Wenzel v . SSA CV-11-269-PB 7/6/12 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE
Thomas Bruce Wenzel
v. Civil N o . 11-cv-269-PB Opinion N o . 2012 DNH 117 Michael J. Astrue, Commissioner, Social Security Administration
MEMORANDUM AND ORDER
Thomas Wenzel seeks judicial review of a decision by the
Commissioner of the Social Security Administration denying his
application for disability insurance benefits. He contends that
the Administrative Law Judge (“ALJ”) who heard his case failed
to properly weigh the medical opinion evidence and erred in
assessing the credibility of his subjective reports of pain.
For the reasons provided below, I affirm the Commissioner’s
decision.
I. BACKGROUND1
Wenzel applied for disability insurance benefits on March
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.” 1 2 , 2009, when he was fifty-one years old. T r . 2 0 . He alleged a
disability onset date of October 2 , 2008, due to a back injury,
arthritis, carpal tunnel syndrome, and depression. Wenzel
completed high school, and worked as a painter for approximately
twenty-five years. T r . 20-21.
A. Medical Evidence
Between April 16 and May 3 0 , 2008, Wenzel sought treatment
for his back pain at the New Hampshire NeuroSpine Institute. He
complained of a twenty-five-year history of lower back pain that
was caused by his heavy workload as a self-employed painter. He
reported that his pain had become worse over the past eighteen
months. An MRI of Wenzel’s lumbar spine showed minor
degenerative disc and facet joint disease.
Dr. Theodore Jacobs, who treated Wenzel at the NeuroSpine
Institute, reported in a May 1 6 , 2008 letter that, upon
examination, Wenzel’s upper and lower extremities were
neurologically intact; his spine was nontender; a straight leg
raise test was negative 2 ; and extension and flexion did not
produce discomfort in his neck or lower back. D r . Jacobs noted
that he was unsure whether Wenzel had a surgically correctable
2 In his brief, Wenzel notes that a straight leg raise test is used to determine whether a patient’s back pain is due to an underlying herniated disc. Doc. N o . 9-1 at 6 n.1. 2 abnormality in his spine.
Wenzel again complained of lower back pain to D r . Jacobs on
May 3 0 , but, upon examination, movement of his neck and lower
back did not produce discomfort and a straight leg raise test
was again negative. D r . Jacobs noted that an M R I , which
revealed severe spinal stenosis and disc herniation, T r . 183,
“overstated any disease in his lumbar spine,” T r . 1 8 1 , and that
a myelogram and CT scan showed only “some mild stenosis” at L4-
5 , T r . 181. D r . Jacobs stated that Wenzel’s exam was benign.
He reassured Wenzel that he was not a surgical candidate, and
recommended that Wenzel seek pain management.
Beginning in February 2008, Wenzel saw D r . Robert Quirbach
of the S t . Joseph Family Medical Center for his complaints of
chronic back pain.3 Examinations performed through June 2009
showed that Wenzel had tightness or tenderness, along with
decreased range of motion, in his lumbosacral spine, and that he
also had some pain and tenderness in his cervical spine. In
July 2008, D r . Quirbach noted that Wenzel was bilaterally
positive on straight leg raise tests. At a number of
appointments, D r . Quirbach stated that Wenzel was doing fairly
3 Wenzel also complained to D r . Quirbach about his depression, a fact that is not relevant to the issues presented for my review. 3 well and/or that his back pain was stable. T r . 1 5 1 , 2 0 8 , 2 1 4 ,
215, 216, 2 2 0 , 225. He also reported that Wenzel was taking
Oxycontin, which was working well and sometimes controlled his
pain.
On June 1 6 , 2009, D r . Hugh Fairley, a non-examining state
agency physician, completed a physical RFC assessment of Wenzel.
Dr. Fairley opined that Wenzel 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
and/or pull without limitations. D r . Fairley opined that Wenzel
had occasional postural limitations, and had no manipulative,
visual, communicative, or environmental limitations.
Between late-June 2009 and October 2010, Wenzel continued
to see D r . Quirbach for his back pain. Across a number of
examinations, Wenzel continued to exhibit back pain and a
decreased range of motion, along with variable levels of
pain/distress. T r . 238-277. Wenzel was bilaterally positive on
a straight leg raise test performed in October 2009, and was
again positive in several straight leg raise tests performed in
the following months. T r . 238-73.
In a September 2010 appointment, D r . Quirbach noted that 4 Wenzel’s back pain had “been doing better recently.” T r . 242.
After an examination performed the following month, D r . Quirbach
reported that Wenzel’s back pain had been “stable,” but that
Wenzel was experiencing difficulty transitioning to a lower dose
of Oxycontin. T r . 238.
On November 2 , 2010, D r . Quirbach completed a medical
assessment of Wenzel’s physical ability to perform work-related
activities. D r . Quirbach stated that in an eight-hour day
Wenzel could occasionally lift and carry twenty pounds;
frequently lift and carry ten pounds; stand and walk with normal
breaks for about three hours; and sit with normal breaks for
about four hours. D r . Quirbach also stated that Wenzel could
never twist, but could occasionally bend, crouch, climb stairs,
and climb ladders. He opined that Wenzel’s impairments would
cause him to be absent from work more than three times per
month, and that Wenzel could not work eight hours a day, five
days a week.
B. Hearing Testimony
After Wenzel’s application for disability insurance
benefits was denied initially and upon reconsideration, he
requested a hearing before an ALJ. At his November 1 5 , 2010
hearing, Wenzel was represented by an attorney, and appeared and 5 testified on his own behalf. A vocational expert also
testified.
Wenzel reported that in 2003, he injured his arms when he
fell off a ladder. He testified that he experienced shooting
pains in his right arm, was unable to stretch his left arm, and
experienced arthritis in his hands. He stated that he also
experienced pain due to a lower back and neck condition. He
testified that as a result of the Oxycontin that he took for his
hands and back pain, he experienced side effects, including
difficulty driving, a loss of concentration, and memory
problems. He reported that he was not receiving any treatment
at the time aside from pain medication because his insurance
company would not cover additional treatment.
Speaking about his functional capabilities, Wenzel stated
that he could not sit for much more than an hour before needing
to move around. He reported that he could sometimes walk for
twenty minutes at a time without sitting down or lying down.
When asked about his activities of daily living, Wenzel
testified that during the day he watched television, stretched,
and did some chores.
C. ALJ’s Decision
The ALJ denied Wenzel’s application in a decision dated 6 December 2 3 , 2010. After determining that Wenzel had not
engaged in substantial gainful activity since his disability
onset date and that Wenzel’s degenerative disc disease with
associated back and neck pain was a severe -- though not a
listing level -- impairment, the ALJ found that Wenzel retained
the RFC to perform a full range of light work. In accordance
with that RFC, the ALJ determined that Wenzel, though unable to
perform his past relevant work as a painter, could perform jobs
existing in significant numbers in the national economy and
therefore was not disabled. Although the Decision Review Board
selected Wenzel’s claim for review, it did not complete its
review during the time permitted, thereby leaving the ALJ’s
decision as the final decision of the Commissioner.
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
“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). 7 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 Rodriquez 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.
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 8 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
Wenzel challenges the Commissioner’s decision on two
principal grounds. First, he contends that errors in the ALJ’s
evaluation of the medical opinion evidence led to an RFC
determination that is unsupported by substantial evidence.
Second, he contends that the ALJ failed to sufficiently explain,
by reference to the relevant criteria set out in 20 C.F.R. §
404.1529, why his subjective complaints of pain were not
credible. I address each argument in turn.
A. Medical Opinion Evidence & RFC Determination
An ALJ must take into account the medical opinions in a
claimant’s case record when making a disability determination.
20 C.F.R. § 404.1527(b). When the opinion of a treating
physician is well supported and not inconsistent with other
record evidence, it must be given controlling weight. Id.; 9 Social Security Ruling 96-2p, 1996 WL 374188 (July 2 , 1996)
[hereinafter SSR 96-2p]. In all other instances, an ALJ must
assess a number of factors to determine how much weight to give
to an opinion, including: 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 whether the source is a specialist. 20 C.F.R. §
404.1527(c)(2).
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.
Wenzel first argues that the ALJ could not have relied on
Dr. Fairley’s June 1 6 , 2009 opinion because D r . Quirbach’s
treatment notes subsequent to that date undermine the basis of
Dr. Fairley’s opinion. I disagree. Although a medical opinion
may no longer be due significant weight if it was based on a 10 materially incomplete record, see, e.g., Alcantara v . Astrue,
257 Fed. Appx. 333, 334 (1st Cir. 2007) (agency physician’s
opinion not due significant weight where, inter alia, claimant’s
condition deteriorated after date of opinion due to father’s
death); Shinn ex. rel. Shinn v . Comm’r of Soc. Sec., 391 F.3d
1276, 1287 (11th Cir. 2004) (because agency physicians were not
privy to the many crises for which claimant had not been
hospitalized, their opinions were “based on woefully incomplete
evidence” and should not have been accorded significant weight),
in this case Wenzel has not identified any symptom or condition
described by the treatment notes after June 1 6 , 2009 that is not
also indicated in the prior treatment notes. Wenzel draws
attention to two observations in D r . Quirbach’s more recent
treatment notes: Wenzel’s positive straight leg raise tests and
limited range of motion in his lumbar region. Both findings,
however, were also described in the treatment notes prior to
that date, see T r . 145, 1 5 1 , 1 5 2 , and were therefore included in
the portion of the record considered by D r . Fairley.
In other words, the ALJ was entitled to accord substantial
weight to D r . Fairley’s opinion because the treatment notes of
Dr. Quirbach that postdated D r . Fairley’s assessment continued
to document the same complaints of pain and the same clinical 11 findings of which D r . Fairley was already aware. Moreover,
though they were not available to D r . Fairley, D r . Quirbach’s
post-June 1 6 , 2009 treatment notes were available for
consideration by the ALJ.4 In his decision, the ALJ cited to
recent instances where D r . Quirbach described Wenzel’s back
condition as doing well or as stable, and I perceive no error in
the ALJ’s determination that those notes were not inconsistent
with D r . Fairley’s opinion. See Ferland v . Astrue, N o . 11-cv-
123-SM, 2011 WL 5199989, at *4 (D.N.H. Oct. 3 1 , 2011) (ALJ may
rely on opinion of non-examining consultant who has not examined
full record where other evidence does not establish greater
limitations or where other evidence is arguably consistent with
the assessment).
4 Focusing on one aspect of D r . Quirbach’s more recent treatment notes, Wenzel briefly argues that the ALJ erred by noting a negative straight leg test result found by D r . Jacobs while ignoring the several positive results found by D r . Quirbach since October 2009. Wenzel reads too much into this small omission. First, the ALJ accurately described the results of Dr. Jacobs’s neurological examination by noting that a straight leg test had come up negative. Second, an ALJ is not bound to directly address every piece of evidence in the record, see Rodriguez v . Sec’y of Health & Human Servs., 915 F.2d 1557, 1990 WL 152336, at *1 (1st Cir. 1990) (per curiam; table, text available on Westlaw), and throughout his decision the ALJ demonstrated a strong understanding of the record evidence both supporting and contradicting his view. I find no error in the ALJ’s decision to omit a single of D r . Quirbach’s clinical findings that was never described as important by any medical treatment provider, including D r . Quirbach himself. 12 Wenzel next attacks the ALJ for giving limited weight to
Dr. Quirbach’s opinion. The ALJ provided a number of “good
reasons,” however, for his decision to accord only limited
weight to the opinion of Wenzel’s treating physician, and those
reasons are “sufficiently specific to make clear . . . the
reasons for that weight.” 20 C.F.R. § 404.1527(c)(2); SSR 96-
2p. In particular, the ALJ explained: D r . Quirbach’s opinion
was conclusory; the opinion lacked a meaningful explanation for
why Wenzel could not work full time, even though he was
generally capable of light work; the opinion relied on Wenzel’s
subjective complaints, which the ALJ found not to be credible;
and the opinion was, at least to a degree, undercut by D r .
Quirbach’s own treatment notes, which indicated that Wenzel had
recently done some amount of physical work fixing up apartments.
Although other allocations of weight to the medical opinions may
have been possible on this record, the ALJ adequately explained
his reasons for discounting D r . Quirbach’s opinion, and those
reasons are supported by substantial evidence in the record.
B. Credibility Determination
Wenzel argues that the ALJ erred in finding that his
subjective reports of pain and functional limitations were not
credible. “Because symptoms, such as pain, sometimes suggest a 13 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 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 Wenzel’s
medically determinable symptoms could reasonably be expected to
cause his alleged symptoms. At step two, however, the ALJ found 14 that his “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 . 1 2 . Wenzel contends that the ALJ
misconstrued several treatment notes to support his negative
credibility finding, and failed to adequately consider the
limiting effects of his use of narcotic pain medication. I
disagree.
Wenzel quibbles with a number of the record citations the
ALJ used to explain his determination. Specifically, he argues
that the ALJ: put too much emphasis on instances where his
physicians noted that his pain was mild or stable or improving;
failed to explain why either his doctors’ statements that he was
able to work or the treatment notes indicating that he had
engaged in some work supported a finding that he was able to
work on a full-time basis; noted that a single straight leg
raise test was negative without mentioning the many positive
straight leg raise tests; referenced several diagnostic tests as
support for his position when the tests did not rule out his
symptoms; failed to explain why his decision not to follow up
with physical therapy appointments is relevant in light of his
ability to do the same exercises at home; and determined that he 15 had not used his pain medicines appropriately on the sole basis
of a single treatment note indicating that he needed a refill a
little early.
Wenzel’s contentions have some force, insofar as he
accurately details why each of the ALJ’s record citations is
limited in its probative value. Nonetheless, each citation does
still have some probative value, and the combined weight of the
record support is enough to meet the substantial evidence bar.
Most persuasively, the ALJ’s credibility determination finds
support in the diagnostic imaging tests that revealed only
“minor” degenerative disk and facet joint disease, T r . 176, the
various record references to Wenzel continuing to do some amount
of physical work painting and refurbishing, see Teixeira v .
Astrue, 755 F. Supp. 2d 3 4 0 , 347 (D. Mass. 2010) (although
“performance of household chores or the like ought not be
equated to an ability to participate effectively in the
workforce, evidence of daily activities can be used to support a
negative credibility finding”), and the several instances in the
treatment notes where Wenzel was described as being in only mild
pain or distress. I must defer to the ALJ’s determination
where, as here, it is supported by specific findings and is
based on substantial record evidence. See Frustaglia v . Sec’y 16 of Health & Human Servs., 829 F.2d 1 9 2 , 195 (1st Cir. 1987).
Moreover, to the extent that the record also contains contrary
evidence that supports Wenzel’s reports of disabling pain, the
ALJ’s opinion demonstrates that he reviewed the entire record,
and it is the duty of the ALJ, not a reviewing court, to resolve
conflicts in the evidence. See Irlanda Ortiz, 955 F.2d at 769.
Wenzel’s next argument is that the ALJ failed to adequately
address the side effects of his Oxycontin use. Pursuant to
Avery v . Secretary of Health and Human Services, an ALJ must
consider a number of factors in his credibility analysis,
including “[t]he type, dosage, effectiveness, and side effects
of any medication” the claimant has taken. 797 F.2d 1 9 , 22-23
(1st Cir. 1986); see 20 C.F.R. 404.1529(c). Although an ALJ is
expected to inquire into and consider all relevant factors, his
decision need not contain an explicit written analysis of each.
Vega v . Astrue, Civ. N o . 11-10406-WGY, 2012 U.S. Dist. LEXIS
44416, at *19-21 (D. Mass. Mar. 3 0 , 2012) (citing several cases
for that proposition).
In this case, Wenzel argues that the ALJ failed to consider
his hearing testimony vis-à-vis the side effects of his
Oxycontin use. At the hearing, Wenzel became disoriented and
explained to the ALJ that he had just “spaced out” because his 17 Oxycontin had “kick[ed] in.” T r . 3 4 . He also testified that he
had difficulties with memory and concentration and could not
drive while taking the medication. These limitations do not
appear to infringe on his ability to perform light work,
however, and neither the treatment notes nor the medical
opinions indicate that any of the side effects of Wenzel’s
Oxycontin use would limit his ability to perform a job at that
level of exertion. Accordingly, it was not error for the ALJ to
opt against including a written discussion of the side effects
of Wenzel’s medication. See Vega, 2012 U.S. Dist. LEXIS 44416,
at *19-21.
IV. CONCLUSION
For the foregoing reasons, I grant the Commissioner’s
motion to affirm (Doc. N o . 12) and deny Wenzel’s motion to
reverse (Doc. N o . 9 ) . The clerk is directed to enter judgment
accordingly and close the case.
SO ORDERED.
/s/Paul Barbadoro Paul Barbadoro United States District Judge
July 6, 2012
18 cc: Jeffry A . Schapira, Esq. Robert J. Rabuck, Esq.