Figueroa v . SSA CV-11-100-PB 6/7/12 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE
Reyna Figueroa
v. Civil N o . 11-cv-100-PB Opinion N o . 2012 DNH 101 Michael J. Astrue, Commissioner, Social Security Administration
MEMORANDUM AND ORDER
Reyna Figueroa seeks judicial review of a decision by the
Commissioner of the Social Security Administration denying her
application for disability insurance benefits. Figueroa alleges
that the decision finding her not disabled is unsupported by
substantial evidence, and specifically, that the Administrative
Law Judge (“ALJ”) in her case improperly discounted the opinion
of her treating physician and accorded insufficient weight to
her subjective complaints. For the reasons provided below, I
deny Figueroa’s motion to reverse the Commissioner’s decision.
I. BACKGROUND1
Figueroa applied for disability insurance benefits on
January 2 1 , 2009, when she was twenty-eight years old. She
1 Except where otherwise noted, the background information is drawn from the parties' Joint Statement of Material Facts (Doc. N o . 1 3 ) . See LR 9.1(b). I cite to the administrative record with the notation “Tr.” alleged a disability onset date of November 1 , 2008, due to
rheumatoid arthritis. She attended school through eighth grade
and did not start high school. T r . 3 9 . In the past she worked
as a housekeeper, a packer, and an assembly worker.
A. Administrative Proceedings
Figueroa’s application was denied initially and on
reconsideration. She requested a hearing, and on October 4 ,
2010, she appeared and testified at a hearing before an ALJ. In
a decision dated October 1 8 , 2010, the ALJ denied her
application and informed her that the Decision Review Board
(“DRB”) had selected her claim for review. By notice dated
January 1 9 , 2011, the DRB informed Figueroa that it was
affirming the ALJ’s decision.
B. Medical History
Medical records detailing Figueroa’s rheumatoid arthritis
date back to July 2006, when she visited the Southern New
Hampshire Medical Center in Nashua for unrelated chest pain.
Her treatment provider noted that she had a past history of
rheumatoid arthritis, and x-rays showed scattered arthritic
changes in her hands and left foot. An examination at that time
revealed that she was alert and oriented, well nourished, well
developed, and in no acute distress. She had no joint swelling 2 in her extremities.
Starting in January 2008, Figueroa sought treatment from
Dr. John Gorman, a rheumatologist. On multiple occasions prior
to Figueroa’s alleged disability onset date, D r . Gorman reported
that Figueroa’s rheumatoid arthritis was doing well with
medication.
At Figueroa’s initial visit with D r . Gorman, examinations
showed no joint swelling or tenderness. On June 2 , 2008, D r .
Gorman reported that Figueroa’s joints moved freely without pain
and that her grip formation and her grip strength were well
preserved. Her shoulder ached at times but not severely enough
to warrant a corticosteroid injection.
In July 2008, Figueroa informed D r . Gorman that her
rheumatoid arthritis was causing moderate tenderness in her left
shoulder, and she received an injection of Lidocaine. In
September 2008, she received another Lidocaine injection for
moderate tenderness in her right shoulder also caused by the
rheumatoid arthritis. D r . Gorman stated in October 2008 that
Figueroa had mild tenderness in her shoulders and wrists.
On January 1 9 , 2009, Figueroa complained to D r . Gorman of
worsening pain in her shoulders, wrists, hands, knees, ankles,
and feet. Her shoulders exhibited some tenderness on 3 examination, but she was able to move them fairly well.
On March 1 3 , 2009, D r . Gorman reported that Figueroa’s
arthritis had not changed. He stated that she had particularly
bad days about twice a week, and that her worst joints were her
shoulders, wrists, hands, ankles, and feet. She continued to
have tenderness in her shoulders, wrists, hands, knees, ankles,
and feet. She was restarted on Methotrexate.
In May 2009, D r . Gorman noted that Figueroa’s arthritis had
improved, and he instructed her to continue taking Methotrexate
and Enbrel. In August 2009, he reported that Figueroa’s
arthritis had become a little more active. She had more pain in
her shoulders and her hands and left ankle bothered her at
times. Examination revealed moderate shoulder tenderness with
stiffness, a mildly tender left ankle, and mild squeeze
tenderness of her hands. Her rheumatoid arthritis was fairly
stable but was still active at a low grade. D r . Gorman injected
both of her shoulders with Lidocaine.
On December 2 1 , 2009, D r . Gorman stated that Figueroa had
significant aching and stiffness in her ankles and feet, and
that her arthritis waxed and waned and tended to be worse in the
colder months. An examination revealed tenderness and low-grade
swelling in both her ankles. 4 Radiological testing performed in December 2009 showed that
Figueroa had scattered arthritic changes in her hands and her
left foot, which may have been due to rheumatoid arthritis.
Figueroa was treated at the emergency department of
Southern New Hampshire Medical Center on June 2 3 , 2010. She was
prescribed Ibuprofen and Vicodin for arthritic pain in her right
shoulder.
C. Medical Opinions
On September 2 4 , 2010, D r . Gorman completed a Residual
Functional Capacity (“RFC”) questionnaire. He diagnosed
Figueroa with rheumatoid arthritis and fibromyalgia, and opined
that she often experienced pain severe enough to interfere with
her attention and concentration. He further opined that she
experienced depression and anxiety, and was incapable of a low-
stress job. With respect to her physical capabilities, he
stated that in an eight-hour workday, Figueroa could rarely lift
and carry less than ten pounds; could never lift and carry ten
pounds or more; could sit for about two hours; and could rarely
twist, stoop, crouch, climb ladders, or climb stairs. In a
competitive work situation, she could walk for twenty minutes at
a time; sit for thirty minutes at a time; and stand for forty-
five minutes at a time. 5 In addition to D r . Gorman, two other doctors provided
opinions on Figueroa’s capabilities. D r . Jonathan Jaffe, a non-
examining state agency physician, completed a physical RFC
assessment of Figueroa on April 1 3 , 2009, based upon a review of
the record evidence. D r . Jaffe opined that she could
occasionally lift and/or carry twenty pounds; frequently lift
and/or carry ten pounds; stand and/or walk for about six hours
in an eight-hour workday; sit for about six hours in an eight-
hour workday; and push/pull without additional limitation. He
further opined that she had no postural, manipulative, visual,
communicative, or environmental limitations.
Dr. Dennis Becotte saw Figueroa for a consultative
psychological exam on May 1 9 , 2009. Figueroa was alert and
oriented with a broad range of affect and no evidence of formal
thought disorder. Her intellectual functioning was in the low-
average range. D r . Becotte noted that Figueroa’s daily
activities included taking care of her children, cleaning, and
cooking. He diagnosed her with rheumatoid arthritis and
adjustment disorder with a depressed mood. D r . Becotte noted
that Figueroa took medication for her arthritis, but was not
presently taking any psychotropic medication. He opined that
her mental status would not prevent her from maintaining 6 attendance and schedules; making simple decisions; interacting
appropriately with coworkers and supervisors; and tolerating
stressors common to work-like situations.
D. Hearing Testimony
At the administrative hearing, Figueroa testified that she
experienced difficulty doing repetitive work, particularly work
involving repetitive arm movements. She reported difficulties
with her fingers, shoulders, knees, wrists, and feet, and
testified that pain in her shoulders rendered her unable to lift
objects and that pain in her fingers affected her ability to
grip and grasp items. She stated that, on a typical day, she
took her children to school, cooked, picked up her children from
school, and then rested. She testified that she experienced
four bad days a week regarding her pain. On those days, it was
difficult for her to clean the house because of the pain in her
hands. She said she needed both hands to lift a gallon of milk.
She reclined to rest about two hours a day.
Following Figueroa’s testimony, a vocational expert (“VE”)
testified. The ALJ asked the VE whether a person who could lift
twenty pounds occasionally and ten pounds frequently; stand or
walk for six hours in an eight-hour workday; sit for six hours
in an eight-hour workday; had unlimited use of her hands to 7 operate controls as well as push and pull; and had no other
limitations, could perform Figueroa’s prior work. The VE
answered in the affirmative. The VE also testified that such a
person could also work as a laundry worker or addresser.
E. ALJ’s Decision
The ALJ evaluated Figueroa’s claim in accordance with the
five-step sequential evaluation process for evaluating
disability claims. He found that she had not engaged in
substantial gainful activity since November 1 , 2008, her alleged
onset date. The ALJ next determined that her rheumatoid
arthritis constituted a severe impairment, but that the
impairment did not meet or equal a listed impairment. He
concluded that she had the RFC to perform a full range of light
work and that she could perform her past relevant work as a
housekeeper, packer, and assembly worker. Accordingly, he
determined that Figueroa was not disabled and denied her claim.
Figueroa now challenges the ALJ’s determination in this court.
II. STANDARD OF REVIEW
Under 42 U.S.C. § 405(g), I am authorized to review the
pleadings submitted by the parties and the administrative record
and enter a judgment affirming, modifying, or reversing the 8 “final decision” of the Commissioner. My review “is limited to
determining whether the ALJ used the proper legal standards and
found facts [based] upon the proper quantum of evidence.” Ward
v . Comm’r of Soc. Sec., 211 F.3d 6 5 2 , 655 (1st Cir. 2000).
The findings of fact made by the ALJ are accorded deference
so long as they are supported by substantial evidence. Id.
Substantial evidence to support factual findings exists “‘if a
reasonable mind, reviewing the evidence in the record as a
whole, could accept it as adequate to support his conclusion.’”
Irlanda Ortiz v . Sec’y of Health and Human Servs., 955 F.2d 765,
769 (1st Cir. 1991) (per curiam) (quoting Rodriguez v . Sec’y of
Health and Human Servs., 647 F.2d 2 1 8 , 222 (1st Cir. 1981)). If
the substantial evidence standard is met, factual findings are
conclusive even if the record “arguably could support a
different conclusion.” Id. at 770. Findings are not
conclusive, however, if they are derived by “ignoring evidence,
misapplying the law, or judging matters entrusted to experts.”
Nguyen v . Chater, 172 F.3d 3 1 , 35 (1st Cir. 1999) (per curiam).
The ALJ is responsible for determining issues of
credibility and for drawing inferences from evidence on the
record. Ortiz, 955 F.2d at 769. It is the role of the ALJ, not
the court, to resolve conflicts in the evidence. Id. 9 The ALJ follows a five-step sequential analysis for
determining whether an applicant is disabled. 20 C.F.R. §§
404.1520, 416.920. The applicant bears the burden, through the
first four steps, of proving that her impairments preclude her
from working. Freeman v . Barnhart, 274 F.3d 606, 608 (1st Cir.
2001). At the fifth step, the Commissioner determines whether
work that the claimant can d o , despite her impairments, exists
in significant numbers in the national economy and must produce
substantial evidence to support that finding. Seavey v .
Barnhart, 276 F.3d 1 , 5 (1st Cir. 2001).
III. ANALYSIS
Figueroa challenges the ALJ’s decision on two grounds. She
contends that he failed to properly weigh the opinion of her
treating physician and that he erred in finding her subjective
complaints not credible.2 I address each argument in turn.
A. ALJ’s Treatment of Dr. Gorman’s Opinion
An ALJ must take into account the medical opinions in a
claimant’s case record when making a disability determination.
2 Figueroa’s brief also contains a separate section in which she contends that the ALJ’s RFC assessment is not based on substantial evidence in the record. This claim is based entirely on her other arguments, however, and so I do not address it separately. 10 20 C.F.R. § 404.1527(b). More weight should generally be
accorded to the opinions of medical sources who have examined
the claimant, and more weight should generally be accorded to
treating sources than non-treating sources. 20 C.F.R. §
404.1527(c)(1)-(2). The rationale for giving more weight to
treating sources is that “these sources are likely to be the
medical professionals most able to provide a detailed,
longitudinal picture of [the claimant’s] medical impairment(s)
and may bring a unique perspective . . . that cannot be obtained
from the objective medical findings alone or from reports of
individual examinations[.]” 20 C.F.R. § 404.1527(c)(2).
When the opinion of a treating physician is well supported
and not inconsistent with other record evidence, it must be
given controlling weight. Id.; Social Security Ruling 96-2p,
1996 WL 374188 (July 2 , 1996) [hereinafter SSR 96-2p]. In all
other instances, a number of factors apply to determine how much
weight should be given to an opinion. 20 C.F.R. §
404.1527(c)(2). The factors to be considered include: the
length of the treatment relationship and frequency of
examination; the nature and extent of the treatment
relationship; the record evidence supporting the opinion; the
consistency of the opinion with other record evidence; and 11 whether the source is a specialist. Id.
An ALJ must always provide “good reasons” in his decision
for the weight accorded to a treating source’s opinion. Id.
When an ALJ’s decision is not favorable to the claimant, the
decision must contain reasons for discounting the treating
source’s opinion that are “sufficiently specific to make clear
to any subsequent reviewers” both “the weight the adjudicator
gave” to the opinion and “the reasons for that weight.” SSR 96-
2p.
In assigning only limited weight to the opinion of D r .
Gorman, Figueroa’s treating physician, the ALJ explained that
the functional limitations stated in D r . Gorman’s opinion were
inconsistent with his own clinical observations, inconsistent
with his notations that Figueroa was doing well –- particularly
when she was on her medication, and inconsistent with the
medical opinion of the state agency physician. Figueroa presses
two arguments for why the ALJ’s analysis was inadequate. First,
she claims that the ALJ could not have relied on D r . Gorman’s
statements that she was doing well, because a patient might be
doing well in the context of her infirmity yet still be
disabled. Second, she asserts that the ALJ failed to
sufficiently discuss the factors for evaluating a treating 12 source opinion that are set out in 20 C.F.R. § 404.1527(c).
Neither argument is persuasive.
On her first argument, I agree that in certain cases it may
constitute error to justify a denial of benefits by reference to
a physician’s statement that a patient is doing well. Depending
on the context of the statement, a physician may be implying no
more than that a patient with a severe and debilitating
condition has not suffered additional deterioration. Courts
have overturned decisions where remarks akin to the remarks in
this case have been taken out of context. See, e.g., Morales v .
Apfel, 225 F.3d 3 1 0 , 319 (3d Cir. 2000) (doctor’s notation that
claimant’s condition was “stable” did not support an inference
that he was capable of work); Gude v . Sullivan, 956 F.2d 7 9 1 ,
794 (8th Cir. 1992) (error for ALJ to rely on treating
physician’s note that claimant was “doing well” in context of
her systemic lupus erythematosus as support for discounting his
opinion); Mounce v . Astrue, N o . 10-cv-560-PB, 2011 WL 5282638,
at *9 (D.N.H. Nov. 2 , 2011) (error for ALJ to lift phrase
“spectacularly well” from physician’s notes without considering
context of remarks).
I am satisfied, however, that the ALJ in this case did not
take D r . Gorman’s notations out of context. The instances where 13 Dr. Gorman stated that Figueroa was doing well are all
accompanied by further description noting her generally mild
symptoms at the time. For example, in D r . Gorman’s notes of
January 1 5 , 2008, he indicated that Figueroa’s arthritis was
“doing quite well,” and went on to describe her joints as in
generally good condition, with only her shoulders exhibiting
mild symptoms. T r . 195. Similarly, in his notes of June 2 ,
2008, he stated that Figueroa’s arthritis was “doing well,” and
elaborated that her joints moved freely and without pain, that
there was no warmth, swelling, or tenderness in her joints, and
that her grip formation and grip strength were well preserved.
Tr. 193. Although her shoulders ached at times, he determined
that her symptoms were “not severe enough lately for a
corticosteroid injection.” Id. And in his notes from October
2 , 2008, D r . Gorman again expressed his positive outlook on
Figueroa’s condition by stating that her arthritis was generally
doing “very well,” and that a recent worsening of her symptoms
had likely occurred only because she had been off of her
medication for two weeks. T r . 190. In light of the content of
Dr. Gorman’s notes, I conclude that the ALJ did not take D r .
Gorman’s remarks out of context. D r . Gorman’s statements
provide support for the ALJ’s position that the doctor’s opinion 14 was undermined by his own clinical notes, and I perceive no
error in the ALJ’s use of D r . Gorman’s statements.
On Figueroa’s claim that the ALJ failed to properly explain
his reasons for discounting D r . Gorman’s opinion, I determine
that the ALJ’s discussion of his reasons, although limited, is
adequate. Figueroa points out that the ALJ did not explicitly
take account of all of the factors articulated in 20 C.F.R. §
404.1527(c), for example, the length of D r . Gorman’s treatment
relationship with Figueroa or the import of D r . Gorman’s
specialization in rheumatology. Although more detail would have
been preferable, the ALJ’s decision is nonetheless “sufficiently
specific to make clear to [ ] subsequent reviewers the weight the
adjudicator gave to the treating source’s medical opinion and
the reasons for that weight.” SSR 96-2p. The ALJ relied on the
agency physician’s opposing opinion in conjunction with the
portions of D r . Gorman’s notes -- including his statements about
Figueroa’s condition and his clinical observations of her often
mild symptoms -- that undermine his opinion and support the
agency physician’s opposing position. I am able to discern the
rationale the ALJ used to reach his determination and that
determination is founded on “good reasons” that are supported by
substantial record evidence. See 20 C.F.R. § 404.1527(c)(2); 15 SSR 96-2p. I therefore decline to reverse the ALJ’s decision on
the basis of the weight he gave to D r . Gorman’s opinion.
B. Credibility of Subjective Complaints
Figueroa argues that the ALJ erred in finding that her
subjective reports of pain and functional limitations were not
credible. “Because symptoms, such as pain, sometimes suggest a
greater severity of impairment than can be shown by objective
medical evidence alone, any statements of the individual
concerning his or her symptoms must be carefully considered[.]”
SSR 96-7p, 1996 WL 374186, at *3 (July 2 , 1996); see also 20
C.F.R. §§ 404.1529(c)(3), 416.929(c)(3). A two-step analysis
governs an ALJ’s evaluation of symptoms such as pain. SSR 96-
7 p , 1996 WL 374186, at * 2 . First, the ALJ considers whether the
claimant is suffering from “an underlying medically determinable
physical or mental impairment . . . that could reasonably be
expected to produce the individual’s pain or other symptoms.”
Id. If the claimant meets that threshold, the ALJ moves to the
second step:
[T]he adjudicator must evaluate the intensity, persistence, and limiting effects of the individual’s symptoms to determine the extent to which the symptoms limit the individual’s ability to do basic work activities. For this purpose, whenever the individual’s statements about the intensity, persistence, or functionally limiting effects of pain
16 or other symptoms are not substantiated by objective medical evidence, the adjudicator must make a finding on the credibility of the individual’s statements based on a consideration of the entire case record.
Id.
At step one, the ALJ in this case found that Figueroa’s
medically determinable symptoms could reasonably be expected to
cause her alleged symptoms. At step two, however, the ALJ found
that her “statements concerning the intensity, persistence and
limiting effects of those symptoms are not credible to the
extent they are inconsistent with the [ ] residual functional
capacity assessment.” T r . at 2 8 . Figueroa asserts that the ALJ
failed to fully acknowledge a number of factors that supported
her credibility and weighed in favor of a finding of disability.
I disagree.
Figueroa’s argument is essentially a recitation of those
facts that weigh in her favor. She points to her limited
activities of daily living, arguing that although she was not
totally incapacitated and could engage in “low grade” activities
like occasional cooking and cleaning, none of the activities
suggest the ability to perform substantial gainful activity.
She notes that she complained of particularly bad days where her
symptoms were severe and that certain factors exacerbated her
17 symptoms. She draws attention to her prescription for Enbrel,
medication used for treating rheumatoid arthritis. She also
argues that D r . Gorman’s opinion supports her subjective
complaints.
Even though many of these facts may be probative of whether
Figueroa’s subjective complaints are credible, it is not my task
to make a credibility finding in the first instance. See Ward,
211 F.3d at 655 (setting out scope of judicial review). My
review is limited to deciding whether the ALJ’s credibility
determination is based on substantial evidence, and Figueroa has
failed to show any error in the ALJ’s decision. See Frustaglia
v . Sec’y of Health & Human Servs., 829 F.2d 1 9 2 , 195 (1st Cir.
1987) (ALJ’s credibility determinations are “entitled to
deference, especially when supported by specific findings,” and
will be upheld when “their adequacy is supported by substantial
evidence”). Far from ignoring the evidence cited by Figueroa,
the ALJ’s opinion clearly shows that he considered most of the
facts listed by Figueroa: he discussed in some detail her
activities of daily living, he went through portions of the
record that show she suffered periods of increased and decreased
pain, and he offered explanations for his weighing of the
medical opinion evidence. In finding the evidence now 18 emphasized by Figueroa unpersuasive, the ALJ cited to record
evidence contradicting her subjective complaints, most
significantly the various portions of the medical treatment
notes indicating that her symptoms were typically fairly mild
when she was taking her medication. Even if the record in this
case could arguably justify an alternative finding on Figueroa’s
credibility, and ultimately on her RFC and disability status,
the ALJ’s determinations are supported by substantial record
evidence, and must be affirmed. Id.
IV. CONCLUSION
For the foregoing reasons, I grant the Commissioner’s
motion to affirm (Doc. N o . 11) and deny Figueroa’s motion to
reverse (Doc. N o . 8 ) . The clerk is directed to enter judgment
accordingly and close the case.
SO ORDERED.
/s/Paul Barbadoro Paul Barbadoro United States District Judge
June 7 , 2012
cc: Raymond J. Kelly, Esq. Gretchen Leah Witt, Esq.