UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE
Pamela Kiesman
v. Civil No. 17-cv-243-JD Opinion No. 2018 DNH 081 Acting Commissioner, Social Security Administration
O R D E R
Pamela Kiesman seeks judicial review, pursuant to 42 U.S.C.
§ 405(g), of the decision of the Acting Commissioner of Social
Security, denying her application for disability benefits under
Title II of the Social Security Act. Kiesman moves to reverse
on the grounds that the Administrative Law Judge (“ALJ”) erred
in weighing medical opinions, in assessing her residual
functional capacity, and in finding she could return to her
previous work. The Acting Commissioner moves to affirm.
Standard of Review
In reviewing the final decision of the Acting Commissioner
in a social security case, the court “is limited to determining
whether the ALJ deployed the proper legal standards and found
facts upon the proper quantum of evidence.” Nguyen v. Chater,
172 F.3d 31, 35 (1st Cir. 1999); accord Seavey v. Barnhart, 276 F.3d 1, 9 (1st Cir. 2001). The court defers to the ALJ’s
factual findings as long as they are supported by substantial
evidence. § 405(g); see also Fischer v. Colvin, 831 F.3d 31, 34
(1st Cir. 2016). Substantial evidence is “more than a scintilla
of evidence” but less than a preponderance of the evidence.
Purdy v. Berryhill, --- F.3d ---, 2018 WL 1601791, at *3 (1st
Cir. Apr. 3, 2018) (internal quotation marks omitted). When
the record could support differing conclusions, the court must
uphold the ALJ’s findings “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 &
Human Servs., 955 F.2d 765, 769 (1st Cir. 1991) (internal
quotation marks omitted); accord Purdy, 2018 WL 1601791, at *4.
Background
Kiesman worked as an administrative clerk at a church until
December of 2004, when she was forty-two years old. She stopped
working because her work hours had been cut so that the job did
not justify her travel time and because she decided to take care
of her father-in-law. Two years later, in October of 2006,
Kiesman injured her back when she was riding through a field in
a truck and the truck hit a sink hole.
2 An MRI of her back showed a burst fracture at L1. Kiesman
was treated with physical therapy, steroid injections, and
prescription pain medication. Because Kiesman continued to
complain of pain, her primary care physician, Dr. David Riss,
prescribed pain medication over the next few years. Dr. Riss
refilled Kiesman’s pain medication prescriptions but said he
would do drug testing as required by Kiesman’s pain management
contract.
In June of 2009, Kiesman applied for disability benefits.
She saw Dr. Riss a month later, complaining of aching all over
and lacking energy. On examination, Dr. Riss stated that the
results were good and that he did not know what was wrong with
Kiesman. Dr. Riss referred Kiesman to an orthopedic specialist,
Dr. Jerry Knirk, who did an examination and noted that his
objective findings did not justify the large amount of narcotic
pain medication that Kiesman was taking. Dr. Knirk ordered
physical therapy.
Dr. Riss completed a questionnaire in August of 2009 for
Medicaid. He indicated that Kiesman could only lift less than
ten pounds, could stand or walk for less than two hours in an
eight-hour day, and could sit for less than six hours. Dr. Riss
also indicated limitations in her ability to push and pull and
to do postural activities.
3 At first Kiesman improved with physical therapy. After
several months, however, she stopped attending appointments
because of financial and transportation issues. She was
discharged in June of 2010. Dr. Knirk saw Kiesman again in
January of 2011. He noted that Kiesman had not stayed with
physical therapy long enough to benefit and that she had changed
“her clinical story” to add issues that were not present at her
last examination in November of 2009. Dr. Knirk found no
objective basis for Kiesman’s complaints of pain and ordered
Kiesman asked Dr. Riss to refer her to another specialist.
In April of 2011, Dr. Riss referred Kiesman to Maine Medical
Partners Neurosurgery and Spine Unit.
In June of 2012, Dr. Riss completed a physical capacity
questionnaire for Kiesman with the same limitations indicated in
the 2009 questionnaire except that he increased her limitations
as to postural activities. Dr. Riss also indicated that Kiesman
had no ability to do handling, feeling, or fingering activities
but amended the questionnaire six months later by crossing out
those limitations. He left the parts of the form blank that
asked for medical findings to support his assessments. In a
letter dated July 30, 2012, Dr. Riss stated that Kiesman could
4 not even do a sedentary job but noted that she had seen
neurosurgeons and orthopedic doctors for her impairments.
Kiesman’s last insured date for social security benefits
was December 31, 2009. In January of 2012, Kiesman applied for
benefits due to disability that she claimed was caused by a
broken back and anxiety. Her application was denied initially
and was again denied following a hearing before an ALJ. Kiesman
sought review under § 405(g), and in response the Commissioner
conceded error, agreeing that the case should be remanded. The
court remanded the case and ordered “rehearing to develop a more
robust evidentiary record.”
On remand, the ALJ held a second hearing on February 11,
2016, and June 9, 2016. Kiesman appeared, with her attorney,
and testified. A medical expert, Dr. Louis Fuchs, board
certified in orthopedic medicine, testified at the hearing based
on his review of Kiesman’s medical records. A vocational expert
also testified.
The ALJ issued a decision on August 4, 2016, finding that
as of December 31, 2009, Kiesman had the residual functional
capacity to perform light work with additional limitations of
being able to stand or walk for four hours and sit for six hours
and the option to change positions as needed. The ALJ also
found that she could occasionally do postural activities and
5 could occasionally reach overhead and do handling and fingering
activities. Based on that assessment, the vocational expert
testified that Kiesman could return to her previous work as an
administrative clerk. As a result, the ALJ concluded that
Kiesman was not disabled. The Appeals Council denied review.
Discussion
Kiesman contends that the ALJ erred in relying on the
opinion of Dr. Fuchs, in giving little weight to Dr. Riss’s
opinion, in assessing her residual functional capacity, and in
failing to explain the conflict between the Dictionary of
Occupational Titles (“DOT”) and Kiesman’s previous work as an
administrative clerk. The Acting Commissioner contends that the
ALJ appropriately weighed and considered the medical opinion
evidence, accurately assessed Kiesman’s residual functional
capacity, and properly relied on the vocational expert to find
that Kiesman could return to her previous work.
In determining whether a claimant is disabled for purposes
of social security benefits, the ALJ follows a five-step
sequential analysis. 20 C.F.R. § 404.1520; Purdy, 2018 WL
1601791, at *1-*2. The claimant 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.
6 2001). At the fifth step, the Acting Commissioner has the
burden of showing “evidence of specific jobs in the national
economy that the applicant can still perform.” Purdy, 2018 WL
1601791, at *2
A. Medical Opinion Evidence
Kiesman faults the ALJ for giving great weight to Dr.
Fuchs’s opinions while giving little weight to Dr. Riss’s
opinions. In support, Kiesman notes that Dr. Fuchs did not
examine her and contends that Dr. Fuchs only considered two of
her twenty-nine medical records. She argues that because Dr.
Riss was her long-term treating primary care physician, the ALJ
should have given his opinions more weight.
An ALJ is required to consider the medical opinions along
with all other relevant evidence in a claimant’s record. 20
C.F.R. § 404.1527(b).1 “Medical opinions are statements from
acceptable medical sources that reflect judgments about the
nature and severity of [the claimant’s] impairment(s), including
[the claimant’s] symptoms, diagnosis and prognosis, what [the
claimant] can still do despite impairment(s), and [the
1 Because Kiesman’s claim was filed before March 27, 2017, the new rule for considering medical opinions does not apply. See 20 C.F.R. § 404.1520c; Purdy, 2018 WL 1601791, at *4, n.8 (discussing § 416.920c under Title XVI).
7 claimant’s] physical or mental restrictions.” § 404.1527(a)(1).
Medical opinions are evaluated based on the nature of the
medical source’s relationship with the claimant, the consistency
of the opinion with the other record evidence, the medical
source’s specialty, and other factors that support or detract
from the opinion. § 404.1527(c).
A “treating source” is a physician or other acceptable
medical source who has provided “medical treatment or evaluation
and who has, or has had, an ongoing treatment relationship with
[the claimant].” § 404.1527(a)(2). An “ongoing treatment
relationship” exists “when the medical evidence establishes that
[the claimant] see[s], or ha[s] seen the [physician] with a
frequency consistent with accepted medical practice for the type
of treatment and/or evaluation required for your medical
condition(s).” Id.
If a treating physician’s opinion is well-supported by
objective medical evidence and not inconsistent with other
medical evidence in the record, the ALJ will give the opinion
controlling weight. Id. When the ALJ does not give a treating
physician’s opinion controlling weight, the ALJ will consider
the length of the treatment relationship and the frequency of
examinations along with the other factors used to assess all
medical opinions. § 404.1527(c). In other words, “a treating
8 physician’s opinion is entitled to weight that reflects the
physician’s opportunity for direct and continual observation.”
Purdy, 2018 WL 1601791, at *4.
1. Dr. Riss
The ALJ acknowledged that Dr. Riss was Kiesman’s treating
primary care physician. The ALJ gave Dr. Riss’s opinions little
weight because of the lack of objective medical evidence in the
record, even in Dr. Riss’s own treatment notes, that would
support the level of impairment Dr. Riss found. The ALJ also
noted that Dr. Riss provided only conclusory opinions without
objective evidence to support his findings. The ALJ cited Dr.
Riss’s treatment note from July of 2009 when Dr. Riss found good
results on examination, despite Kiesman’s complaints of aching
all over and staying in bed. Dr. Riss stated at that time that
he did not know what was wrong with Kiesman.
The ALJ distinguished Dr. Knirk’s findings and opinions and
Kiesman’s own reports of her daily activities which showed
functional ability beyond the sedentary level that Dr. Riss
checked. Dr. Knirk was Kiesman’s treating orthopedic
specialist. The ALJ highlighted Dr. Knirk’s normal findings on
examination in November of 2009, right before Kiesman’s date
last insured on December 31, 2009. Dr. Knirk also noted that he
9 did not find much reason for Kiesman to need the large amounts
of narcotic medication she was taking.
Therefore, the ALJ properly considered and weighed Dr.
Riss’s opinions. See Purdy, 2018 WL 1601791, at *5.
2. Dr. Fuchs
Dr. Fuchs testified that he had reviewed all of Kiesman’s
medical records and found that as of December 31, 2009, she
could lift and carry up to ten pounds frequently and twenty
pounds occasionally. He also found that Kiesman could sit,
stand, and walk for one hour at a time but could sit for a total
of six hours with the ability to change positions when
uncomfortable and could stand or walk for a total of three to
four hours during an eight-hour day. Dr. Fuchs also found that
Kiesman was limited to occasionally doing postural activities
and overhead reaching.
In weighing Dr. Fuchs’s opinion, the ALJ explained that Dr.
Fuchs was serving as an impartial medical expert who was board
certified in orthopedic medicine. The ALJ noted that Dr. Fuchs
considered medical evidence before and after Kiesman’s last
insured date and found no additional functional limitations.
The ALJ also noted that Dr. Fuchs had explained that a finding
of “Waddel signs,” as found by Dr. Knirk and discussed by Dr.
10 Jaffe, indicated that Kiesman’s complaints of pain lacked
veracity.2 The ALJ gave Dr. Fuchs’s opinion of Kiesman’s
functional capacity great weight.
Kiesman contends that was error because Dr. Fuchs only
considered two of her twenty-nine medical records. She further
contends that Dr. Fuchs’s opinion was therefore based on an
incomplete record. She cites medical records in 2006, right
after she injured her back, and in 2007 to show that she was
more impaired that Dr. Fuchs found.
Kiesman misunderstands Dr. Fuchs’s testimony. Dr. Fuchs
received and reviewed all of the medical evidence. He testified
that he found two specific records, both records of treatment
after December 31, 2009, pertinent because those showed that
“aside from decreased back motion neurologically Ms. Kiesman is
generally intact.” Dr. Fuchs also testified that “there’s no
evidence from my review of any significant limitations except
those perhaps of a postural nature; that is considering her age
she would have some limitations with kneeling, crouching,
2 Kiesman faults the ALJ for noting the findings of Waddell signs. Contrary to Kiesman’s theory, the ALJ did not rely on findings of Waddell signs to conclude that Kiesman was not credible or was not disabled. See Ormon v. Astrue, 497 Fed. Appx. 81, 86 (1st Cir. 2012); Ledoux v. Colvin, 2016 WL 3676193, at *5 (D.N.H. July 6, 2016). Instead, the ALJ noted that the medical sources had commented on the findings of Waddell signs.
11 bending, et cetera, but other than that no significant
limitations.”
Kiesman has not shown that the ALJ erred in giving Dr.
Fuchs’s opinion great weight.
B. Residual Functional Capacity Assessment
The ALJ found that Kiesman could perform light work with
additional limitations of being able to stand or walk for four
hours and sit for six hours but required the ability to change
positions as needed. The ALJ also found that she could
occasionally do postural activities and could occasionally reach
overhead and do handling and fingering activities. Kiesman
contends that the ALJ erred because the assessment is not
supported by substantial evidence, is not the same as the light
work definition in 20 C.F.R. § 404.1567(b), lacks a definition
of the sit or stand option, and did not account for Kiesman’s
gastrointestinal disorder. The Acting Commissioner argues that
the assessment was done properly.
1. Substantial Evidence
Kiesman contends that the ALJ’s residual functional
capacity assessment is wrong because of a typographical error in
using “sit” when the ALJ meant “six” and because the time
12 limitations for sitting, standing, and walking are cryptic or
ambiguous and not supported by substantial evidence. Despite
Kiesman’s interpretation and attempt to find confusion, the
ALJ’s assessment is sufficiently supported by the opinions
provided by Dr. Fuchs and Dr. Jaffee.
Kiesman argues that the ALJ’s finding that she could
“stand/walk for up to 4 hours each” means that she could stand
for four hours and then walk for four hours for a total of eight
hours in a work day. That is not what the ALJ found. Although
the ALJ’s residual functional capacity assessment would have
been more clear if he had expressly said that Kiesman could
stand and or walk for a total of four hours, that is what he
intended.3
The ALJ relied on Dr. Fuchs’s opinion that Kiesman could
“be ambulatory probably for at least three to four hours” in an
eight-hour work day. The ALJ clarified with Dr. Fuchs that
“ambulatory” meant standing and walking combined. Although
Kiesman interprets that opinion to limit her to three hours of
standing and walking, that is not what Dr. Fuchs found. Dr.
3 The ALJ’s residual functional capacity assessment is sloppy, unfortunately, with the typographical error of “sit” instead of “six” and the imprecise wording of Kiesman’s ability to walk and stand. Sloppiness, however, does not necessarily require remand if the meaning is sufficiently clear, which it is in this case.
13 Fuchs’s opinion supports an ability to walk and stand for up to
a total of four hours in an eight-hour work day.
The ALJ also relied on Dr. Jaffe’s opinion that Kiesman
could “[s]tand and/or walk (with normal breaks) for a total of –
about 6 hours in an 8-hour day.” Dr. Jaffee’s opinion that
Kiesman could stand and walk for a total of six hours provides
support for an increased ability to stand and walk. The ALJ’s
finding of a more limited ability to stand and walk for a total
of four hours is well within that limit.
Kiesman represents in her response to the Acting
Commissioner’s motion to affirm that the ALJ found that she was
capable of walking for only two hours per day. Based on that
representation, she argues that the ALJ’s hypothetical to the
vocational expert was wrong because it included an ability to
stand and/or walk for up to four hours. As a result, she
contends, the vocational expert’s opinion does not provide
substantial evidence to support the finding that she was not
disabled.
Kiesman cites “Tr. 16” in support of her reference to the
finding in the ALJ’s decision. That document, however, is a
prior decision, dated March 15, 2013, that is not at issue in
this case. Kiesman, who is represented by counsel, did not
identify the document as a prior decision, and does not explain
14 what relevance the finding in a prior decision has to the
court’s review of the current decision dated August 4, 2016. As
such, the argument is meritless.
Kiesman also contends that the requirement that she be able
to change positions as needed is ambiguous. She does not
develop her theory of ambiguity and the limitation does not
appear to be ambiguous on its face. See, e.g., Sprague v.
Astrue, 2011 WL 1253894, at *4 (D. Me. Mar. 30, 2011). Kiesman
has not shown that the ALJ erred in including a limitation that
she must have the ability to change positions as needed.
2. Regulatory and DOT Definition
Kiesman contends that the ALJ’s assessment is erroneous
because it is more limited than the statutory definition of
light work. Because of that discrepancy, Kiesman argues, the
ALJ’s assessment conflicts with the DOT definition of
administrative clerk. She contends that the DOT provides the
controlling definition, which shows that she could not do her
former work as an administrative clerk.
Light work requires “a good deal of walking or standing”
while sedentary work requires more sitting. § 404.1567(a) &
(b). A claimant need not be able to perform a full range of
light work as long as the assessment with limitations accurately
15 describe her functional capacity. Couture v. Colvin, No. 14-CV-
00069-JL, 2015 WL 3905273, at *4–5 (D.N.H. June 25, 2015).
Variations from the statutory definition in functional capacity
can be considered and evaluated by the vocational expert. Silva
v. Berryhill, 263 F. Supp. 3d 342, 349–50 (D. Mass. 2017).
The ALJ included the limitation that Kiesman could stand
and walk for only four hours in a work day to the vocational
expert. Even with that limitation, the vocational expert
testified that Kiesman could return to her previous work as an
administrative clerk. The ALJ asked the vocational expert to
notify him about any conflicts with the DOT, and the vocational
expert found none. Therefore, in this case, the ALJ properly
relied on that opinion to find that Kiesman could do her
previous work as an administrative clerk. See, e.g., Lavoie v.
Berryhill, 2018 WL 922140, at *8 (D.N.H. Feb. 16, 2018).
3. Gastrointestinal Disorder
Kiesman asserts that the ALJ erred by failing to include
limitations for her gastrointestinal disorder. The ALJ found
that there were medical records showing a history of
gastrointestinal issues but with only limited symptoms before
December of 2009. The ALJ also noted that Kiesman testified
that medication controlled her symptoms. Based on that record,
16 the ALJ found that the gastrointestinal disorder was not severe
and did not cause significant functional imitations. The ALJ
did consider those issues, however, along with her other
impairments.
Kiesman argues that the ALJ should have included
limitations for her gastrointestinal disorder. She points to no
medical evidence that the ALJ ignored or opinions that support
any functional limitations for that condition. Therefore, she
has not shown error.
Conclusion
For the foregoing reasons, the claimant’s motion to reverse
(document no. 9) is denied. The Acting Commissioner’s motion to
affirm (document no. 14) is granted.
The clerk of court shall enter judgment accordingly and
close the case.
SO ORDERED.
__________________________ Joseph A. DiClerico, Jr. United States District Judge
April 17, 2018
cc: Karen B. Fitzmaurice, Esq. Penelope E. Gronbeck, Esq. Terry L. Ollila, Esq.