UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE
Lisa Aldridge
v. Civil No. 18-cv-177-LM Opinion No. 2019 DNH 034 Nancy A. Berryhill, Acting Commissioner of Social Security
O R D E R
Lisa Aldridge seeks judicial review, pursuant to 42 U.S.C.
§ 405(g), of the decision of the Acting Commissioner of the
Social Security Administration, denying her application for
disability insurance benefits. Aldridge moves to reverse the
Acting Commissioner’s decision, and the Acting Commissioner
moves to affirm. For the reasons discussed below, the decision
of the Acting Commissioner is affirmed.
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 [Administrative Law Judge] 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. 42 U.S.C. § 405(g); see also Fischer v. Colvin, 831 F.3d 31, 34 (1st Cir. 2016). “Substantial evidence
is more than a scintilla. It means such relevant evidence as a
reasonable mind might accept as adequate to support a
conclusion.” Astralis Condo. Ass’n v. Sec’y Dep’t of Housing &
Urban Dev., 620 F.3d 62, 66 (1st Cir. 2010).
In determining whether a claimant is disabled, the ALJ
follows a five-step sequential analysis. 20 C.F.R.
§ 404.1520(a)(4). The claimant “has the burden of production
and proof at the first four steps of the process.” Freeman v.
Barnhart, 274 F.3d 606, 608 (1st Cir. 2001). The first three
steps are (1) determining whether the claimant is engaged in
substantial gainful activity; (2) determining whether she has a
severe impairment; and (3) determining whether the impairment
meets or equals a listed impairment. 20 C.F.R.
§ 404.1520(a)(4)(i)-(iii).
At the fourth step of the sequential analysis, the ALJ
assesses the claimant’s residual functional capacity (“RFC”),
which is a determination of the most a person can do in a work
setting despite her limitations caused by impairments, id.
§ 404.1545(a)(1), and her past relevant work, id.
§ 404.1520(a)(4)(iv). If the claimant can perform her past
relevant work, the ALJ will find that the claimant is not
disabled. See id. § 404.1520(a)(4)(iv). If the claimant cannot
perform her past relevant work, the ALJ proceeds to Step Five,
2 in which the ALJ has the burden of showing that jobs exist in
the economy which the claimant can do in light of the RFC
assessment. See id. § 404.1520(a)(4)(v).
BACKGROUND
A detailed statement of the facts can be found in the
parties’ Joint Statement of Material Facts (doc. no. 10). The
court provides a brief summary of the case here.
On October 13, 2014, Aldridge filed an application for
disability insurance benefits. She alleged a disability onset
date of November 1, 2012, which she subsequently amended to
December 1, 2013. Aldridge alleged a disability due to
headaches, lupus, degenerative disc disease, pinched nerve, high
blood pressure, high cholesterol, and depression/anxiety.
After Aldridge’s claim was denied, she requested a hearing
in front of an ALJ. On September 19, 2016, the ALJ held a
hearing, during which Aldridge, who was represented by an
attorney, appeared and testified.
On December 7, 2016, the ALJ issued an unfavorable
decision. He found that Aldridge had the following severe
impairments: degenerative disc disease of the cervical spine and
depression. The ALJ also found that Aldridge’s high blood
pressure and high cholesterol were not severe impairments and
that her lupus, headaches, and pinched nerve were not medically
3 determined. The ALJ found that Aldridge had the residual
functional capacity to perform light work, as defined in 20
C.F.R. § 404.1567(b), except that she was limited to simple,
uncomplicated tasks with no more than one to three step
instructions.
In assessing Aldridge’s residual functional capacity, the
ALJ gave significant weight to the opinions of Dr. Peter Loeser,
a physician specializing in internal medicine who performed a
consultative exam on Aldridge on June 2, 2015; Dr. Cheryl
Bildner, a psychologist who performed a consultative exam on
Aldridge on June 8, 2015; and two state-agency consultants who
reviewed Aldridge’s medical records up to June 2015. The ALJ
gave little weight to the opinion of Anita Lawrence, a
physician’s assistant who treated Aldridge.
Christine Spaulding, an impartial vocational expert,
testified at the hearing by telephone. In response to
hypotheticals posed by the ALJ, Spaulding testified that a
person with Aldridge’s RFC could perform jobs that exist in
significant numbers in the national economy, including fast food
worker, cashier, and cleaner. The vocational expert also
testified that Aldridge could perform her past work as an
assembler. Based on the vocational expert’s testimony, the ALJ
found at Step Four, and in the alternative at Step Five, that
Aldridge was not disabled.
4 On January 10, 2018, the Appeals Council denied Aldridge’s
request for review, making the ALJ’s decision the Acting
Commissioner’s final decision. This action followed.
DISCUSSION
Aldridge raises two claims of error on appeal. She argues
that the ALJ erred in (1) weighing the medical opinion evidence
and (2) evaluating Aldridge’s testimony about her symptoms and
limitations.
I. Weight of Opinions
Aldridge contends that the ALJ erred in his evaluation of
several medical opinions in the record. Specifically, she
argues that the ALJ erred by assigning little weight to
Lawrence’s opinion while assigning substantial weight to the
opinions of Dr. Loeser, Dr. Bildner, and the state-agency
consultants. Aldridge contends that the ALJ incorrectly found
that Lawrence’s own records contradicted her opinion and that
Lawrence cited no objective medical evidence to support her
conclusions. Aldridge also argues that the ALJ erroneously
found that evidence that was not reviewed by the two non-
examining state-agency consultants was immaterial. Aldridge
thus contends that the ALJ should not have given the
consultants’ opinions substantial weight.
5 “An ALJ is required to consider opinions along with all
other relevant evidence in a claimant’s record.” Ledoux v.
Acting Comm’r, Soc. Sec. Admin., No. 17-cv-707-JD, 2018 WL
2932732, at *4 (D.N.H. June 12, 2018). “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 claimant’s] physical or mental
restrictions.” § 404.1527(a)(1).
The ALJ analyzes the opinions of state agency consultants,
treating sources, and examining sources under the same rubric.
See id.; § 404.1527(c). The ALJ must consider “the examining
relationship, treatment relationship (including length of the
treatment relationship, frequency of examination, and nature and
extent of the treatment relationship), supportability of the
opinion by evidence in the record, consistency with the medical
opinions of other physicians,” along with the doctor’s expertise
in the area and any other relevant factors. Johnson v.
Berryhill, No. 16-cv-375-PB, 2017 WL 4564727, at *5 (D.N.H. Oct.
12, 2017).
6 A. Dr. Loeser
Aldridge criticizes Dr. Loeser’s opinion because he “did not
assess Ms. Aldridge’s current functional limitations and instead
stated only his opinion that the limited range of motion in her
cervical spine was likely to improve with treatment.” Doc. 7-1
at 9. Viewed generously, Aldridge’s argument is that the ALJ
erred by giving Dr. Loeser’s opinion substantial weight despite
Dr. Loeser not offering an assessment of Aldridge’s functional
capacity.
Although he did not offer an opinion about Aldridge’s
functional capacity, Dr. Loeser observed that Aldridge was able
to sit, stand, squat, and walk on her toes and heels, and he
stated that Aldridge was able to move around the examination
room “with ease.” Admin. Rec. at 33. He further opined that
Aldridge’s limited range of motion would improve with treatment.
In rendering his opinion, Dr. Loeser reviewed Aldridge’s medical
records, including the June 2013 MRI relied on by Lawrence in
rendering her opinion. The ALJ also credited Dr. Loeser’s
expertise. Substantial evidence thus supports the ALJ’s
decision to give Dr. Loeser’s opinion substantial weight.
B. Lawrence
Aldridge argues that the ALJ erred by giving Lawrence’s
opinion about Aldridge’s functional capacity little weight. She
7 contends that the ALJ mischaracterized Lawrence’s treatment
records in finding that her opinions were not consistent with
her treatment notes and the record.
The ALJ’s decision to give Lawrence’s opinion, which stated
that Aldridge could not perform activities beyond the sedentary
exertional level, little weight is supported by substantial
evidence. First, because Lawrence is a physician’s assistant,
she is not an “acceptable medical source” as defined by 20
C.F.R. § 404.1502.1 And, although she treated Aldridge, Lawrence
is not a “treating source” whose opinion may be entitled to
controlling weight. Taylor v. Astrue, 899 F. Supp. 2d 83, 88
(D. Mass. 2012) (noting that only “acceptable medical sources”
can be considered “treating sources”). The ALJ was thus within
his discretion to give Lawrence’s opinion less weight than the
opinions of acceptable medical sources. See SSR 06-03P, 2006 WL
2329939, at *5 (S.S.A. Aug. 9, 2006) (“The fact that a medical
opinion is from an ‘acceptable medical source’ is a factor that
may justify giving that opinion greater weight than an opinion
from a medical source who is not an ‘acceptable medical source’
. . . .”).
1 Aldridge filed her application for benefits before March 27, 2017. For claims filed after March 27, 2017, a physician’s assistant may be an acceptable medical source for ailments within his or her licensed scope of practice. See § 404.1502(a)(8).
8 Furthermore, Lawrence gave only limited examples of
objective medical evidence to support her suggested limitations,
which was a sufficient reason for the ALJ to give her opinion
limited weight. See McGrath v. Astrue, No. 10-cv-455-JL, 2012
WL 976026, at *5 n.13 (D.N.H. Mar. 22, 2012) (“When an opinion
is given in a cursory fashion, the ALJ can properly give it less
weight.”). Lawrence generally stated that Aldridge’s chronic
neck pain, bilateral arm weakness, and paresthesia resulted in
the selected limitations, citing only a June 2013 MRI that
showed “minimal degeneration” of Aldridge’s thoracic spine,
slight decrease of disc space height in the cervical spine and
“minimal foraminal encroachment” and “mild foraminal stenosis.”
Lawrence, however, did not explain why these conditions limited
Aldridge’s activity levels to the degree asserted in her
opinion.
Aldridge takes issue with the ALJ’s characterizations of
Lawrence’s treatment notes. For example, Aldridge argues that
the ALJ erroneously concluded that Lawrence’s treatment records
suggested that she had “normal musculoskeletal” status. The
ALJ’s finding that Lawrence’s opinion was not consistent with
the record as a whole, however, was not premised merely on
whether Lawrence found that Aldridge had a “normal
musculoskeletal status,” or exclusively on any of the
mischaracterizations alleged by Aldridge. Instead, the ALJ
9 weighed Lawrence’s opinion based on the fact that she was not an
acceptable medical source and on the inconsistencies between her
opinion and those of the acceptable medical sources. The ALJ
was entitled to resolve the conflicts in the evidence. At best,
Aldridge asks the court to reweigh the evidence, but
“[r]esolving evidentiary conflicts is strictly the domain of the
[ALJ].” See Quaglia v. Colvin, 52 F. Supp. 3d 323, 334
(D. Mass. 2014).
C. Dr. Bildner
As with Dr. Loeser, Aldridge appears to contend that the ALJ
erred by giving Dr. Bildner’s opinion substantial weight.
Aldridge, however, fails to develop any argument about why the
ALJ erred in giving Dr. Bildner’s opinion substantial weight.
Aldridge merely repeats the ALJ’s reasons for his decision to
give Dr. Bildner’s opinion substantial weight without providing
any relevant argument to show error. To the extent Aldridge
intended to challenge the weight the ALJ gave to Dr. Bildner’s
opinion, that argument is not sufficiently developed to be
addressed. See United States v. Zannino, 895 F.2d 1, 17 (1st
Cir. 1990) (“It is not enough merely to mention a possible
argument in the most skeletal way, leaving the court to do
counsel’s work . . . .”).
10 D. Non-Examining State-Agency Consultants
Aldridge contends that the opinions of the two non-examining
state-agency consultants, Drs. Stephanie Green and Jan Jacobson,
should not have been given substantial weight because the
consultants did not review the medical records after June 2015.
Aldridge asserts that Lawrence’s treatment records from April
and July 2015, as well as Lawrence’s December 2015 opinion,
contained facts regarding hip pain and other spinal pain that
the ALJ ignored in assessing whether the unreviewed medical
records were material.
Substantial evidence supports the ALJ’s decision to give
Drs. Green’s and Jacobson’s opinions substantial weight. Dr.
Jacobsen, a psychologist, offered an opinion that was consistent
with the opinion of Dr. Bildner, who performed a consultative
psychological examination. Aldridge does not explain why
Lawrence’s treatment records after June 2015, which focus on
Aldridge’s physical ailments and do not provide significant
insight about Aldridge’s degree of pain, were necessary to
further inform Dr. Jacobson about Aldridge’s mental status.
Indeed, the treatment records about Aldridge’s mental status
after Dr. Jacobson’s review are consistent with her opinion, as
they indicated that Aldridge was “generally stable” and that she
successfully completed counseling in April 2016.
11 Dr. Green likewise offered an opinion that was generally
consistent with the medical record, including the treatment
records which post-dated her review. As the ALJ found, the
post-review treatment notes did not document any meaningful
changes in Aldridge’s condition. Giandomenico v. U.S. Soc. Sec.
Admin., Acting Comm’r, No. 16-CV-506-PB, 2017 WL 5484657, at *4
(D.N.H. Nov. 15, 2017) (An “ALJ may rely on a consultant’s
outdated opinion if he determines that the evidence postdating
the opinion did not materially change the record on which it was
based.”). Although Aldridge reported a new symptom, hip pain,
after Dr. Green’s review, it was still recommended by Lawrence
that Aldridge “increase movement and go out for walks with [her]
dog at least twice a day.” Admin. Rec. at 34. Lawrence did not
include hip pain as a reason for the suggested limitations in
her medical opinion. Furthermore, the only medical evidence
cited by Lawrence in her medical opinion, a June 2013 MRI, was
reviewed by Dr. Green. Substantial evidence supports the ALJ’s
decision to give Dr. Green’s opinion substantial weight.
For these reasons, the ALJ did not err in evaluating the
medical opinion evidence in the record.
II. Aldridge’s Subjective Complaints and Symptoms
Aldridge contends that the ALJ improperly evaluated her
subjective complaints and symptoms. Specifically, Aldridge
12 contends that her treatment records show that she suffered pain
symptoms to a greater degree than found by the ALJ. She argues
that Lawrence’s treatment notes are consistent with her alleged
pain symptoms and that the ALJ erred in evaluating her
subjective complaints and symptoms.
“[U]nder SSR 16–3p, which supersedes SSR 96–7p, an ALJ
determining whether an applicant has a residual functional
capacity that precludes a finding of disability must ‘evaluate
the intensity and persistence of an individual’s symptoms such
as pain and determine the extent to which an individual’s
symptoms limit his or her ability to perform work-related
activities.’” Coskery v. Berryhill, 892 F.3d 1, 4 (1st Cir.
2018) (quoting SSR 16-3p, 82 Fed. Reg. 49462, 49464 (Oct. 25,
2017)). “Moreover, SSR 16–3p provides that, in conducting that
inquiry, the ALJ must ‘examine the entire case record, including
the objective medical evidence; an individual’s statements about
the intensity, persistence, and limiting effects of symptoms;
statements and other information provided by medical sources and
other persons; and any other relevant evidence in the
individual’s case record.’” Id. (quoting SSR 16-3p, 82 Fed.
Reg. at 49464).
In evaluating Aldridge’s subjective complaints, the ALJ
discussed Aldridge’s testimony that she suffered from neck pain,
pain when lifting, walking, numbness in her hands, and
13 depression. The ALJ also noted Aldridge’s testimony that she
could sit for 20 minutes; stand for 20 minutes; walk for 15
minutes; and lift only one pound. The ALJ nevertheless
concluded that Aldridge’s statements about the intensity,
persistence, and limiting effects of Aldridge’s symptoms were
not supported by the record.
Aldridge argues that the ALJ contravened SSR 16-3p’s
instruction that an ALJ “not disregard an individual's
statements about the intensity, persistence, and limiting
effects of symptoms solely because the objective medical
evidence does not substantiate the degree of impairment-related
symptoms alleged by the individual.” SSR 16-3p, 82 Fed. Reg. at
49465. The ALJ, however, examined the record as a whole, and he
cited the treatment records from Lawrence, the medical opinions,
and Aldridge’s own reports of her daily activities in making his
findings.
For example, Dr. Loeser reported that, in the June 2015
examination, Aldridge “moved with ease around the examination
room without any apparent deficits or impairments.” Admin. Rec.
at 33. And Dr. Bildner observed in June 2015 that, while
Aldridge was depressed, “her thought processes appeared intact,”
she was alert, her attention and concentration “appeared fair,”
and she left her house three to four times a week to grocery
shop or go for a walk. Id. at 410-11. In addition, Dr. Bildner
14 noted, Aldridge reported caring for a “high energy” five-month-
old puppy. A March 2015 function report indicated that Aldridge
was able to drive if she “had to,” that she watched television
for four hours at a time, and that she could “visit with
friends.” Admin. Rec. at 31. Although the medical records
noted Aldridge’s pain, they also found that she maintained a
“normal” gait and activity levels inconsistent with the degree
of Aldridge’s self-reported limitations. Given the entirety of
the record, sufficient evidence supports the ALJ’s discounting
of Aldridge’s statements regarding the intensity, persistence,
and limiting effects of her symptoms.
Aldridge argues that her “normal gait” was an insufficient
reason to conclude that her pain symptoms were not as limiting
as alleged. Aldridge’s “normal gait,” however, is evidence that
supports the ALJ’s finding that Aldridge’s pain symptoms were
not as serious as alleged. See Balaguer v. Astrue, 880 F. Supp.
2d 258, 269 (D. Mass. 2012) (concluding that ALJ’s discounting
of applicant’s testimony was supported by substantial evidence
in part because “the medical evidence revealed that Balaguer had
no significant abnormalities in gait . . . .”). Furthermore, as
noted above, other evidence supported the ALJ’s finding.
Aldridge asserts that the ALJ merely repeated the state-
agency consultant’s findings about Aldridge’s lifting
limitations without citing supporting evidence. In his opinion,
15 the ALJ reviewed the medical evidence and the opinions of each
medical source. He concluded that Aldridge’s allegation that
she could lift only one pound was not consistent with the
medical opinions and examinations, none of which noted a
limitation to that degree. Lawrence’s opinion that Aldridge
could lift five pounds occasionally had limited explanation,
and, as discussed above, substantial evidence supports the ALJ’s
decision to give that opinion little weight. Aldridge points to
no evidence consistent with her testimony that she could lift
only one pound.
Next, Aldridge contends that the ALJ’s findings that she
would be able to carry out simple one-to-three step instructions
in an employment setting were contradicted by Lawrence’s opinion
and Aldridge’s own testimony that her pain interfered with her
concentration. The ALJ, however, relied on the opinion of Dr.
Bildner in this regard. Dr. Bildner examined Aldridge, noted
her deficiencies and abilities, and concluded that she would be
able to follow simple instructions and perform unskilled work.
The state-agency consultant concurred with Dr. Bildner’s opinion
about Aldridge’s mental capability. Although disparities
existed between Aldridge’s testimony, Lawrence’s opinion, and
Dr. Bildner’s opinion, the ALJ was within his discretion to
resolve the conflicts against Aldridge. See Qualgia, 52 F.
Supp. 3d at 337.
16 CONCLUSION
For the foregoing reasons, Aldridge’s motion to reverse
(doc. no. 7) is denied, and the Acting Commissioner's motion to
affirm (doc. no. 9) is granted. The clerk of the court shall
enter judgment in accordance with this order and close the case.
SO ORDERED.
__________________________ Landya McCafferty United States District Judge
March 5, 2019
cc: Counsel of Record