United States District Court, E.D. Pennsylvania
DOUGLAS M. FUEHRER
v.
ANDREW SAUL, COMMISSIONER OF SOCIAL SECURITY[1]
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 ...