The opinion
IN THE UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF MISSOURI
ST. JOSEPH DIVISION
DALLAS NAUMAN,
Plaintiff,
v. No. 5:18-cv-06159-NKL
ANDREW SAUL,
Commissioner of Social Security,
Defendant.
ORDER
Plaintiff Dallas Nauman seeks review of the decision by Defendant denying his claim for
Supplemental Security Income. For the reasons set forth below, the Court affirms the ALJ’s
decision.
I. BACKGROUND
Nauman filed an application for Supplemental Security Income on July 13, 2016 and
Disability Insurance Benefits on August 12, 2016 under Titles XVI and II of the Social Security
Act, respectively. Tr. 155–59, 163–64. Nauman claims he became disabled on June 18, 2016,1
Tr. 30, and listed the following causes of his disability: chronic nausea, stomach and abdomen
pain, lymphoma stomach cancer in remission, digestive issues, frequent vomiting, multiple
stomach surgeries, chronic fatigue and confusion, problems with bending, stooping, standing, and
walking, and weakness in his lumbar back, Tr. 185. Shortly after his alleged onset date, he reported
taking, pursuant to prescriptions, Baclofen for pain, Norco, Pepcid and Viokase for digestive
1 Nauman originally claimed he became disabled April 7, 2015, Tr. 156, but Mr. Nauman amended
his alleged onset date during his hearing before the ALJ, Tr. 30.
issues, Promethazine and Zofran for nausea, Xanax for anxiety and Pamelor for depression. Tr.
188. He has an eighth-grade education level and had worked in construction for approximately 20
years, but he stopped working in 2013 due to his condition. Tr. 186–87.
The Administrative Law Judge (ALJ) concluded, after a hearing, that Plaintiff had the
following severe impairments: left hip fracture, status post pinning, osteoarthritis of the right
thumb, gastroesophageal reflux disease, gastroparesis, pancreatitis, reactive gastropathy, peptic
ulcer disease, sun sensitivity, history of fibromyalgia/myofasciitis, history of chronic obstructive
disorder, learning disorder, alcohol abuse/dependence, and cognitive neurological disorder due to
past chemotherapy. Tr. 13. The ALJ nonetheless concluded that Nauman retained the residual
functional capacity (“RFC”) to perform work as follows:
sedentary work . . . including the ability to lift and carry up to 10 pounds
occasionally, stand and/or walk up to 2 hours in an 8 hours workday, and sit up to
6 hours in an 8 hour workday. The claimant can never climb ladders, ropes or
scaffolds, balance, kneel, crouch or crawl, but he can occasionally climb ramps and
stairs, and stoop. The claimant can frequently handle and finger with the right hand.
He must avoid extreme cold weather, extreme heat, exposure to sunlight, humidity,
and excessive vibration. The claimant must avoid irritants, such as fumes, odors,
dust, gases and poorly ventilated areas. He must also avoid operational control of
moving machinery, unprotected heights and hazardous machinery. Due to his
mental impairments, the claimant is limited to simple, routine and repetitive tasks,
which may required detailed instructions, but do not involve complex tasks. The
work must be in an environment free of fast-paced production requirements and
involve only simple, work-related decision, and few, if any, work place changes.
He cannot have any interaction with the public. He can work around co-workers,
but he can have only occasional interaction with co-workers.
Tr. 14. Based on the testimony of a vocational expert, the ALJ concluded that Nauman’s RFC
would allow him to work as a lens inserter, wire wrapper, and production checker—jobs that exist
in significant numbers in the national economy. Tr. 19. The ALJ therefore concluded that Nauman
was not under a “disability” as that term is defined in the Act. Tr. 10–20. As the Appeals Council
subsequently denied Plaintiff’s request for review, Tr. 1–4, the ALJ’s decision constitutes the final
decision of the Commissioner subject to judicial review.
II. STANDARD
The Court must affirm the Commissioner’s denial of social security benefits “if substantial
evidence in the record as a whole supports the ALJ’s decision.” Milam v. Colvin, 794 F.3d 978,
983 (8th Cir. 2015). “Substantial evidence is less than a preponderance, but is enough so that a
reasonable mind would find it adequate to support the ALJ’s conclusion.” Singh v. Apfel, 222 F.3d
448, 451 (8th Cir. 2000). “[A]s long as substantial evidence in the record supports the
Commissioner’s decision, [the Court] may not reverse it because substantial evidence also exists
in the record that would have supported a contrary outcome, or because [the Court] would have
decided the case differently.” Andrews v. Colvin, 791 F.3d 923, 928 (8th Cir. 2015) (quotation
marks and citation omitted). The Court must “defer heavily to the findings and conclusions of the
Social Security Administration.” Michel v. Colvin, 640 F. App’x 585, 592 (8th Cir. 2016)
(quotation marks and citations omitted).
III. DISCUSSION
Nauman argues that the ALJ failed to provide reasons supported by substantial evidence
for discounting the opinion of Nauman’s treating oncologist and an examining phycologist, and
that the ALJ failed to develop the record as to Nauman’s mental abilities before formulating an
RFC assessment. Nauman contends that these errors make the RFC deficient, and therefore
remand is appropriate.
The RFC is “the most a claimant can still do despite [his] physical or mental limitations.”
Swink v. Saul, 931 F.3d 765, 769 (8th Cir. 2019) (quoting 42 U.S.C. § 404.1520(a)(1)). An RFC
must be “based on all of the relevant evidence, including the medical records, observations of
treating physicians and others, and an individual’s own description of [his] limitations.” Myers v.
Colvin, 721 F.3d 521, 527 (8th Cir. 2013) (quotations omitted). In determining the RFC, “a
treating physician’s opinion is generally entitled to substantial weight,” but such an opinion “does
not automatically control in the face of other credible evidence on the record that detracts from
that opinion.” Brown v. Astrue, 611 F.3d 941, 951 (8th Cir. 2010) (quoting Heino v. Astrue, 578
F.3d 873, 880 (8th Cir. 2009)). When “discount[ing] a treating physician’s opinion, [the ALJ]
should give good reasons for doing so.” Id.
Dr. Raj Rangineni, Nauman’s treating oncologist, provided the following medical
opinions: a brief letter dated January 8, 2014, Tr. 610; a check-the-box form titled “MEDICAL
SOURCE STATEMENT – MENTAL” and a similar “MEDICAL SOURCE STATEMENT –
PHYSICAL” that was accompanied by a written explanation of Nauman’s treatment and
symptoms, each dated October 13, 2016, Tr. 528–33; and another set of source statements similar
to those submitted in October 2016 that were dated December 5, 2017, Tr. 543–48.
These opinions generally advised that Nauman could occasionally lift up to 10 pounds,
occasionally use his hands or arms, stand for up to two hours in a day and sit for four hours, but
would need to change positions every 15 minutes, would require frequent breaks, would be off-
task 25% of the time and absent at least four days per month. Tr. 532–33, 544–45. The ALJ
afforded “partial weight” to Dr. Rangineni’s opinion, incorporating his recommended limits on
lifting, standing and walking in the RFC, but not Dr. Rangineni’s recommendations regarding
nonexertional limits, Nauman’s ability to sit or be on task, or Dr. Rangineni’s opinion regarding
Nauman’s likely absences from work. Tr. 17. The ALJ concluded that, unlike the some of the
physical limitations set forth by Dr. Rangineni,
the limitations in sitting and other nonexertional limitations that would warrant a
finding of disability are not supported by the mild objective findings on
examination or tests. The claimant even testified that he does not really have issues
with sitting. Further, the limitations regarding sitting, being off task and having
frequent absences are not supported by Dr. Ragineni’s [sic] his own treatment notes
or the overall evidence. Moreover, these opinions are often vague and conclusory
statements without any medical findings to support them. . . . Furthermore, Dr.
Ragineni indicated in January 2014 that the claimant had treated lymphoma with
chemotherapy and radiation therapy and continues to have chronic issues with
pancreatitis and pain . . . but this statement is not an opinion and was made well
before the claimant’s alleged amended onset date and not regarding the pertinent
period.
Tr. 17.
Nauman contends that the ALJ erred by failing to specify which tests or examinations the
ALJ deemed mild and inconsistent with Dr. Rangineni’s opinion or how they related to Nauman’s
functioning, particularly with respect to Nauman’s gastroparesis. Doc. 9, p. 11. However, in
discussing Nauman’s allegations regarding his abdomen, nausea and vomiting, the ALJ compared
two upper GI endoscopies, and noted that despite new complaints of diarrhea in 2017, the test
returned essentially the same findings and did not result in additional treatment. Tr. 15, 642–43,
656–57. The ALJ also considered a CT scan of Nauman’s abdomen and pelvis, which showed
mild prominence of the proximal small bowel without evidence of high-grade obstruction and no
mass, and concluded that the results did not support additional physical restrictions. Tr. 15, 741.
The ALJ also emphasized that Nauman usually reports levels of pain between 2 and 4, where 10
is the highest, and also indicated that his pain medication improves his functioning. Tr. 16, 292–
320, 612–24. Regarding Nauman’s hip fracture, the ALJ discussed x-rays showing screw fixation
and satisfactory alignment, Tr. 16, 555, 557, and found that objective evidence consistent with
Nauman’s own reports to his doctor that he was “doing well” with “no complaints.” Tr. 502–04.
Finally, the ALJ noted that an MRI of the brain was inconsistent with Nauman’s alleged memory
problems. Tr. 16, 561. Thus, the ALJ both specified which objective tests or examinations were
inconsistent with the more restrictive limitations set forth in Dr. Rangenini’s opinion.
Second, Nauman argues that the ALJ erred by failing to indicate what evidence
contradicted, or failed to support, Dr. Rangineni’s opinion regarding Nauman’s ability to sit, stay
on task and be present at work. Doc. 9, p. 12. However, in addition to the evidence discussed
above regarding Nauman’s digestive issues and pain, the ALJ highlighted evidence in the record
indicating that Nauman spent much of 2016 doing construction work and concluded that such work
“suggest[s] that [Nauman] is much more physically capable than alleged.” Tr. 16–17,
B20F/1,10,16. This analysis supports the ALJ’s conclusions that parts of Dr. Rangineni’s opinion
are not supported by the record.
More specifically, Nauman argues Dr. Rangineni’s opinion regarding ability to stay on task
and be present is supported by Dr. Rangineni’s documentation of Nauman’s digestive issues and
records showing that Nauman was treated by a gastroenterologist and pain management specialist.
However, Dr. Rangineni’s records generally show only mild complaints, if any, regarding
gastrointestinal issues. See, e.g., Tr. 749–50 (“Denies any nausea or vomiting. No constipation.
Mild diarrhea . . . Complains of mild diarrhea at this point” in January 2017), 760 (“Denies any
nausea or vomiting. No constipation. No diarrhea” in December 2016), 769 (same in October
2016), 264 (same in March 2015), 276 (same in November 2014 but adding “Abdominal pain in
left flank area”), 290 (“No constipation, No diarrhea. Nausea. Abdominal pain post pancreatitis,
improving” in July 2014). Moreover, records from Nauman’s pain specialist indicate that
medication managed and controlled Nauman’s pain, Tr. 16, and records from Nauman’s
gastroenterologist show that Zofran and Phenergan treat Nauman’s nausea “pretty well,” Tr. 659.
Finally, the treatment recommended by Nauman’s gastroenterologist suggests that Nauman’s
conditions are mild. Tr. 643 (“Discharge patient to home. Await pathology. Return to my office
in 6 months.”), 647 (“Use fiber, for example Citrucel, Fibercon, Konsyl or Metamucil.”), 653
(prescribing dicyclomine for abdominal pain and diarrhea, noting that Nauman “is not particularly
compliant with dietary modification for his gastroparesis” but to continue with Zofran as needed),
657 (“discharge patient to home. Gastroparesis diet. Use metoclopramide.”).
Therefore, the ALJ provided reasons for discounting portions of Dr. Rangineni’s opinion
regarding Nauman’s physical limitations, and those reasons were adequately supported by the
record as a whole.
With respect to his mental limitations, Nauman argues that the ALJ erred by finding Dr.
Rangineni’s opinion regarding Nauman’s confusion and memory problems to be outside Dr.
Rangineni’s area of expertise and argues that the ALJ failed to specify what kind of mental health
treatment would have supported Dr. Rangineni’s opinion. Dr. Rangineni advised that Nauman
suffers from memory lapses and confusion, conditions that may be related to his past
chemotherapy. Tr. 531, 543. He further noted that some of the medications prescribed for
Nauman’s physical conditions cause drowsiness. Tr. 531, 543. Based on these issues, Dr.
Rangineni advised that Nauman has marked limitations in his ability to understand and remember
and his ability to maintain sustained concentration and persistence. As with his opinions regarding
Nauman’s physical limitations, Dr. Rangineni further advised that Nauman would be “off task”
approximately 25% of the time or more and miss four days of work per month. Tr. 528–29, 547–
48.
The ALJ gave “little weight” to Dr. Rangineni’s opinion regarding Nauman’s mental
limitations. Tr. 17. Specifically, the ALJ said that confusion and memory lapses “are not medical
diagnoses, as indicated, and are opinions regarding mental symptoms, which are outside [Dr.
Rangineni’s] area of expertise.” Id. The ALJ also found that the “limitations regarding . . . being
off task and having frequent absences are not supported by . . . his own treatment notes or the
overall evidence,” stated that “[t]he medical evidence of record contains little to no
contemporaneous medical health treatment notes supporting such restrictive limits, but only
contains Medical Source Statements” based on subjective evidence, and described Dr. Rangineni’s
opinion as conclusory. Id. However, the ALJ noted that Dr. Rangineni’s opinion had not been
ignored, id., and limited the Nauman’s RFC to simple, routine and repetitive tasks in an
environment that is free of fast-paced production requirements and requires only simple, work-
related decisions. Tr. 14.
There is substantial evidence in the record as a whole to support the ALJ’s decision to
discount, in part, Dr. Rangineni’s opinion on mental limitations. First, Dr. Rangineni’s opinion
relied on Nauman’s subjective complaints. Tr. 16. With respect to Nauman’s subjective account
of his symptoms, the ALJ specifically provided reasons to conclude the severity of his limitations
were not as great as Nauman alleged. The ALJ repeatedly relied on his ability to work various
temporary jobs. Tr. 16–18. As noted above, the record reflects that Nauman was “working
regularly over the summer doing construction” in 2017, Tr. 612, and appears to have been working
since at least as early as December 2016, Tr. 618, 621. Based in part on this evidence, the ALJ
concluded that Nauman was, indeed, able to work after his alleged onset date, and that his mental
limitations did not preclude him from “performing simple, routine, and repetitive work” as
described in the RFC. Tr. 16. Especially because this time frame coincides with the time in which
Nauman first reported his confusion, Tr. 797, the record supports the ALJ’s conclusion that
Nauman’s confusion and memory issues were not disabling.2
2 The Court would reach the same conclusion even if the ALJ erred by discounting Dr. Rangineni’s
opinion based on his lack of mental health expertise. Given the other reasons for the ALJ’s
decision to discount Dr. Rangineni’s opinion, it is clear that any such error is harmless.
For similar reasons, the Court finds the ALJ’s decision to discount the opinion of Bill
Graham, PhD, is supported by substantial evidence. This is especially so given the extreme
limitations contained in Dr. Graham’s opinion. (Tr. 18, 537-539)
Finally, Nauman argues that the ALJ should have developed the record with respect to his
mental limitations before determining the RFC. According to Nauman, additional development is
required because the ALJ found that Nauman had cognitive and psychiatric conditions that
constitute severe impairments, and the ALJ discounted the medical source opinions that addressed
Nauman’s mental limitations. However, while a claimant’s “RFC is a medical question that must
be based on ‘some medical evidence[,]’” Julin v. Colvin, 826 F.3d 1082, 1089 (8th Cir. 2016), it
need not be supported by a specific medical opinion. Myers, 721 F.3d at 526–27. Here, the ALJ
incorporated portions of the medical source opinions in to the RFC—but only those that were
supported by the medical evidence and the record as a whole—and made a determination that is
supported by substantial evidence. Accordingly, the ALJ did not err by failing to further develop
the record.
IV. CONCLUSION
Because it is supported by substantial evidence in the record as a whole, the Court affirms
the ALJ’s decision.
s/ Nanette K. Laughrey
NANETTE K. LAUGHREY
United States District Judge
Dated: August 29, 2019
Jefferson City, Missouri