“the Commissioner may discount or even disregard the opinion of a treating physician where other medical assessments are supported by better or more thorough medical evidence”
How later courts described this case
- “the Commissioner may discount or even disregard the opinion of a treating physician where other medical assessments are supported by better or more thorough medical evidence”
- the ALJ is not required to seek additional clarifying statements from a treating physician unless a crucial issue is undeveloped
- “[t]he ALJ is required to order medical examinations and tests only if the medical records presented to him do not give sufficient medical evidence to determine whether the claimant is disabled”
- a medical source opinion that Plaintiff is “disabled” or “unable to work” is an issue reserved for the ALJ
Written by the judges who cited it.
The opinion
IN THE UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF MISSOURI
WESTERN DIVISION
JOHN B. THOMPSON, )
)
Plaintiff, )
)
v. ) No. 4:17-00689-CV-RK
)
NANCY A. BERRYHILL, )
)
Defendant. )
ORDER
Before the Court is Plaintiff’s appeal brought under 42 U.S.C. § 405(g) seeking review of
Defendant Social Security Administration’s (“SSA”) denial of disability benefits as rendered in a
decision by an Administrative Law Judge (“ALJ”). For the reasons below, the decision of the ALJ
is AFFIRMED.
Standard of Review
The Court’s review of the ALJ’s decision to deny disability benefits is limited to
determining if the decision “complies with the relevant legal requirements and is supported by
substantial evidence in the record as a whole.” Halverson v. Astrue, 600 F.3d 922, 929
(8th Cir. 2010) (quoting Ford v. Astrue, 518 F.3d 979, 981 (8th Cir. 2008)). “Substantial evidence
is less than a preponderance of the evidence, but is ‘such relevant evidence as a reasonable mind
would find adequate to support the [ALJ’s] conclusion.’” Grable v. Colvin, 770 F.3d 1196, 1201
(8th Cir. 2014) (quoting Davis v. Apfel, 239 F.3d 962, 966 (8th Cir. 2001)). In determining
whether existing evidence is substantial, the Court takes into account “evidence that detracts from
the [ALJ’s] decision as well as evidence that supports it.” Cline v. Colvin, 771 F.3d 1098, 1102
(8th Cir. 2014) (citation omitted). “If the ALJ’s decision is supported by substantial evidence, [the
Court] may not reverse even if substantial evidence would support the opposite outcome or [the
Court] would have decided differently.” Smith v. Colvin, 756 F.3d 621, 625 (8th Cir. 2014) (citing
Davis v. Apfel, 239 F.3d 962, 966 (8th Cir. 2001)). The Court does not “re-weigh the evidence
presented to the ALJ.” Guilliams v. Barnhart, 393 F.3d 798, 801 (8th Cir. 2005) (citing Baldwin v.
Barnhart, 349 F.3d 549, 555 (8th Cir. 2003)). The Court must “defer heavily to the findings and
conclusions of the [ALJ].” Hurd v. Astrue, 621 F.3d 734, 738 (8th Cir. 2010) (citation omitted).
Discussion
By way of overview, Plaintiff suffers from the following severe impairments: degenerative
disc disease of the lumbar spine; osteoarthritis of the right shoulder; affective disorder; and anxiety
disorder. The ALJ also determined that Plaintiff has the following non-severe impairments:
hypertension; history of gastroesophageal reflux disease (GERD); and headaches. However, the
ALJ found that none of Plaintiff’s impairments, whether considered alone or in combination, meet
or medically equal the criteria of one of the listed impairments in 20 CFR Pt. 404. Subpt. P, App.
1 (“Listing”). Additionally, the ALJ found that despite his limitations, Plaintiff retained the
residual functional capacity (“RFC”) to perform light work as defined in 20 CFR 404.1567(b)
except Plaintiff cannot climb ladders, ropes, or scaffolds; can occasionally climb ramps and stairs;
can occasionally balance, stoop, kneel, crouch, and crawl; frequently reach overhead with the right
upper extremity; and can perform simple, routine tasks with occasional interaction with others,
such as supervisors, coworkers, and the general public. Although the ALJ found Plaintiff was
unable to perform any past relevant work, considering Plaintiff’s age, education, work experience,
and RFC, there are jobs that exist in significant numbers in the national economy that the Plaintiff
can perform.
Plaintiff presents the following arguments on appeal: (1) whether the ALJ properly
assessed the RFC on a function-by-function basis and whether he erroneously assessed exertional
levels first; (2) whether the ALJ properly weighed treating provider Dr. Lawrenzi’s opinion and
nurse Boyd’s opinion, (3) whether the ALJ’s RFC determination is supported by substantial
evidence regarding Plaintiff’s physical impairments and mental impairments; and (4) whether the
ALJ sustained his burden at step five.
First, substantial evidence supports the functional abilities and limitations included in the
RFC determination. Plaintiff argues the ALJ erred by listing the exertional level first in the RFC
and failing to include all functional limitations in the RFC. Plaintiff relies on three cases in support
of his position, but all three cases are distinguishable.1 The ALJ is not required to address every
1 Plaintiff relies on Hayes v. Astrue to support his contention that the RFC’s functional limitations
were insufficient to account for Plaintiff’s limitations. 2012 WL 393406, at *5 (W.D. Mo. Feb. 6, 2012).
However, Hayes is distinguishable because no functional limitations were presented in the Hayes RFC, but
here, the ALJ presented functional limitations in the RFC.
Plaintiff’s reliance on Brown v. Astrue is similarly displaced. 2010 WL 889835, at *25 (E.D. Mo.
Mar. 8, 2010). In Brown, the ALJ failed to include limitations in the RFC as to conditions resulting from
the plaintiff’s stroke and peripheral neuropathy, and the medical record clearly indicated limitations would
functional limitation; instead, the ALJ only need address limitations that result from the
individual’s medically determinable impairments. See Depover v. Barnhart, 349 F.3d 563, 567
(8th Cir. 2003) (the ALJ did not make “specific findings . . . as to sitting, standing, and walking,
[and] we do not believe that he [ALJ] overlooked those functions . . . the record reflects that the
ALJ implicitly found that [claimant] was not limited to these areas . . . all of the functions that the
ALJ specifically addressed in the RFC were those in which he found a limitation, thus giving us
some reason to believe that those functions that he omitted were those that were not limited”).
Here, the ALJ found no restrictions concerning Plaintiff’s ability to sit or walk; therefore, the ALJ
did not err by not including sitting or walking restrictions in the RFC.
Next, substantial evidence supports the ALJ’s decision to give treating provider Dr.
Lawrenzi’s opinion little weight because: (1) the portion of Dr. Lawrenzi’s opinion stating the
claimant cannot be gainfully employed is not a medical opinion and instead reserved for the ALJ;
(2) Dr. Lawrenzi’s opinion did not provide any specific functional limitations regarding Plaintiff’s
ability to work; and (3) his opinion is inconsistent with his treatment notes stating Plaintiff has
only “mild” degenerative disc disease. See Ellis v. Barnhart, 392 F.3d 988, 994-95 (8th Cir. 2005)
(a medical source opinion that Plaintiff is “disabled” or “unable to work” is an issue reserved for
the ALJ); Fentress v. Berryhill, 854 F.3d 1016, 1020 (8th Cir. 2017) (“the Commissioner may
discount or even disregard the opinion of a treating physician where other medical assessments are
supported by better or more thorough medical evidence”) (citations and quotations omitted);
Vossen v. Astrue, 612 F.3d 1011, 1016 (8th Cir. 2010) (the ALJ is not required to seek additional
clarifying statements from a treating physician unless a crucial issue is undeveloped); Prosch v.
Apfel, 201 F.3d 1010, 1013 (8th Cir. 2000) (affirming the ALJ’s decision “to discount or even
disregard the opinion of a treating physician where other medical assessments are supported by
result from the stroke and peripheral neuropathy regarding the plaintiff’s ability to reach, pull, and handle
items. Id. Therefore, the Court determined that the ALJ’s silence regarding the plaintiff’s reaching, pulling,
and handling limitations, despite the medical record suggesting otherwise, meant the ALJ had not
considered these limitations. Id. Here, unlike Brown, while the ALJ is silent regarding sitting or standing
limitations, the medical record does not suggest Plaintiff’s sitting or standing abilities would be limited.
Finally, Plaintiff’s reference to Proffitt v. Astrue is unavailing. 2009 WL 315690, at *3 (Feb. 6,
2009). In Proffitt, the ALJ did not address the plaintiff’s ability to sit, stand, or walk, and the Court
determined the medical evidence “clearly substantiates a lower extremity impairment” such that remand
was necessary to include this lower extremity limitation in the RFC. Id. However, here the medical
evidence does not substantiate a requirement that a specific limitation resulting from an impairment is
required in the RFC.
better or more thorough medical evidence, or where a treating physician renders inconsistent
opinions that undermine the credibility of such opinions”) (internal citations and quotations
omitted).
Next, substantial evidence supports the ALJ’s RFC concerning Plaintiff’s physical
impairments. Plaintiff argues the ALJ had a duty to develop the record concerning limitations
stemming from Plaintiff’s physical impairments. However, the ALJ was not required to develop
the record further or seek additional medical opinions because the record provided sufficient
information for the ALJ to determine whether Plaintiff was disabled. Barrett v. Shalala, 38 F.3d
1019, 1023 (8th Cir. 1994) (“[t]he ALJ is required to order medical examinations and tests only if
the medical records presented to him do not give sufficient medical evidence to determine whether
the claimant is disabled”). The medical record and testing indicates: (1) Plaintiff reported
improvement in sleep disturbances in February 2015 and no sleep disturbances at all in November
2015; (2) Plaintiff has not required any aggressive care or emergency treatment for physical
symptoms nor have his providers recommended such measures; (3) Plaintiff is able to perform
extensive activities of daily living including: preparing simple meals, watching television, driving
a car, and maintaining proper grooming and hygiene; (4) physical examinations show Plaintiff
moves all extremities normally; (5) an MRI indicated no significant central spinal canal or neural
foraminal stenosis at any level; and (6) Plaintiff indicated his low back pain is “much better
controlled” with a new medication regimen and he was satisfied with the level of pain control. See
KKC ex rel. Stoner v. Colvin, 818 F.3d 364, 372 (8th Cir. 2016) (the ALJ was not required to seek
additional information from treatment providers where the information from the medical source
did not list specific functional limitations, and the plaintiff’s medical records, function reports, and
testimony indicated plaintiff was able to perform work). Accordingly, substantial evidence
supports the ALJ’s RFC determination concerning Plaintiff’s physical impairments.
Next, substantial evidence supports the ALJ’s RFC determination concerning Plaintiff’s
mental impairments. Despite Plaintiff’s argument, the ALJ’s RFC restriction limiting Plaintiff to
simple routine tasks was sufficient to account for Plaintiff’s moderate restriction in concentration,
persistence, or pace. See Howard v. Massanari, 255 F.3d 577, 582 (8th Cir. 2001) (plaintiff’s
deficiencies in concentration, persistence, or pace were adequately captured in an RFC restriction
limiting plaintiff to simple, routine, repetitive tasks). Next, the ALJ appropriately weighed
Advanced Practice Registered Nurse (APRN) Boyd’s opinion concerning Plaintiff’s mental
functional abilities. The ALJ gave Ms. Boyd’s opinion little weight because her opinion was
inconsistent with her own treatment notes and the overall medical evidence;2 Ms. Boyd’s opinion
provided a disability determination, which is left to the Commissioner to decide;3 and Ms. Boyd
is not an acceptable medical source.4
Next, the ALJ appropriately considered and discounted Plaintiff’s GAF score of 45 when
the ALJ formulated the RFC. See Jones v. Astrue, 619 F.3d 963, 973 (8th Cir. 2010) (a GAF score
“is a subjective determination that represents the physician’s judgment of the [plaintiff’s] overall
level of functioning”) (citations omitted); Mabry v. Colvin, 815 F.3d 386, 391 (8th Cir. 2016)
(while “GAF scores may be relevant to the determination of disability based on mental
impairments, an ALJ may afford greater weight to medical evidence and testimony than to GAF
scores”) (citations and quotations omitted). The ALJ discounted the GAF score because it was
significantly based on the Plaintiff’s subjective complaints rather than from objective testing and
inconsistent with Plaintiff’s ability to complete a variety of activities of daily living.
Finally, substantial evidence supports the ALJ’s determination at step five that jobs exist
in the national economy that Plaintiff is able to perform considering his RFC, age, education, and
work experience. Plaintiff argues an unresolved inconsistency exists between the hypothetical
provided to the vocational expert and the RFC. Specifically, Plaintiff argues the vocational expert
incorrectly opined that Plaintiff is able to perform the work of small parts assembler (DOT
706.684-22) because the job of small products assembler “frequently works at bench as member
of assembly group assembling one or two specific parts and passing unit to another worker,” but
Plaintiff’s RFC restricts him to only occasional interaction with coworkers.5 The Court declines
2 Ms. Boyd opined that Plaintiff had marked limitations. However, Ms. Boyd’s medical findings
indicate that Plaintiff’s thoughts are linear and well-organized, he is oriented, has good insight and
judgment, is not suicidal, and is sleeping better. Further, she makes no referrals for more aggressive care.
Ms. Boyd’s opinions are also inconsistent with the overall record that found Plaintiff has not required any
aggressive, psychiatric hospitalization, or emergency treatment for mental symptoms nor have his providers
recommended such measures. Finally, Plaintiff is able to perform extensive activities of daily living.
3 Ms. Boyd opined that Plaintiff would be absent from work three times a month and there “was no
possibility for this patient to engage in meaningful work on a continuous basis.” (Doc. 7-3.)
4 Treadway v. Colvin, 2016 U.S. Dist. LEXIS 28329, at *70 (E.D. Mo. Mar. 7, 2016). However,
APRN’s are considered acceptable medical sources in cases filed after March 27, 2017. 20 C.F.R.
§ 404.1502.
5 The Department of Occupational Titles’ description for a Small Products Assembler is,
“[p]erforms any combination of following repetitive tasks on assembly line to mass produce small products
. . . . Frequently works at bench as member of assembly group assembling one or two specific parts and
to address the inconsistency issue because, despite any alleged error, Plaintiff does not dispute that
other jobs exist in significant numbers in the economy that Plaintiff can perform. The vocational
expert testified Plaintiff is also able to perform the following jobs: (1) price maker with 280,000
jobs in the United States and (2) inspector/hand packager with 38,000 jobs in the United States.
Accordingly, substantial evidence supports that the ALJ’s decision that Plaintiff can perform work
in the national economy.
Conclusion
Having carefully reviewed the record before the Court and the parties’ submissions on
appeal, the Court concludes that substantial evidence on the record as a whole supports the ALJ’s
decision.
IT IS THEREFORE, ORDERED that the decision of the ALJ is AFFIRMED.
s/ Roseann A. Ketchmark
ROSEANN A. KETCHMARK, JUDGE
UNITED STATES DISTRICT COURT
DATED: September 4, 2018
passing unit to another worker . . . May be assigned to different work stations as production needs require.”
DOT 706.684-022.