.) This course of treatment reportedly yielded an 80% improvement in her lumbar pain. (Tr. 584.)

         In March of 2014 physical examinations of Emenhizer showed some tenderness in her spine, limited range of motion, and an equivocal straight leg-raising test on the right side. (Tr. 555, 558, 584, 588.) However, examination also revealed that Emenhizer experienced intact sensation, trace ankle, moderate tenderness in the heel, full (5/5) strength, and a normal gait (Tr. 555, 558, 584, 588.) Based upon these findings, Dr. Thaker followed a conservative course of treatment for Emenhizer explaining to her that she was physically deconditioned and encouraging her to participate in mild physical activity and pursue weight reduction. (Tr.555, 584.)

         In June of 2014, Dr. Thaker referred Emenhizer to Dr. John Sefter, D.O., an orthopedist, to evaluate her lumbar pain. (Tr. 608-11.) Like Dr. Thaker, Dr. Sefter reached equivocal medical findings as to Emenhizer and prescribed a conservative course of treatment. Thus, while Dr. Sefter noted that Emenhizer reported a fifteen-year history of back pain, he also found that she had undergone only conservative treatment measures, consisting of physical therapy, chiropractic manipulation, and pain injections. (Tr. 608.) A musculoskeletal examination revealed fluid range of motion, with only slight loss of range of motion of the lumbar spine and neurological examination revealed good motor strength without deficit, intact sensation, and no signs of upper motor neuron pathology. (Tr. 609.) Dr. Sefter, therefore, assessed Emenhizer with slight degenerative disc disease but no spinal instability or neurological deficit. (Tr. 610.) The doctor also concluded that surgery was “immensely” contraindicated for Emenhizer, continuing to endorse more conservative treatment methods. (Tr. 606-07.) Dr. Sefter also considered Emenhizer's MRI results to be, “actually quite normal, ” (Tr. 606-07.), and prescribed a modest treatment path for her, consisting of facet joint rather than epidural injections, weight loss, and smoking cessation. (Tr. 610.)

         The treatment records of Emenhizer's primary care physician, Dr. Carleton, also presented a mixed picture regarding her health and degree of impairment, a picture that was not entirely consistent with the severe limitations that Dr. Carleton described in his expert report. Thus, while Dr. Carleton's treatment notes documented a variety of complaints by Emenhizer, (Tr. 496, 500, 503, and 504.), those same records contained far more mundane and unremarkable medical findings, such as a normal cardiovascular examination, (Tr. ...

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