United States District Court, W.D. Virginia, Roanoke Division
GLEN E. CONRAD, Chief District Judge.
Plaintiff has filed this action challenging the final decision of the Commissioner of Social Security denying plaintiff's claims for disability insurance benefits and supplemental security income benefits under the Social Security Act, as amended, 42 U.S.C. §§ 416(i) and 423, and 42 U.S.C. § 1381 et seq., respectively. Jurisdiction of this court is pursuant to 42 U.S.C. § 405(g) and 42 U.S.C. § 1383(c)(3). This court's review is limited to a determination as to whether there is substantial evidence to support the Commissioner's conclusion that plaintiff failed to establish entitlement to benefits under the Act. If such substantial evidence exists, the final decision of the Commissioner must be affirmed. Laws v. Celebrezze , 368 F.2d 640 (4th Cir. 1966). Stated briefly, substantial evidence has been defined as such relevant evidence, considering the record as a whole, as might be found adequate to support a conclusion by a reasonable mind. Richardson v. Perales , 402 U.S. 389, 401 (1971).
The plaintiff, Joyce Sawyers, was born on August 16, 1958, and eventually completed her college education. Mrs. Sawyers received a bachelor's of business administration degree. (TR 43). Plaintiff has worked primarily as a customer service representative for a satellite television provider and as a newspaper delivery driver. She last worked on a regular and sustained basis in 2011. On June 27, 2011, Mrs. Sawyers filed an application for a period of disability and disability insurance benefits. Shortly thereafter, she also filed an application for supplemental security income benefits. In filing her applications, plaintiff alleged that she became disabled for all forms of substantial gainful employment on June 24, 2011, due to chronic diabetic neuropathy in her legs and feet; diverticulosis; depression; anxiety attacks; back deterioration and narrowing of the spinal canal; sleep apnea; diabetes; and classical migraines. Mrs. Sawyers now maintains that she has remained disabled to the present time. As to her application for disability insurance benefits, the record reveals that plaintiff met the insured status requirements of the Act at all relevant times covered by the final decision of the Commissioner. See generally, 42 U.S.C. §§ 416(i) and 423(a).
Mrs. Sawyers' applications were denied upon initial consideration and reconsideration. She then requested and received a de novo hearing and review before an Administrative Law Judge. In an opinion dated June 27, 2013, the Law Judge also determined that plaintiff is not disabled. The Law Judge found that Mrs. Sawyers suffers severe impairments, including peripheral neuropathy; diabetes mellitus; morbid obesity; obstructive sleep apnea; degenerative changes in the lumbar and cervical spine, osteoarthritis of knees; and degenerative changes in the left shoulder. (TR 25). While the Law Judge also noted that Mrs. Sawyers also suffers from hypertension and numbness in her right fingers, the Law Judge held that these difficulties are not severe and amenable to treatment. The Law Judge noted that plaintiff experiences some emotional symptoms, including depression and moodiness. However, the Law Judge observed that Mrs. Sawyers has not been treated by mental health providers for these difficulties. The Law Judge ruled that Mrs. Sawyers does not experience any severe psychiatric or psychological impairments. (TR 26-28). Nevertheless, based primarily on plaintiff's musculoskeletal problems, the Law Judge determined that Mrs. Sawyers is incapable of performing more than a limited range of sedentary work activity. The Law Judge assessed plaintiff's residual functional capacity as follows:
After careful consideration of the entire record, this Administrative Law Judge finds that the claimant has the residual functional capacity to perform sedentary work as defined in 20 CFR 404.1567(a) and 416.967(a) as follows: lift and carry 20 pounds occasionally and 10 pounds frequently; sit for 6 hours of an 8-hour workday and stand and/or walk for 2 hours in an 8 hour workday; frequent reaching overhead bilaterally; no crawling or kneeling; occasional balancing, stooping, crouching, and climbing of ramps and stairs; and avoidance of even moderate exposure to temperature extremes and excess humidity, pollutants and irritants, hazardous machinery, unprotected heights, and vibrating surfaces; no climbing of ladders, ropes or scaffolds; and no jobs that require driving.
(TR 30). Given such a residual functional capacity, and after considering plaintiff's age, education, and work experience, as well as testimony from a vocational expert, the Law Judge ruled that Mrs. Sawyers retains the capacity to return to her past relevant work as a customer service representative. (TR 31). Accordingly, the Law Judge ultimately concluded that Mrs. Sawyers is not disabled, and that she is not entitled to benefits under either federal program. See 20 C.F.R. §§ 404.1520(f) and 416.920(f). The Law Judge's opinion was adopted as the final decision of the Commissioner by the Social Security Administration's Appeals Council. Having exhausted all available administrative remedies, Mrs. Sawyers has now appealed to this court. While plaintiff may be disabled for certain forms of employment, the crucial factual determination is whether plaintiff is disabled for all forms of substantial gainful employment. See 42 U.S.C. §§ 423(d)(2) and 1382c(a). There are four elements of proof which must be considered in making such an analysis. These elements are summarized as follows: (1) objective medical facts and clinical findings; (2) the opinions and conclusions of treating physicians; (3) subjective evidence of physical manifestations of impairments, as described through a claimant's testimony; and (4) the claimant's education, vocational history, residual skills, and age. Vitek v. Finch , 438 F.2d 1157, 1159-60 (4th Cir. 1971); Underwood v. Ribicoff , 298 F.2d 850, 851 (4th Cir. 1962).
After a review of the record in this case, the court is constrained to conclude that the Commissioner's final decision is supported by substantial evidence. Mrs. Sawyers suffers from a variety of musculo skeletal problems, complicated by peripheral diabetic neuropathy. Objective studies have revealed fairly severe spinal stenosis in her lumbar spine, as well as degenerative changes in her cervical spine, lumbar spine, left shoulder, and knees. She also experiences morbid obesity. For the most part, Mrs. Sawyers has received conservative treatment for her physical discomfort. She has been seen on a regular basis at The Pain Center of Christiansburg. Based on the reports from the Pain Center, it is clear that plaintiff is disabled for anything other than a limited range of sedentary work activity. Indeed, three nurse practitioners who have evaluated Mrs. Sawyers have produced reports indicating that she is disabled for all forms of work.
The difficulty in this case is that there are no "acceptable medical sources, " within the meaning of 20 C.F.R. §§ 404.1513(a) and 416.913(a), who have submitted evidence documenting total disability. Based on his examinations at the Pain Center, Dr. Don Bivins, a treating neurologist, has submitted several functional assessments. (TR 570-71, 572-73). While plaintiff suggests that Dr. Bivins' assessment forms are incomplete, it is clear that Dr. Bivins responded to certain of the questions on the forms, and that he did not suggest that Mrs. Sawyers is totally disabled. An orthopaedic specialist, Dr. Jeffery R. Chain, assessed plaintiff's knee problems on referral from the Pain Center. Dr. Chain listed physical findings as follows:
Well-developed woman awake alert and oriented in no acute distress. She walks with a mild limp on the right. The right knee has no soft tissue swelling, ecchymosis, redness, or effusion. Range of motion of the right knee is 00 to 1200. There is tenderness under the patellar facets with less tenderness along the medial and lateral joint lines. Her collateral and crucial ligaments are stable. McMurray's is negative. Skin and neurovascular exams are intact to the right lower extremity.
(TR 689). Dr. Chain diagnosed mild degenerative arthritis in both knees.
Dr. Raymond V. Harron, a neurosurgeon evaluated Mrs. Sawyers on November 26, 2012, also on referral from the Pain Center. Dr. Harron summarized plaintiff's complaints as follows:
I had the pleasure of evaluating Ms. Sawyers today in my office. She is a 54-year-old white female who presents for evaluation of low back pain and pain radiating into her legs when she stands and ambulates predominantly. She also has some neck symptoms. She states her back problems have been ongoing for several years and for at least the last two years she feels they are getting progressively worse. She states that she cannot walk as far as she has in the past because of increasing pain in her back and down into her legs. She denies bowel or bladder dysfunction associated with her symptoms. She is currently in pain management for her problem.
(TR 699). The neurosurgeon submitted the following clinical findings and impressions:
On examination, she goes from a sitting to a standing position well. She stands pretty erectly but has a little bit of an anthropoid posture. She walks without limping. She walks without assistive devices. No muscular atrophy of the lower extremities is appreciated. Her lower extremity motor power is strong bilaterally. Babinski sign is absent bilaterally. No ...