Ripson v. Commissioner of Social Security

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

ORLANDO DIVISION

KRISTIN B. RIPSON,

Plaintiff,

v. Case No.: 6:22-cv-288-KCD

COMMISSIONER OF SOCIAL

SECURITY,

Defendant.

/

ORDER

Plaintiff Kristin B. Ripson 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. 21; Doc. 24) and are not fully repeated here. In short,

Ripson filed her initial application for disability benefits in 2013. (Tr. 127.) Her

request was denied at all levels (Tr. 60) but appealed and remanded for the

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

been omitted in this and later citations.

Administrative Law Judge (ALJ) to consider additional evidence (Tr. 924,

1111-12). Meanwhile, Ripson had successfully filed a claim for disability

benefits beginning April 1, 2017. (Tr. 1111-12) Thus, the period at issue runs

from the date her alleged disability began on June 9, 2012, until April 1, 2017.

(Tr. 924.)

Following a hearing, the ALJ again found that Ripson was not disabled.

(Tr. 937.) 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 Ripson’s impairments qualified as severe,

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

with restrictions:

The claimant can stand and walk 4 hours total and sit

at least 6 hours. The claimant can never climb ladders,

ropes, or scaffolds, or work in high, exposed places. She

can occasionally climb ramps and stairs, stoop, kneel,

crouch, or crawl. She can occasionally work in close

proximity to moving, mechanical parts. She can

frequently reach in all directions, except only

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).

occasionally reach overhead. She can frequently

handle bilaterally. She can have frequent exposure to

temperature extremes, and vibrations. She can

perform simple routine tasks and maintain occasional

interactions with coworkers and the public.

(Tr. 933-34.) After considering the RFC and other evidence, including

vocational expert testimony, the ALJ ultimately concluded that Ripson would

be capable of successfully transitioning to other jobs that exist in significant

numbers in the national economy. (Tr. 937.) Thus, Ripson was not disabled as

that term is defined in this context. (Tr. 937.) She 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

Ripson argues on appeal that the ALJ did not properly consider some of

the medical opinions in the record. (Doc. 21 at 19.) Specifically, Ripson objects

to the ALJ’s analyses of Dr. Weiss, Dr. Gayles, and Dr. Vinuela. (Doc. 21 at 22-

30.)

The Social Security Regulations for evaluating medical opinions changed

in March 2017. Because Ripson’s claim was filed before that time, the prior

regulations apply. See Revisions to Rules Regarding the Evaluation of Medical

Evidence, 82 Fed. Reg. 5844-01, 2017 WL 168819 (Jan. 18, 2017).

“Medical opinions are statements from acceptable medical sources that

reflect judgments about the nature and severity of [the claimant’s]

impairment(s), including [her] symptoms, diagnosis and prognosis, what [she]

can still do despite impairment(s), and [her] physical or mental restrictions.”

20 C.F.R. § 404.1527(a)(1). The ALJ considers every medical opinion received

together with the rest of the relevant evidence. Id. § 404.1527(b)-(c). An ALJ

assesses a medical opinion by looking at several factors, including:

(1) examining relationship—giving more weight to

opinions from a medical source that has examined

the claimant than one that hasn’t;

(2) treatment relationship—generally giving more

weight to opinions from a medical source that

treats the claimant than one that doesn’t;

(3) supportability—giving more weight to opinions

supported by other evidence from the medical

source, particularly medical signs and laboratory

findings;

(4) consistency—giving more weight to opinions that

are consistent with the record as a whole;

(5) specialization—generally giving more weight to

opinions from a specialist about medical issues in

their area of specialty than to opinions from a

medical source who is not a specialist;

(6) any other factors that support or contradict the

medical opinion.

Id. § 404.1527(c)(1)-(6).

The second factor is particularly relevant for present purposes because

Ripson claims all three contested medical opinions come from treating sources.

(Doc. 21 at 26, 28.) The Eleventh Circuit set a “good cause” standard for

disregarding this kind of evidence:

Absent good cause, an ALJ is to give the medical

opinions of treating physicians substantial or

considerable weight. Good cause exists when the: (1)

treating physician’s opinion was not bolstered by the

evidence; (2) evidence supported a contrary finding; or

(3) treating physician’s opinion was conclusory or

inconsistent with the doctor’s own medical records.

With good cause, an ALJ may disregard a treating

physician’s opinion, but he must clearly articulate

[the] reasons for doing so.

Winschel, 631 F.3d at 1179. Finally, regardless of the ALJ’s ultimate

conclusion, she must state the weight given to each medical opinion. And the

ALJ must explain her reasoning in enough detail for a reviewing court to

determine whether she supported it with substantial evidence. Id.

With these legal standards as the backdrop, the medical opinions are

addressed in turn.

A. Dr. Weiss

Dr. Weiss, a neurologist, gave two medical opinions: first for the period

beginning 12/1/15 (Tr. 1355-58), and second for the period beginning 10/18/16

(Tr. 1557-60). In his first opinion, he stated Ripson had “probable” multiple

sclerosis and thus could walk one-half city block, could sit 15-20 minutes before

needing to stand up and only 2 hours out of a full workday, could stand for 5

minutes before needing to sit down and less than 2 hours of a full workday.

(Tr. 1356.) He also said Ripson would need to take unscheduled breaks, could

rarely twist or lift 10 pounds, and could never stoop, crouch, or squat. (Tr. 1356-

57.) Dr. Weiss estimated Ripson would be off-task 25% of the day or more and

would be absent from work more than 4 days per month. (Tr. 1358.) He left

several questions unanswered on the form used to submit this opinion. (Tr.

1355-58.)

The ALJ gave this opinion “very little weight, as it is inconsistent with

this physician’s later withdrawal of the [multiple sclerosis] diagnosis. Further

it is inconsistent with other opinions in the record that are well supported by

objective findings.” (Tr. 929.) This conclusion is improper, Ripson contends,

because Dr. Weiss never withdrew his diagnosis of “probable multiple

sclerosis.” (Doc. 21 at 23.)

The Court is not convinced by Ripson’s argument. Dr. Weiss later stated,

“I believe she has [relapsing-remitting multiple sclerosis], but I cannot be

certain,” and “I am not sure if this is [multiple sclerosis]—at this point we are

watching and waiting. We have offered her a second opinion.” (Tr. 932, 1417,

1443.) And in Dr. Weiss’s second opinion, in response to the question asking,

“does your patient has multiple sclerosis?” he did not check “yes” or “no.” (Tr.

1557.) Instead, he wrote “undetermined at this time.” (Tr. 1557.) Thus,

semantics aside, there is at least substantial evidence to support the ALJ’s

expressed lack of confidence in a multiple sclerosis diagnosis from Dr. Weiss.

This is especially true, as the ALJ noted, given other objective findings.

For example, Dr. Goldstein, a medical expert, testified that the record does not

support a diagnosis of multiple sclerosis and that, in his view, “Dr. Weiss says

there is not sufficient support of the diagnosis.” (Tr. 930, 968.) Other objective

evidence that contradicts Dr. Weiss’s opinion includes medical opinions from

Dr. Cooper and Dr. Goldstein finding Ripson to be far less limited. (Tr. 742-52,

928, 930, 967-71.)

Dr. Weiss’s second opinion included very similar limitations to his first.

(Tr. 1557-60.) The ALJ stated she gave “this opinion very little weight, as it is

inconsistent with treatment notes from 2016 showing the claimant had a

normal gait, muscle strength, station, sensation, and reflexes.” (Tr. 930.) This

inconsistency is seen when comparing the opinion with the treatment notes in

the transcript on pages 1460-61, 1466-67, and 1471. Although Dr. Weiss’s

treatment notes do also show some pain sensation and physical limitations,

they are different enough with the limitations in his medical opinion to create

a genuine inconsistency. See Simon v. Commm’r of Soc. Sec., 7 F.4th 1094, 1107

(11th Cir. 2021). And viewing the record as a whole, Dr. Weiss’s second medical

opinion is contradicted just as much as his first by Dr. Cooper’s and Dr.

Goldstein’s medical opinions.

Thus, it appears evidence supporting a contrary finding provided the

ALJ good cause to give less weight to a treating physician’s medical opinion.

And afterward, the ALJ properly relied on the factors of supportability and

consistency to evaluate Dr. Weiss’s medical opinion. This affords substantial

evidence.

B. Dr. Gayles

Dr. Gayles found Ripson could occasionally lift 10 pounds, could stand

and walk for less than 2 hours per day, and could sit for about 3 hours per day.

(Tr. 905-06, 928.) He further said Ripson could only sit for 10 minutes before

changing position and stand for 5 minutes before changing position; she would

need the ability to change position at-will and would sometimes need to lie

down at unpredictable intervals during a workday. (Tr. 905-06, 928.) Dr.

Gayles estimated that Ripson could never twist, stoop, crouch, or climb ladders

and could only occasionally climb stairs. (Tr. 905-08, 928.) He thought her

condition would limit Ripson’s reaching, pushing, pulling, kneeling, crawling,

and balancing abilities. (Tr. 905-08, 928.) Dr. Gayles opined her symptoms

would frequently interfere with simple work-related tasks and would cause her

to miss work more than 4 days per month. (Tr. 905-08, 928.) Finally, he

determined these symptoms began when she had an accident and fell in

December 2013. (Tr. 905-08, 928.)

The ALJ gave “this opinion little weight, as it is not supported by

objective evidence.” (Tr. 928.) As Ripson notes in her brief, the opinions of Dr.

Gayles and Dr. Weiss are similar. (Doc. 21 at 26.) Thus, the same objective

evidence (cited above) that is inconsistent with Dr. Weiss’s opinion would

contravene Dr. Gayles. Also, as the ALJ aptly noted, Dr. Gayles’s reliance on a

December 2013 sprained ankle is problematic because the record shows Ripson

was treated for this injury and her treatment provider noted improvement

shortly after. (Tr. 493-98, 928.)

For these reasons, there was good cause to give Dr. Gayles’s opinion less

weight as a treating physician. His opinion was not bolstered by the evidence

and, in fact, some evidence supported a contrary finding. Like with Dr. Weiss’s

medical opinion, the ALJ properly relied on the factors of supportability and

consistency to evaluate his medical opinion. Thus, there is substantial evidence

for the ALJ’s treatment of Dr. Gayles.

C. Dr. Vinuela

Dr. Vinuela gave at least three opinions, but Ripson argues the ALJ

erred in evaluating only one of them. (Doc. 21 at 27-29.) For the period between

January 2014 and March 2016, Dr. Vinuela found Ripson to be seriously

limited in several areas of mental functioning including her ability to:

remember work-like procedures, maintain regular attendance and be

punctual, sustain an ordinary routine without special supervision, complete a

normal workday and workweek without interruptions from her psychological

symptoms, perform at a consistent pace without an unreasonable number and

length of rest periods, and set realistic goals or make plans independently of

others. (Tr. 907-09, 927.) The form Dr. Vinuela used stated that a “serious

limitation” meant Ripson would be distracted from the relevant job activity for

11-40% of the time. (Tr. 907.) In Dr. Vinuela’s opinion, these limitations would

keep Ripson from work more than 4 days per month. (Tr. 907-09, 927.)

The ALJ gave this opinion little weight because “the limitations are

worded in vague terms.” (Tr. 927.) She is right. One category on the form,

“maintain attention for two hour segment,” was marked with simply a question

mark and no other rating. (Tr. 907.) Dr. Vinuela ranked several areas as simply

“N/A.” (Tr. 907-08.) And one category was marked with both a check mark in

the most serious limitation ranking but also the letters “N/A.” (Tr. 907.) What

was the ALJ to make of such imprecise descriptions? Dr. Vinuela could have

elaborated in the spaces left for him to explain the limitations and “include the

medical/clinical findings that support this assessment.” (Tr. 907-08.) Yet he

crossed these sections out with a line, indicating he intentionally left them

blank. (Tr. 907-08.) The only additional information Dr. Vinuela provided

responded to the question asking for any other reasons Ripson would struggle

to work at a regular job on a sustained basis. While the instructions directed

him to rely on his own examination, Dr. Vinuela reiterated Ripson’s subjective

response: “Pt complains of severe pain, anxiety, and depression.” (Tr. 908.) All

of this indicates it would be reasonable to conclude that this medical opinion

was too vague. See, e.g., Bloodsworth, 703 F.2d at 1240 (explaining that “the

opinion of a treating physician may be rejected when it is so brief and

conclusory that it lacks persuasive weight”); Williams v. Berryhill, No. CV 17-

00346-N, 2018 WL 3236052, at *7 (S.D. Ala. July 2, 2018) (finding good cause

to discount the opinion of a treating physician where the physician “did not

provide a detailed explanation for his assessment”).

There are other reasons that support the ALJ affording less weight to

Dr. Vinuela’s medical opinion. For example, as the ALJ noted, “it is not

sufficient for a treating source to merely circle limitation levels on a pre-

printed form. Rather, the degree of limitation indicated in the opinion must be

well supported by objective evidence and a recitation of evidence relied upon.”

(Tr. 927.) And conversely, an opinion unsupported by relevant evidence,

particularly medical signs and laboratory findings, will result in a finding of

reduced weight. 20 C.F.R. § 404.1527(c)(3). Finally, Dr. Vinuela’s opinion was

at least partially contradicted by mental assessments from other medical

sources including Dr. Gayles, Dr. Cooper, and Dr. Sullivan. (Tr. 523-24, 528,

742, 933, 1373.)

Thus, good cause exists here to give a treating physician’s medical

opinion less weight because Dr. Vinuela’s opinion was not bolstered by the

evidence and because it was conclusory. And like the last two medical opinions,

the ALJ properly relied on the factors of supportability and consistency to

evaluate Dr. Vinuela’s medical opinion. As a result, there is substantial

evidence to affirm the ALJ’s conclusion here as well.

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

Kristin Ripson and close the file.

ENTERED in Fort Myers, Florida this January 18, 2023.

a r ee

Lyte 6 Lash”

© Kale C. Dudek

United States Magistrate Judge

Copies: All Parties of Record

13