Fuehrer v. Saul

          MEMORANDUM

          Juan R. Sánchez, C.J.

         Plaintiff Douglas M. Fuehrer seeks review of the Commissioner of Social Security's denial of his applications for a period of disability and disability insurance benefits (DIB) and for supplemental security income (SSI). United States Magistrate Judge Timothy R. Rice has issued a Report and Recommendation recommending that Plaintiff's request for review be denied. Plaintiff objects to the Report and Recommendation, arguing the Magistrate Judge erred in concluding the Administrative Law Judge (ALJ) (1) properly weighed opinion evidence from two of Plaintiff's treating physicians in evaluating Plaintiff's residual functional capacity (RFC), (2) supported his RFC assessment with substantial evidence, and (3) adequately considered the combined effects of Plaintiff's impairments. Upon de novo review of the Report and Recommendation, the Court agrees with the Magistrate Judge that the ALJ's determination is supported by substantial evidence. Accordingly, Plaintiff's objections will be overruled, the Report and Recommendation will be approved and adopted, and Plaintiff's request for review will be denied.

         BACKGROUND^[2]

         In a decision issued on May 13, 2015, an ALJ, applying the Social Security Administration's five-step sequential evaluation process for evaluating DIB and SSI claims, see 20 C.F.R. §§ 404.1520(a), 416.920(a), found Plaintiff was not disabled. The ALJ found Plaintiff suffered from several severe physical and mental impairments: degenerative disc disease of the lumbar spine, status post fracture of the lower right limb, cubital tunnel syndrome, major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, and a personality disorder. R. at 12. But the ALJ determined these impairments, individually and in combination, did not render him per se disabled. R. at 14-16.

         The ALJ thus proceeded to determine Plaintiff's RFC, ^[3] finding that, despite his limitations, he could still perform “light work, ” as defined in 20 C.F.R. §§ 404.1567(b) and 416.967(b), subject to several additional restrictions. R. at 16. Specifically, the ALJ found Plaintiff could lift and carry 20 pounds only occasionally and 10 pounds frequently; could sit for a total of six hours and stand and walk for a total of six hours in an eight-hour workday; could balance, stoop, kneel, crouch, crawl, and climb ramps and stairs only occasionally with no climbing of ladders and scaffolds; could have only occasional exposure to humidity, wetness, and extreme cold; could perform only routine and repetitive tasks and use judgment consistent with such tasks; and could tolerate only occasional changes in a routine work setting. Id. Given these limitations, the ALJ found Plaintiff could not perform his past relevant work as a roofer. R. at 22. However, crediting the hearing testimony of a vocational expert, the ALJ found Plaintiff was capable of making a successful adjustment to other work as he could perform the requirements of representative occupations such as housekeeper, packer, and inspector. R. at 23. In formulating his RFC finding, the ALJ gave “little weight” to form “Physical Medical Source Statements” completed by two of Plaintiff's treating physicians-Jeffrey Darnall, M.D. and Daniel Rubino, M.D.-both of whom opined that Plaintiff had disabling functional limitations as a result of his lumbar spine issues. See R. at 20. The ALJ gave “partial weight” to opinion evidence from a third doctor, consultative examiner Andrew Bongiovanni, D.O., who offered a less restrictive assessment of Plaintiff's ability to perform work-related activities. See R. at 19.

         In his request for review, Plaintiff argues the ALJ's RFC finding is not supported by substantial evidence because the ALJ (1) erred in giving Dr. Darnall and Dr. Rubino's opinions “little weight, ” (2) formulated his own RFC finding without regard to the record, and (3) failed to consider the combined impact of Plaintiff's physical and mental impairments. After conducting a thorough review of the record, the Magistrate Judge issued a Report and Recommendation addressing each of the asserted errors and recommending Plaintiff's request for review be denied. Plaintiff objects to the Magistrate Judge's analysis of each of the issues raised in his request for review.

         DISCUSSION

         Under 28 U.S.C. § 636(b)(1), this Court reviews Plaintiff's objections to the Report and Recommendation de novo. Review of a final decision of the Commissioner of Social Security, however, is limited to determining whether the decision is supported by substantial evidence. See Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005). “Substantial evidence is ‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'” Id. (quoting Reefer v. Barnhart, 326 F.3d 376, 379 (3d Cir. 2003)). It requires “more than a mere scintilla but may be somewhat less than a preponderance of the evidence.” Id. (quoting Ginsburg v. Richardson, 436 F.3d 1146, 1148 (3d Cir. 1971)). Where there is substantial evidence in the record to support the Commissioner's findings, a court is bound by those findings, even if the record also contains other evidence that could support a finding of disability. See Simmonds v. Heckler, 807 F.2d 54, 58 (3d Cir. 1986).

         Plaintiff's primary objection concerns the ALJ's evaluation of opinion evidence from Dr. Darnall and Dr. Rubino. Plaintiff contends the ALJ should have given these opinions “controlling weight, ” or at least “significant weight, ” under the regulations in effect when his DIB and SSI claims were filed. Under those regulations, a treating physician's opinion on the nature and severity of a claimant's impairment is entitled to “controlling weight” if the opinion is “well-supported by medically acceptable clinical and laboratory diagnostic techniques” and “not inconsistent with the other substantial evidence in [the] case record.” 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). If a treating physician's opinion is not entitled to controlling weight, the ALJ may reject the opinion outright “only on the basis of contradictory medical evidence, ” but may afford the opinion “more or less weight depending upon the extent to which supporting explanations are provided.” Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir. 1999). Factors to be considered in determining the appropriate weight to give a treating physician's opinion include, inter alia, the length of the treatment relationship and frequency of examination, the nature and extent of the treatment relationship, the supportability of the opinion, the consistency of the opinion with the record as a whole, and whether the source was a specialist. See 20 C.F.R. §§ 404.1527(c)(2)-(5), 416.927(c)(2)-(5). The ALJ may also consider other factors, including the source's “amount of understanding of [the Social Security Administration's] disability programs and their evidentiary requirements.” Id. §§ 404.1527(c)(6), 416.927(c)(6). The Third Circuit has noted that form reports, like the Physical Medical Source Statements at issue in this case, “in which a physician's obligation is only to check a box or fill in a blank[, ] are weak evidence at best.” Mason v. Shalala, 994 F.2d 1058, 1065 (3d Cir. 1993); accord Galette v. Comm'r Soc. Sec., 708 Fed.Appx. 88, 91 (3d Cir. 2017).

         Dr. Darnall, Plaintiff's primary care physician, completed a Physical Medical Source Statement for Plaintiff in November 2014. In response to the questions on the form, he listed Plaintiff's diagnoses as chronic lumbar pain, depression, and chronic hepatitis C, and identified pain as Plaintiff's sole symptom, characterizing the pain as “severe, constant, lumbar, radiates to leg.” R. at 416. Dr. Darnall opined that, as a result of his impairments, Plaintiff could sit and stand/walk for less than two hours total in an eight-hour workday, would require the use of a cane or other hand-held assistive device while standing and walking, and would require four to six unscheduled breaks of 15 to 20 minutes each due to muscle weakness and back pain. R. at 417-18. He also opined that Plaintiff could lift or carry 20 pounds only rarely and 10 pounds or less occasionally, and could climb stairs occasionally, stoop only rarely, and never twist, crouch, or climb ladders. R. at 418. He stated Plaintiff was likely to be off task 20% of the time and to be absent from work more than four days per month. R. at 419.

         The ALJ gave Dr. Darnall's opinion “little weight, ” finding it was inconsistent with other clinical and objective findings in the record and noting Dr. Darnall “lack[ed] program knowledge.” R. at 20. The ALJ specifically found Dr. Darnall's opinion was not supported by findings from (1) his own physical examination of Plaintiff in April 2012, which noted Plaintiff exhibited “normal range of motion and strength of the extremities with no focal neurological deficits and a normal gait”; (2) a June 2014 physical examination by treating orthopedist Thomas Duffy, D.O., which found “normal lower extremity strength bilaterally and normal neurovascular functioning”; (3) a June 2014 examination by urgent care physician David Figucia, M.D., which found “normal lower extremity strength bilaterally and a normal gait”; and (4) a January 2015 examination by urologist David Raezer, M.D., which noted that Plaintiff “had no musculoskeletal or neurological complaints.” R. at 20.

         Plaintiff argues the ALJ erred in concluding Dr. Darnall's opinion was not supported by the medical evidence because, notwithstanding the findings cited by the ALJ, other medical evidence in the record supports the opinion. Plaintiff contends Dr. Darnall's opinion is consistent with his own examination findings, with objective diagnostic evidence (x-rays and an MRI) revealing problems at the base of Plaintiff's lumbar spine, and with other examination findings in the record by Dr. Duffy, Dr. Figucia, and other providers. He argues the ALJ erred in ignoring the record evidence supporting Dr. Darnall's opinion. The Court disagrees.

         As an initial matter, Dr. Darnall's own examination findings provide scant support for his opinion. Although Plaintiff saw Dr. Darnall at least six times between April 2012 and November 2014, he did not complain of back pain until June 2014, at which time he stated the pain did not radiate into his legs, contrary to the characterization in his Physical Medical Source Statement. Compare R. at 361, with R. at 416. Dr. Darnall's examination findings from that visit include a finding of lumbar spasm bilaterally; however, he also noted Plaintiff was in “no acute distress” at the time. R. at 362. The only other relevant examination findings in Dr. Darnall's treatment notes are the findings from his original examination of Plaintiff in April 2012 that Plaintiff had “[n]ormal gait, neck and spine with normal alignment and mobility” and “[n]ormal range of motion and strength” of the extremities with no focal neurologic deficits. R. at 414. While Dr. Darnall's November 2014 Physical Medical Source Statement lists tenderness, spasm, and decreased range of motion as the relevant “clinical findings and objective signs, ” R. at 416, his treatment notes do not include examination findings of tenderness or decreased range of motion.

         With respect to the diagnostic evidence, the ALJ did not ignore the studies cited by Plaintiff-lumbar spine x-rays taken in April 2014 and a lumbar spine MRI taken in June 2014. Rather, as the Magistrate Judge noted, the ALJ expressly acknowledged these studies and “correctly summarized their findings, ” many of which were also present in pelvic CT scans Plaintiff underwent in November 2012 and January 2013 for urologic issues. R. & R. 17-18 (citing R. at 17). The ALJ recognized that the diagnostic evidence shows spinal impairment, including “multilevel degenerative changes, spondylosis, spondylolisthesis and bilateral neural foraminal stenosis at the L5-S1 level, and compression of the L5 nerve root.” R. at 17. But whether that impairment is disabling depends on “the functional limitations that result from th[e] impairment.” Phillips v. Barnhart, 91 Fed.Appx. 775, 780 (3d Cir. 2004). As the Magistrate Judge noted, evidence of Plaintiff's spinal impairment was present to a substantial degree when Dr. Bongiovanni examined him in June 2013, found no neurological deficits and only mildly limited lumbar range of motion, and opined that he could perform a far greater range of work-related activities than Dr. Darnall. See R. at 275-76; R. at 380 (January 2013 CT scan showing anterolisthesis (another term for spondylolisthesis) and mild degenerative changes of the spine); R. at 400 (November 2012 CT scan showing, inter alia, anterolisthesis, spondylolysis, “severe bilateral neural foraminal stenosis at ¶ 5-S1, ” and “[l]umbar spondylosis and facet joint osteoarthritis”). And ...