noting a distinction between the use of a “medically required hand-held assistive device” and the use of a cane that “was not prescribed by any physician”
How later courts described this case
- noting a distinction between the use of a “medically required hand-held assistive device” and the use of a cane that “was not prescribed by any physician”
- district court summarily affirmed the ALJ
- explaining that a treating physician’s opinion that consists of “conclusory statements—checked boxes, circled answer, and brief fill-in-the-blank responses” and “cite[s] no medical evidence and provide[s] little to no elaboration” can be rejected on that basis alone
Written by the judges who cited it.
The opinion
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION
STACEY HARGER, )
)
Plaintiff, )
v. ) Case No. 4:24-cv-01302-SEP
)
FRANK BISIGNANO,1 )
)
Defendant. )
MEMORANDUM AND ORDER
This is an action under 42 U.S.C. § 405(g) for judicial review of the final decision of
Defendant Frank Bisignano, the Commissioner of Social Security, denying the application of
Plaintiff Stacey Harger for Supplemental Security Income (SSI) under Title XVI of the Social
Security Act (Act), 42 U.S.C. §§ 1381, et seq. Because there is substantial evidence to support
the decision, the Court will affirm the Commissioner’s denial of Plaintiff’s application.
I. BACKGROUND
On September 21, 2015, Plaintiff filed for SSI (Tr. 297-302), alleging that she had been
unable to work due to disability since January 1, 2015. (Tr. 304). She alleged disability due to
congestive heart failure, high blood pressure, diabetes type II, joint disease, cholesterol,
Takahara’s disease, and kidney disease. (Tr. 325). Her application was initially denied, and she
requested review of that decision by an Administrative Law Judge (ALJ). (Tr. 131-40). On May
29, 2018, after a hearing at which Plaintiff was represented by counsel, ALJ Julian Cosentino
issued a decision finding that Plaintiff had not been under a disability, as defined in the Act,
since August 21, 2015, when she filed her application. (Tr. 105-22). Plaintiff requested review
from the SSA Appeals Council, which vacated the ALJ’s decision and remanded for the ALJ to
give further consideration to treating source opinion and explain the weight given to such
evidence, and to give further consideration to Plaintiff’s maximum residual functional capacity
during the entire period at issue, taking into consideration the treating source opinion. (Tr.
123-27).
1 Frank Bisignano became Commissioner for the Social Security Administration in May 2025. Pursuant
to Federal Rule of Civil Procedure 25(d), Bisignano is substituted as Defendant in this suit. See 42 U.S.C.
§405(g).
On December 1, 2022, after another hearing, ALJ Chandreka Allen issued a decision
finding again that Plaintiff had not been under a disability, as defined in the Act, since she filed
her application. (Tr. 6-20). Plaintiff requested review of the ALJ’s decision, which the SSA
Appeals Council denied on August 11, 2023. (Tr. 1-5, 295-96). The ALJ’s decision of
December 1, 2022, stands as the Commissioner’s final decision.
II. STANDARD FOR DETERMINING DISABILITY UNDER THE ACT
To be eligible for benefits under the Act, a claimant must prove she is disabled. Pearsall
v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001); Baker v. Sec’y of Health & Human Servs.,
955 F.2d 552, 555 (8th Cir. 1992). The Act defines as disabled a person who is unable “to
engage in any substantial gainful activity by reason of any medically determinable physical or
mental impairment which can be expected to result in death or which has lasted or can be
expected to last for a continuous period of not less than 12 months.” 42 U.S.C.
§ 1382c(a)(3)(A); see also Hurd v. Astrue, 621 F.3d 734, 738 (8th Cir. 2010). The impairment
must be “of such severity that he is not only unable to do his previous work but cannot,
considering his age, education, and work experience, engage in any other kind of substantial
gainful work which exists in the national economy, regardless of whether such work exists in the
immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he
would be hired if he applied for work.” 42 U.S.C. § 1382c(a)(3)(B).
To determine whether a claimant is disabled, the Commissioner engages in a five-step
evaluation process. See 20 C.F.R. §§ 404.1520(a), 416.920(a);2 see also McCoy v. Astrue, 648
F.3d 605, 611 (8th Cir. 2011) (discussing the five-step process). At Step One, the Commissioner
determines whether the claimant is currently engaging in “substantial gainful activity”; if so, then
she is not disabled. 20 C.F.R. §§ 404.1520(a)(4)(i); McCoy, 648 F.3d at 611. At Step Two, the
Commissioner determines whether the claimant has a severe impairment, which is “any
impairment or combination of impairments which significantly limits [the claimant’s] physical or
mental ability to do basic work activities”; if the claimant does not have a severe impairment, she
is not disabled. 20 C.F.R. §§ 404.1520(a)(4)(ii), 404.1520(c); McCoy, 648 F.3d at 611. At Step
Three, the Commissioner evaluates whether the claimant’s impairment meets or equals one of
the impairments listed in 20 C.F.R. Part 404, Subpart P, Appendix 1 (the “listings”). 20 C.F.R.
§§ 404.1520(a)(4)(iii); McCoy, 648 F.3d at 611. If the claimant has such an impairment, the
2 All references are to the version of the regulations in effect on the date of the ALJ’s decision.
Commissioner will find the claimant disabled; if not, the Commissioner proceeds with the rest of
the five-step process. 20 C.F.R. §§ 404.1520(d); McCoy, 648 F.3d at 611.
Prior to Step Four, the Commissioner must assess the claimant’s “residual functional
capacity” (RFC), which is “the most a claimant can do despite [her] limitations.” Moore v.
Astrue, 572 F.3d 520, 523 (8th Cir. 2009) (citing 20 C.F.R. § 404.1545(a)(1)); see also 20 C.F.R.
§§ 404.1520(e). At Step Four, the Commissioner determines whether the claimant can return to
her past relevant work by comparing the claimant’s RFC with the physical and mental demands
of the claimant’s past relevant work. 20 C.F.R. §§ 404.1520(a)(4)(iv), 404.1520(f); McCoy, 648
F.3d at 611. If the claimant can perform her past relevant work, she is not disabled; if the
claimant cannot, the analysis proceeds to the next step. Id. At Step Five, the Commissioner
considers the claimant’s RFC, age, education, and work experience to determine whether the
claimant can make an adjustment to other work in the national economy; if she cannot make such
an adjustment, she will be found disabled. 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v);
McCoy, 648 F.3d at 611.
Through Step Four, the burden remains on the claimant to prove that she is disabled.
Moore, 572 F.3d at 523. At Step Five, the burden shifts to the Commissioner to establish that,
given the claimant’s RFC, age, education, and work experience, there are a significant number of
other jobs in the national economy that the claimant can perform. Id.; Brock v. Astrue, 674 F.3d
1062, 1064 (8th Cir. 2012).
III. THE ALJ’S DECISION
Applying the five-step analysis, the ALJ here found that Plaintiff had not engaged in
substantial gainful activity since she applied for SSI; that Plaintiff had the severe impairments of
stage 3 chronic kidney disease, degenerative disc disease of the lumbar spine, scoliosis,
degenerative joint disease, and obesity; and that Plaintiff did not have an impairment or
combination of impairments that meets or medically equals the severity of one of the listed
impairments in 20 C.F.R. § 404, Subpart P, Appendix 1. (Tr. 12-13). The ALJ found that
Plaintiff had the RFC to perform light work with certain limitations: she could never climb
ladders, ropes, or scaffolds; she could occasionally climb ramps and stairs; she could frequently
balance, stoop, kneel, crouch, and crawl; she could tolerate no more than occasional exposure to
temperature extremes; and she must avoid hazards such as unprotected heights and dangerous
machinery. (Tr. 12).
The ALJ found that Plaintiff had no past relevant work. (Tr. 19). Considering Plaintiff’s
age, education, work experience, and RFC, and in reliance on the testimony of a vocational
expert, the ALJ found that Plaintiff was able to perform occupations that exist in significant
numbers in the national economy, including cleaner (Dictionary of Occupational Titles (DOT)
No. 323.687-014, 440,000 jobs in the national economy), hand packer (DOT No. 920.687-018,
317,000 jobs in the national economy), and production worker (DOT No. 222.687-014, 197,000
jobs in the national economy). (Tr. 20). Thus, the ALJ concluded that Plaintiff had not been
disabled, as defined in the Act, since the date she filed her application for SSI. Id.
IV. STANDARD FOR JUDICIAL REVIEW
This Court must affirm the Commissioner’s decision if it complies with the relevant legal
requirements and is supported by substantial evidence in the record as a whole. See 42 U.S.C.
§ 1383(c)(3); Richardson v. Perales, 402 U.S. 389, 401 (1971); Pate-Fires v. Astrue, 564 F.3d
935, 942 (8th Cir. 2009); Estes v. Barnhart, 275 F.3d 722, 724 (8th Cir. 2002). “Under the
substantial-evidence standard, a court looks to an existing administrative record and asks
whether it contains ‘sufficien[t] evidence’ to support the agency’s factual determinations.”
Biestek v. Berryhill, 587 U.S. 97, 102 (2019) (quoting Consolidated Edison Co. v. NLRB, 305
U.S. 197, 229 (1938)). “Substantial evidence is less than a preponderance, but is enough that a
reasonable mind would find it adequate to support the Commissioner’s conclusion.” Pate-Fires,
564 F.3d at 942; see also Biestek, 587 U.S. at 103 (“Substantial evidence . . . means—and means
only—‘such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion.’” (quoting Consolidated Edison, 305 U.S. at 229)).
In determining whether substantial evidence supports the Commissioner’s decision, the
Court considers both evidence that supports that decision and evidence that detracts from that
decision. Renstrom v. Astrue, 680 F.3d 1057, 1063 (8th Cir. 2012). But the Court “‘do[es] not
reweigh the evidence presented to the ALJ, and [it] defer[s] to the ALJ’s determinations
regarding the credibility of testimony, as long as those determinations are supported by good
reasons and substantial evidence.’” Id. at 1064 (quoting Gonzales v. Barnhart, 465 F.3d 890,
894 (8th Cir. 2006)). “If, after reviewing the record, the court finds it is possible to draw two
inconsistent positions from the evidence and one of those positions represents the ALJ’s
findings, the court must affirm the ALJ’s decision.” Partee v. Astrue, 638 F.3d 860, 863 (8th
Cir. 2011) (quoting Goff v. Barnhart, 421 F.3d 785, 789 (8th Cir. 2005)).
V. DISCUSSION
Plaintiff challenges the ALJ’s decision, arguing that the ALJ improperly discounted the
medical opinion of her treating cardiologist, Dr. Paul Larsen, by not explaining how she
considered Dr. Larsen’s specialization in determining the weight to give his opinion. Doc. [6] at
5-6. Plaintiff also contends that substantial evidence did not support the ALJ’s discounting of
Dr. Larsen’s opinion that she requires an assistive device for walking. Id. at 6-7. Defendant
argues that the ALJ properly evaluated Dr. Larsen’s opinion and provided adequate reasons for
assigning minimal weight to his opinion. Doc. [7] at 3-11.
As described above, this Court’s role is to determine whether the ALJ’s findings are
supported by substantial evidence on the record as a whole. See 42 U.S.C. § 1383(c)(3);
Richardson, 402 U.S. at 401; Pate-Fire, 564 F.3d at 942; Estes, 275 F.3d at 724. As long as
there is substantial evidence in the record that supports the decision, this Court may not reverse it
simply because substantial evidence exists in the record that would have supported a contrary
outcome, or because the Court would have decided the case differently. Haley v. Massanari, 258
F.3d 742, 747 (8th Cir. 2001).
“Generally, [a] treating physician’s opinion is due controlling weight if that opinion is
well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not
inconsistent with the other substantial evidence in the record.” Wildman v. Astrue, 596 F.3d 959,
964 (8th Cir. 2010) (alteration in original) (quoting Brown v. Barnhart, 390 F.3d 535, 540 (8th
Cir. 2004)). “However, ‘[a]n ALJ may discount or even disregard the opinion of a treating
physician where other medical assessments are supported by better or more thorough medical
evidence, or where a treating physician renders inconsistent opinions that undermine the
credibility of such opinions.’” Id. (alteration in original) (quoting Goff v. Barnhart, 421 F.3d
785, 790 (8th Cir. 2005)).
The Court has reviewed the entire transcript and the parties’ briefs. Based on a careful
review of the record, and for the reasons stated in the ALJ’s opinion and in the Government’s
brief, the Court finds that the record as a whole contains substantial evidence to support the
ALJ’s decision. See Sledge v. Astrue, 364 F. App’x 307 (8th Cir. 2010) (district court summarily
affirmed the ALJ). First, the ALJ did not err in affording Dr. Larsen’s opinion minimal weight
because his medical source statement (MSS) contained little in the way of explanation and
pointed to no objective testing or reasoning in support of his opinion that Plaintiff should use an
assistive device for walking. See Reed v. Barnharti, 399 F.3d 917, 921 (8th Cir. 2005) (“We
have upheld an ALJ’s decision to discount a treating physician’s MSS where the limitations
listed on the form ‘stand alone,’ and were ‘never mentioned in [the physician’s] numerous
records or treatment’ nor supported by ‘any objective testing or reasoning.’” (alterations in
original) (quoting Hogan v. Apfel, 239 F.3d 958, 961 (8th Cir. 2001))); Thomas v. Berryhill, 881
F.3d 672, 675 (8th Cir. 2018) (explaining that a treating physician’s opinion that consists of
“conclusory statements—checked boxes, circled answer, and brief fill-in-the-blank responses”
and “cite[s] no medical evidence and provide[s] little to no elaboration” can be rejected on that
basis alone)). Second, in assigning Dr. Larsen’s opinion minimal weight, the ALJ properly
considered that there was no record evidence that Plaintiff’s walker was prescribed by a
physician, see SSR 96-9p, 1996 WL 374185, at *7 (“To find that a hand-held assistive device is
medically required, there must be medical documentation establishing the need for a hand-held
assistive device to aid in walking or standing, and describing the circumstances for which it is
needed. . . .”); Toland v. Colvin, 761 F.3d 931, 936 (8th Cir. 2014) (noting a distinction between
the use of a “medically required hand-held assistive device” and the use of a cane that “was not
prescribed by any physician”), and that there was no convincing record evidence that Plaintiff
required an assistive device after two isolated falls that took place prior to the alleged onset date,
see 20 C.F.R. § 416.927(c)(4) (“Generally, the more consistent a medical opinion is with the
record as a whole, the more weight we will give to that medical opinion.”); Julin v. Colvin, 826
F.3d 1082, 1088 (8th Cir. 2016) (“Opinions of treating physicians . . . may be given limited
weight if they are conclusory or inconsistent with the record.” (citing Papesh v. Colvin, 786 F.3d
1126, 1132 (8th Cir. 2015))).
The Court acknowledges that the record contains conflicting evidence, and that the ALJ
could have reached a different conclusion. But this Court’s task is not to reweigh the evidence
presented to the ALJ. The ALJ’s weighing of the evidence here fell within the available “zone of
choice,” and the Court cannot disturb that decision merely because it might have reached a
different conclusion. See Buckner v. Astrue, 646 F.3d 549, 556 (8th Cir. 2011).
VI. CONCLUSION
Having reviewed the entire record, the Court finds that the ALJ made a proper RFC
determination based on a fully and fairly developed record, and that the ALJ’s decision is
supported by substantial evidence.
Accordingly,
IT IS HEREBY ORDERED, ADJUDGED, AND DECREED that the decision of the
Commissioner of Social Security is AFFIRMED.
Dated this 30™ day of June, 2025.
SARAH E. PITLYK
UNITED STATES DISTRICT JUDGE