Belanger v. Commissioner of Social Security

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

FORT MYERS DIVISION

JOANNA BELANGER,

Plaintiff,

v. Case No.: 2:21-cv-924-KCD

COMMISSIONER OF SOCIAL

SECURITY,

Defendant.

/

ORDER

Plaintiff Joanna Belanger sues under 42 U.S.C. §§ 405(g) and 1383(c)(3)

for judicial review of the Commissioner of Social Security’s decision denying

her application for disability insurance benefits. (Doc. 1.)1 For the reasons

below, the Commissioner’s decision is affirmed.

I. Background

The procedural history, administrative record, and law are summarized

in the parties’ briefs (Doc. 25, Doc. 28) and are not fully repeated here. Belanger

filed for disability benefits claiming she could not work because of spinal

fusion, spinal stenosis, arthritis, fibromyalgia, anemia, headaches, and

1 Unless otherwise indicated, all internal quotation marks, citations, and alterations have

been omitted in this and later citations.

memory loss. (Tr. 71.) After her application was denied, Belanger sought

review by an administrative law judge. (Tr. 15.)

Following a hearing, the ALJ agreed that Belanger was not disabled.

(Tr. 25.) To make this determination, the ALJ used the multi-step evaluation

process established by the Commissioner. See 20 C.F.R. § 404.1520(a).2 The

ALJ found that although several of Belanger’s impairments qualified as severe,

she retained the residual functional capacity (“RFC”) to perform some work

with restrictions:

[She can] lift twenty pounds occasionally and ten

pounds frequently; she can stand/walk for six hours

per day and sit for six hours per day; she can never

climb ladders, ropes or scaffolds; she can occasionally

climb ramps and stairs, stoop, kneel, crouch and crawl;

she can frequently balance, reach, handle, finger and

feel; and she must avoid vibration, hazardous

machinery and heights.

(Tr. 17, 20.) After considering the RFC and other evidence, including vocational

expert testimony, the ALJ ultimately concluded that Belanger could perform

2 An individual claiming Social Security disability benefits must prove that she is

disabled. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). “The Social

Security Regulations outline a five-step, sequential evaluation process used to

determine whether a claimant is disabled: (1) whether the claimant is currently

engaged in substantial gainful activity; (2) whether the claimant has a severe

impairment or combination of impairments; (3) whether the impairment meets or

equals the severity of the specified impairments in the Listing of Impairments; (4)

based on a residual functional capacity assessment, whether the claimant can

perform any of his or her past relevant work despite the impairment; and (5) whether

there are significant numbers of jobs in the national economy that the claimant can

perform given the claimant’s RFC, age, education, and work experience.” Winschel v.

Comm’r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011).

her past relevant work as a city manager and administrative assistant. (Tr.

23.) The ALJ also found Belanger would be capable of successfully

transitioning to other jobs that exist in significant numbers in the national

economy. (Tr. 24.) Thus, Belanger was not disabled as that term is defined in

this context. (Tr. 25.)

Belanger further exhausted her administrative remedies, and this

lawsuit timely followed. (Doc. 1.)

II. Standard of Review

Review of the Commissioner’s (and, by extension, the ALJ’s) decision

denying benefits is limited to whether substantial evidence supports the

factual findings and whether the correct legal standards were applied. 42

U.S.C. § 405(g); see also Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir.

2002). Substantial evidence means “such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion.” Biestek v. Berryhill,

139 S. Ct. 1148, 1154 (2019). It is more than a mere scintilla but less than a

preponderance. Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005). The

Supreme Court recently explained, “whatever the meaning of ‘substantial’ in

other contexts, the threshold for such evidentiary sufficiency is not high.”

Biestek, 139 S. Ct. at 1154.

When determining whether the decision is supported by substantial

evidence, the court must view the record as a whole, considering evidence

favorable and unfavorable to the Commissioner. Foote v. Chater, 67 F.3d 1553,

1560 (11th Cir. 1995). The court may not reweigh the evidence or substitute its

judgment for that of the Commissioner. And even if the evidence preponderates

against the Commissioner’s decision, the reviewing court must affirm if the

decision is supported by substantial evidence. Bloodsworth v. Heckler, 703 F.2d

1233, 1239 (11th Cir. 1983). Finally, “[u]nder a substantial evidence standard

of review, [the claimant] must do more than point to evidence in the record that

supports [her] position; [she] must show the absence of substantial evidence

supporting the ALJ’s conclusion.” Sims v. Comm’r of Soc. Sec., 706 F. App’x

595, 604 (11th Cir. 2017).

III. Analysis

Belanger presses three arguments on appeal. First, she claims the ALJ

did not properly consider the medical opinion given by her primary care

physician, Dr. Humbarger. (Doc. 25 at 12.) Second, she says substantial

evidence does not support the ALJ’s RFC assessment. (Id. at 17.) And finally,

according to Belanger, the ALJ wrongly rejected her subjective complaints as

not credible. (Id. at 21.) These issues are addressed in turn.

A. Dr. Humbarger

Dr. Humbarger found Belanger has very limited functioning. For

example, he stated she has constant pain, can work in a sitting or standing

position for less than an hour, can sometimes lift or carry five pounds but never

over ten pounds, must rest for at least fifteen minutes every hour, and will

miss more than three days of work per month because of her health problems.

(Tr. 745-50.) But when asked to provide clinical and laboratory support for his

diagnoses, he gave none. (Tr. 745.)

When dealing with a medical opinion, the ALJ must consider its

persuasiveness using several factors: “(1) supportability; (2) consistency; (3)

relationship with the claimant, which includes (i) length of the treatment

relationship, (ii) frequency of examinations, (iii) purpose of the treatment

relationship, (iv) extent of the treatment relationship, and (v) examining

relationship; (4) specialization; and (5) other factors.” 20 C.F.R. § 404.1520c(a)

& (c)(1)-(5). Supportability and consistency “are the most important factors” in

determining persuasiveness. Id. § 404.1520c(b)(2). And because of their

importance, the ALJ must explain “how [he] considered the supportability and

consistency factors for a medical source’s medical opinions.” Id.

Put simply, the ALJ must assess the factors of supportability and

consistency for each medical opinion. “Supportability” refers to how well a

medical opinion is bolstered by objective medical evidence and explanations

provided by the medical source giving the opinion. “Consistency” is a measure

of how the medical opinion aligns with evidence from other sources (medical

and nonmedical). Id. § 404.1520c(c).

Here, the ALJ explained how he evaluated these factors:

The undersigned has considered the opinion of Dr.

Humbarger, M.D. (See Exhibit 15F). The opinion,

however, is not persuasive as it is contradicted by the

doctor’s own treatment notes, which do not show such

extreme limitations. (See Exhibits 6F and 16F). The

opinion is little more than a checklist and contains

little analysis or explanation. Moreover, it is

inconsistent with the overall medical record and the

opinions of the state’s medical experts.

(Tr. 22.) Substantial evidence underlies the ALJ’s supportability assessment.

This is most evident in the lack of supporting documentation in the medical

opinion itself, as noted above. But even setting aside the perfunctory nature of

Dr. Humbarger’s opinions, his treatment history only further undermines

Belanger’s position. For example, Dr. Humbarger’s treatment notes offer

almost no support for Belanger’s functional limitations. And Belanger

regularly reported to Dr. Humbarger that she “feels confident managing

chronic conditions.” (Tr. 751-73.) Finally, Belanger offers nothing to back up

her claim that Dr. Humbarger’s opinion was indeed supported.3 Thus, there is

no error in the ALJ’s supportability determination.

Substantial evidence favors the ALJ’s consistency finding too. For

example, the ALJ noted that other evidence in the record showed Belanger to

3 Belanger does claim Dr. Humbarger’s opinion meets the regulations’ requirement of

supportability and consistency (Doc. 25 at 16), but she continually conflates these two

concepts. As explained, they are not the same, and Belanger does nothing to show how

“objective medical evidence and supporting explanations presented by” Dr. Humbarger do, in

fact, support his opinion.

have a normal gait (Tr. 21, 350, 354, 729), no assistive devices (Tr. 21, 741),

full or nearly full strength in her extremities (Tr. 21, 729), and medication that

provides adequate pain relief (Tr. 21, 704). The state medical consultant, Dr.

Thomas Bixler4 found Belanger could often lift ten pounds (Tr. 66), could work

in a sitting or standing position for about six hours with normal breaks (Tr.

66), and had no postural or manipulative limitations (Tr. 66). On

reconsideration, state medical consultant Dr. Robert Nuss found the same but

with minor postural limitations. (Tr. 80-81.) Both medical consultants said

Belanger could perform light work, which included her previous work as she

actually performed it. (Tr. 67-68, 82-83.) Thus, substantial evidence exists to

find these opinions conflict with Dr. Humbarger’s.

At this point, because the ALJ addressed the required factors and cited

to substantial evidence to support his assessment, it is Belanger’s burden to

prove why substantial evidence does not exist. See Sims, 706 F. App’x at 604.

To meet this burden, Belanger argues that Dr. Humbarger’s opinion aligns

with medical evidence from PA Brett Griffin. And given this consistency, the

ALJ should have discussed Griffin’s opinions instead of ignoring them. (Doc.

25 at 13.) But despite the evidence she cites, there are elements of

inconsistency too. Griffin noted that Belanger is “able to move all extremities

4 Belanger incorrectly refers to this individual as “Dr. Bexley.” (Doc. 25 at 16-17.)

well with the exception of moderate back pain when getting up from a seated

position.” (Tr. 776.) Griffin also said her left upper arm pain “can occasionally

be quite debilitating” (Tr. 777), which contradicts Dr. Humbarger’s assessment

of “constant pain” (Tr. 749.) Finally, Griffin found Belanger has full strength

in her upper and lower extremities and was “hopeful that her axial neck pain

can [be] treated conservatively.” Thus, Griffin’s medical evidence is at least

inconsistent in part. But even more problematic on a fundamental level,

Griffin’s evidence is not a medical opinion and therefore the ALJ did not need

to discuss it to the extent Belanger argues. See 20 C.F.R. § 404.1513 (a)(2); Dye

v. Comm’r of Soc. Sec., No. 5:20-CV-459-NPM, 2022 WL 970186, at *4 (M.D.

Fla. Mar. 31, 2022) (noting the ALJ must consider medical evidence that does

not rise to the level of a medical opinion but need not articulate his thoughts

on it).

Belanger also argues the ALJ should have discussed other evidence, such

as CT scans, EMG/NCV studies, and the treatment notes of Dr. Satinderpaul

Satia and Dr. Morgan Callahan which are consistent with Dr. Humbarger’s

opinion. (Doc. 25 at 15-17.) But the ALJ did not have to refer to every piece of

evidence in the record. Mitchell v. Comm’r, Soc. Sec. Admin., 771 F.3d 780, 782

(11th Cir. 2014). And this argument does not address why the ALJ’s decision

is not supported by substantial evidence—it merely offers additional evidence

in her favor. See Sims, 706 F. App’x at 604. Belanger is essentially asking the

Court to reweigh the evidence, which is not allowed. Payne v. Weinberger, 480

F.2d 1006, 1007 (5th Cir. 1973) (“Resolution of conflicts in the evidence,

including conflicting medical opinions and determinations of credibility are not

for the courts; such functions are solely within the province of the Secretary.”)

At bottom, Belanger has failed to show any error with the ALJ’s assessment of

Dr. Humbarger.

B. Evidence Supporting the RFC

Next, Belanger argues substantial evidence does not support the RFC.

Specifically, she says the ALJ failed to address several items:

• her need for a sit/stand option while working,

• her migraine headaches,

• manipulation/handling limitations stemming from her

arm and shoulder pain, and

• side effects from her medication.

(Doc. 25 at 18-21.) Her claims implicate both steps two and four of the

sequential evaluation process described above. See supra footnote 2.

At step two, the ALJ must determine whether the claimant has a

medically determinable impairment that is “severe” or a combination of

impairments that is “severe.” 20 C.F.R. §§ 404.1520(c). The Eleventh Circuit

has described this analysis “as a screening or filter to eliminate groundless

claims.” Tuggerson-Brown v. Comm’r of Soc. Sec., 572 F. App’x 949, 951 (11th

Cir. 2014). Important for present purposes, an ALJ need not identify every

severe impairment. Id. “The finding of any severe impairment, based on either

a single impairment or a combination of impairments, is enough to satisfy step

two because once the ALJ proceeds beyond step two, he is required to consider

the claimant’s entire medical condition, including impairments the ALJ

determined were not severe.” Burgin v. Comm’r of Soc. Sec., 420 F. App’x 901,

902 (11th Cir. 2011).

At step four of the sequential evaluation process, the ALJ assesses a

claimant’s RFC and ability to do past relevant work. See 20 C.F.R. §§

404.1520(a)(4)(iv). The RFC, defined as the most the claimant can still do

despite her limitations, is based on an evaluation of all the relevant evidence

in the record. See id. §§ 404.1520(e), 404.1545(a)(1) and (a)(3); Social Security

Ruling (“SSR”) 96-8p, 1996 WL 374184 (July 2, 1996). The task of determining

a claimant’s RFC and ability to work rests with the ALJ, not a medical source.

See Moore v. Soc. Sec. Admin., Com’r, 649 F. App'x 941, 945 (11th Cir. 2016).

The Court first considers the lack of a sit/stand option in Belanger’s RFC.

The ALJ did not provide a sit/stand option, but this was only error if

substantial evidence does not support the omission. Dr. Humbarger’s opinion

seemed to indicate such an option would be required (if she could work at all).

(Tr. 747.) But, as noted above, the ALJ reasonably found Dr. Humbarger’s

opinion unpersuasive (Tr. 22), and the RFC is for the ALJ to decide—not the

doctor. Ultimately, substantial evidence supports the omission because the

state medical consultants opined Belanger could work either sitting or

standing for six hours (Tr. 66, 80-81), she denied having balance problems (Tr.

21, 322, 645), she has full strength in her upper and lower extremities (Tr. 403,

408, 677, 707, 713, 729, 741, 776, 794), she usually has a normal gait (Tr. 21,

350, 354, 729), she does not use assistive devices (Tr. 741), and she can walk

on her heels and toes (Tr. 777). Thus, a reasonable mind could conclude that a

sit/stand option was not needed within the RFC.

Next, Belanger claims the ALJ erred by failing to determine whether her

headaches are severe and by ignoring them in the RFC. As an initial matter,

the ALJ was not required to decide on the severity of her headaches because

he found at least one impairment severe. (Tr. 17); Tuggerson-Brown, 572 F.

App’x at 951. And in building the RFC, the ALJ stated he considered all of

Belanger’s symptoms, specifically noting her headaches. (Tr. 20.) Further,

although Belanger complained of headaches to her medical care providers, she

does not allege they cause any functional limitations which could be accounted

for in an RFC. Thus, there is no error here either.

Belanger’s claim the RFC needed manipulative or handling limitations

because of her arm and shoulder pain is similarly unpersuasive. The record

shows Belanger had more than the 90 degrees of arm rotation (Tr. 402, 405-

06) and full or nearly full grip and extremity strength (Tr. 21, 729, 776.) But

even setting that aside, the ALJ noted that Belanger has arthritis in her hands

and weakness in her finger flexors. (Tr. 21.) So he reduced her RFC

accordingly. (Tr. 21.)

Finally, Belanger declares the ALJ should have included mental

limitations to account for the drowsiness caused by her medications. But the

ALJ explained how he evaluated Belanger’s medicinal side effects and why he

did not account for them further in the RFC:

Although the claimant alleges side effects from

medication, the undersigned has considered the type,

dosage, effectiveness, and side effects of any

medication the claimant takes to alleviate pain or

other symptoms. The medical record contains few, if

any, complaints of side effects to a medical source and

the undersigned concludes that any side effects are not

so significant they justify a further reduction of the

claimant’s residual functional capacity. One would

expect that if the claimant’s side effects were truly

significant, then she would have at least mentioned

them more often. Moreover, the record shows the

claimant’s medical provider specifically noted the

claimant’s medications do not have side effects for her.

(See Exhibit 14F at page 2).

(Tr. 22.) Although Belanger correctly notes that she reported side effects

multiple times to Dr. Callahan who then adjusted the medications in response,

it is noteworthy that Dr. Callahan remarked on her final visit: “The

medications prescribed give the patient adequate pain relief without

significant side effects.” (Tr. 704.) Few complaints by the patient and little

concern from the prescribing doctor is substantial evidence for an ALJ to not

consider medicinal side effects in the RFC. Swindle v. Sullivan, 914 F.2d 222,

226 (11th Cir. 1990).

One last thing on this argument. Belanger contends that because the

ALJ did not consider the issues above, proper questions were not addressed to

the vocational expert. (Doc. 25 at 19-21.) But because the ALJ did not err in

forming the RFC and then putting it to the vocational expert, this point is moot.

C. Rejection of Belanger’s Subjective Complaints as Not Credible

Last, Belanger argues that substantive evidence does not support the

ALJ’s finding that her subjective complaints were not credible. (Doc. 25 at 21.)

The Eleventh Circuit recently reiterated the standard used to evaluate this

argument:

A claimant may establish that [s]he has “a disability

through [her] own testimony of pain or other

subjective symptoms.” Dyer v. Barnhart, 395 F.3d

1206, 1210 (11th Cir. 2005). In such a case, the

claimant must show evidence of an underlying medical

condition and either “objective medical evidence that

confirms the severity of the alleged pain arising from

that condition” or “that the objectively determined

medical condition is of such a severity that it can be

reasonably expected to give rise to the alleged pain.”

Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991).

Once a claimant has made this showing, the

Commissioner “must then evaluate the intensity and

persistence of [the claimant’s] symptoms” in light of

“all available evidence,” including the claimant’s

testimony. 20 C.F.R. § 404.1529(c)(1). The

Commissioner “will not reject” a claimant’s statements

“solely because the available objective medical

evidence does not substantiate” the statements. Id. §

404.1529(c)(2). Instead, the ALJ considers several

“[o]ther factors concerning [the claimant’s] functional

limitations and restrictions due to pain and other

symptoms.” Id. § 404.1529(c)(3)(i)-(vii).

If a claimant provides subjective testimony on the

severity of his symptoms, as [the claimant] did here,

the ALJ “must articulate explicit and adequate

reasons” for rejecting the complaints. Foote v. Chater,

67 F.3d 1553, 1561-62 (11th Cir. 1995). The ALJ’s

“credibility determination does not need to cite

particular phrases or formulations[,] but it cannot

merely be a broad rejection” that fails to consider a

claimant’s “medical condition as a whole.” Dyer, 395

F.3d at 1210-11 (cleaned up). We will not disturb “[a]

clearly articulated credibility finding with substantial

supporting evidence in the record.” Foote, 67 F.3d at

1562.

Taylor v. Comm’r of Soc. Sec., No. 21-12804, 2022 WL 1634086, at *5-6 (11th

Cir. May 24, 2022).

Here, the ALJ reiterated this formula, followed it, and cited to

substantial evidence to support his findings. (Tr. 20.) He noted Belanger has

“medically determinable impairments [that] could reasonably be expected to

cause some of the alleged symptoms.” (Tr. 20.) Then, the ALJ considered “the

medical evidence and other evidence in the record” to evaluate the “intensity,

persistence, and limiting effects of these symptoms.” (Tr. 20-21.) Ultimately,

he concluded Belanger’s statements about these symptoms conflict with the

evidence. (Tr. 20-21.) Thus, the question is whether the ALJ’s explanation for

this credibility finding is “clearly articulated . . . with substantial supporting

evidence in the record.” Foote, 67 F.3d at 1562.

The ALJ could not have been clearer:

As for the claimant’s statements about the intensity,

persistence, and limiting effects of his or her

symptoms, they are inconsistent with the record. The

complaints are not fully supported by the objective and

longitudinal medical evidence. The severity of the

claimant’s subjective pain and functional limitations

are out of proportion to the objective findings and

recommended course of treatment.

(Tr. 21.) He then cited this evidence. For example, despite alleging that she

needs to use a cane, Belanger reported that she has normal gait, has no balance

problems, and does not need assistive devices. (Tr. 21, 322, 350, 354, 645, 729,

741.) She is currently being treated with medication for her pain which her

provider most recently noted gives adequate relief with few or no side effects.

(Tr. 22, 704.) Finally, the state medical consultants found Belanger over-

endorsed her symptoms which they concluded were not severe. (Tr. 22, 65, 79.)

Thus, objective medical evidence and Belanger’s own statements provide

substantial grounds for the ALJ’s credibility finding. This is enough to affirm.

See Taylor, 2022 WL 1634086, at *6.

IV. Conclusion

Considering the record as a whole, substantial evidence supports the

ALJ’s findings. Accordingly, the Court AFFIRMS the Commissioner’s decision

and directs the Clerk to enter judgment for the Commissioner and against

Joanna Belanger and close the file.

ENTERED in Fort Myers, Florida this December 22, 2022.

Lhe a 7 a Z

kfleC. Dudek

United States Magistrate Judge

Copies: All Parties of Record

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