United States District Court, W.D. Louisiana, Lafayette Division
REPORT AND RECOMMENDATION
CAROL
B. WHITEHURST UNITED STATES MAGISTRATE JUDGE.
Before
the Court is an appeal of the Commissioner's finding of
non-disability. Considering the administrative record, the
briefs of the parties, and the applicable law, it is
recommended that the Commissioner's decision be AFFIRMED.
Administrative
Proceedings
The
claimant, Janita Randle, fully exhausted her administrative
remedies prior to filing this action in federal court. The
claimant filed an application for disability insurance
benefits (''DIB'') and an application for
supplemental security income benefits
(''SSI''), alleging disability beginning on
July 5, 2012.[1] Her applications were
denied.[2] The claimant requested a hearing,
[3]
which was held on December 9, 2015, before Administrative Law
Judge Mary Gattuso.[4] The ALJ issued a decision on January 26,
2016, [5] concluding that the claimant was not
disabled within the meaning of the Social Security Act
(''the Act'') from July 5, 2012 through the
date of the decision. The claimant asked for review of the
decision, but the Appeals Council concluded on April 28, 2017
that no basis existed for review of the ALJ's
decision.[6] Therefore, the ALJ's decision became
the final decision of the Commissioner for the purpose of the
Court's review pursuant to 42 U.S.C. § 405(g). The
claimant then filed this action seeking review of the
Commissioner's decision.
Summary
of Pertinent Facts
The
claimant was born on July 18, 1966.[7] At the time of the ALJ's
decision, she was 49 years old. She has a high school
education.[8] She has past relevant work experience as a
cashier and recreational aide.[9] She alleges she has been disabled
since July 5, 2012 due to Addison's Disease and
depression and anxiety.
Claimant's
medical care with her internist, Dr. Melancon, began in
January 2012, at which time her records indicate she had
suffered with fatigue and depression for 5 months. She was on
daily doses of Synthroid and Cortisone Acetate, and also
received Prozac and Atenolol. T. 254, 255, 262, 264, 268,
281. Blood tests had multiple abnormal findings, including a
very low cortisol level. T. 258, 260. Claimant presented to
Dr. Melancon several times with swollen grands, sore throat
abdominal pain and upper respiratory infection. T. 267-282.
Claimant
was seen by an endocrinologist, Dr. Alan Burshell, M.D., at
Ochsner Foundation in New Orleans from March 2013 through
March 2014. The records reflect a history of an Addison's
Disease diagnosis in 1989, that she was taking Prednisone in
1991, and since that time had been on daily Hydrocortisone
for over 20 years. T. 336. In March 2013, her Cortisol and
TSH were both low. T. 345, 349. In July 2013 it was noted in
conjunction with her Addison's diagnosis that both ACTH
and Cortisol were low. T. 359. Her Cortisone dosage was
changed from 20 milligrams once per day to 15 mg and 5 mg in
two separate doses. T. 362.
Ochsner
records of November 2013 indicate that since lowering her
Cortisol and increasing thyroid medication, claimant had lost
weight and her blood pressure was low. Her physician
described an "unusual case with evidence for secondary
adrenal insufficiency and hypothyroidism.” T. 369. It
was noted that her last crisis was in July 2012 secondary to
a flu infection. T. 369. Her Cortisone was increased from
15/5 to 20 mg. She was also given a Dexamethasone emergency
kit. T.371.
Claimant
presented for follow-up in March 2014. She was still feeling
fatigued, but better since the last visit. She had not taken
her medications for one week in February 2014, but received a
steroid injection at the Urgent Care Clinic and doubled her
medication dose for one week, with good results. She
exhibited a normal mood and affect. T. 377.
The
record indicates that claimant first received mental health
treatment from Sharon Steward, M.D., with whom she was
treated for depression in 10 Sessions between February 2013
and January 2014. T. 315-325. During that time, Dr. Steward
discussed with claimant the correlation between her mood
swings and her Addison's and Thyroid conditions. T. 319,
327. Dr. Steward documented the claimant's positive
response to counseling with a “much improved
mood” in December 2013, T. 322, T. 329, and indicated
that her Global Assessment of Functioning (GAF) score went up
to an 80 by January 8, 2014.[10] T. 325.
A
consulting psychologist, Dr. Fontenelle, evaluated claimant
on March 25, 2014, at the request of the State
Agency.[11] While he noted that her IQ test results
placed her in a "Low Average" category, he thought
that "Anxiety and Nervousness may limit her true
intellectual capability.” T.412-413. He described that
claimant is: (1) capable to understand job instruction; (2)
says she enjoys performing helping type tasks delivery food
to the elderly; and (3) is able to concentrate to a limited
extent although she is anxious and depressed. T. 414. At that
time Dr. Fontenelle noted that claimant “is not
receiving medication;” “does receive counseling
but discontinued medication through outpatient mental
health.” T. 413-414. He diagnosed Generalized Anxiety
Disorder and Depression Disorder. T.414.
Records
and a "Medical Source Statement" prepared on
September 17, 2014, were supplied by a psychiatrist, Dr.
Ravindra Reddy. T 429. The record documents 10 clinical
visits with Dr. Reddy from March 12, 2014 to August 20, 2015,
with a diagnosis of Major Depressive Disorder and Generalized
Anxiety Disorder. T 424- 496. Claimant's medication
regimen included Lexapro, Seroquel, and Xanax. T.426. Dr.
Reddy felt that claimant had "marked" impairments
in interacting appropriately with supervisors and the public,
as well as responding appropriately to "usual work
situations and to changes in a routine work setting" and
“Moderate” impairments in interacting
appropriately with co-workers.” T.435. During her
appointments from March 2015 to June 2015, claimant indicated
that she was “doing OK” with “some”
depression at times. During those appointments she also
indicated she was in compliance with taking her medications.
T. 493-496. On her last visit in August 2015, however, she
reported that she was “doing worse” and that she
“stopped her medication on her own and has done much
worse.” T. 492.
At the
December 9, 2015 hearing, claimant testified that while she
had days free of symptoms from her Addison's Disease, she
had 3 or 4 days per week when she felt poorly because of an
infection and/or depression. She stated that this caused her
to stay in bed for four days about once a month. She felt she
could not do an 8hour job, both from the effects of physical
problems and depression. T. 45, 49-50, 52-53.
As to
claimant's work activities, the records indicate she was
able to work full-time at a Navy Exchange department store
from May 1998 to January 2001 and in part-time jobs from
March 2005 to January 1, 2014, the date she applied for
disability benefits. T. 192. Specifically, claimant worked
part-time starting in the fourth quarter of 2013 and
extending into 2014, delivering meals for the Council on
Aging five days a week, three hours per day. T. 41.
With
regard to her activities of daily living, claimant testified
that she lives with her husband and during the day, she plays
with her puppies, watches television and reads the newspaper,
but is unable to watch a two hour movie without falling
asleep. She is able to cook and clean at her own pace. She
shops once a month with her husband. They visit their son who
attends college in Lafayette, and eat out. She visits with
her sister. She drives occasionally after being cleared by
her cardiologist in January 2015, but she is afraid that she
will pass out when driving.[12]
The ALJ
posited 3 hypothetical scenarios to the testifying vocational
expert. Hypothetical (1) being off task 20% of the work day,
and (2) being absent for 2 days per month, yielded testimony
that there was no work in the economy. The third
hypothetical, with limitation to light work with occasional
performance of postural activities and additional
restrictions as to routine and repetitive tasks and contact
with the public, coworkers, and supervisors, yielded
testimony that jobs existed. T. 63-65.
In
response to a hypothetical from claimant's counsel that
tracked the marked restrictions in personal associations
assigned by the treating psychiatrist (the ability to
interact with supervisors and to respond appropriately to
usual work situations and changes in routine work setting),
the vocational expert testified that such a person could not
sustain employment in the types of jobs identified in
response to the Judge's third hypothetical. T. 66.
In her
January 26, 2016 ruling, the ALJ found that claimant had
severe impairments of: “disorders of the thyroid gland,
disorders of the adrenal gland, affective disorder, and
anxiety disorder." T. 22. The ALJ later stated, with
respect to Addison's Disease and hypothyroidism:
"There is no indication that either impairment has
caused significant functional limitations." T. 28.
Analysis
A.
Standard of Review
Judicial
review of the Commissioner's denial of disability
benefits is limited to determining whether substantial
evidence supports the decision and whether the proper legal
standards were used in evaluating the evidence.[13]
''Substantial evidence is more than a scintilla, less
than a preponderance, and is such relevant evidence as a
reasonable mind might accept as adequate to support a
conclusion.''[14]Substantial evidence ''must do
more than create a suspicion of the existence of the fact to
be established, but 'no substantial evidence' will
only be found when there is a 'conspicuous absence of
credible choices' or 'no contrary medical
evidence.'''[15]
If the
Commissioner's findings are supported by substantial
evidence, then they are conclusive and must be
affirmed.[16] In reviewing the Commissioner's
findings, a court must carefully examine the entire record,
but refrain from re-weighing the evidence or substituting its
judgment for that of the Commissioner.[17]Conflicts in
the evidence and credibility assessments are for the
Commissioner to resolve, not the courts.[18] Four elements
of proof are weighed by the courts in determining if
substantial evidence supports the Commissioner's
determination: (1) objective medical facts, (2) diagnoses and
opinions of treating and examining physicians, (3) the
claimant's subjective evidence of pain and disability,
and (4) the claimant's age, education and work
experience.[19]
B.
Entitlement to Benefits
The
Disability Insurance Benefit (''DIB'')
program provides income to individuals who are forced into
involuntary, premature retirement, provided they are both
insured and disabled, regardless of indigence.[20] Every
individual who meets certain income and resource
requirements, has filed an application for benefits, and is
determined to be disabled is eligible to receive Supplemental
Security Income (''SSI'')
benefits.[21]
The
term ''disabled'' or
''disability'' means the inability to
''engage in any substantial gainful activity by
reason of any medically determinable physical or mental
impairment which can be expected to result in death or which
has lasted or can be expected to last for a continuous period
of not less than twelve months.''[22] A claimant
shall be determined to be disabled only if his physical or
mental impairment or impairments are so severe that he is
unable to not only do his previous work, but cannot,
considering his age, education, and work experience,
participate in any other kind of substantial gainful work
which exists in significant numbers in the national economy,
regardless of whether such work exists in the area in which
the claimant lives, whether a specific job vacancy exists, or
whether the claimant would be hired if he applied for
work.[23]
C.
Evaluation Process and Burden of Proof
The
Commissioner uses a sequential five-step inquiry to determine
whether a claimant is disabled. This process required the ALJ
to determine whether the claimant (1) is currently working;
(2) has a severe impairment; (3) has an impairment listed in
or medically equivalent to those in 20 C.F.R. Part 404,
Subpart P, Appendix 1; (4) is able to do the kind of work he
did in the past; and (5) can perform any other
work.[24] If it is determined at any step of that
process that a claimant is or is not disabled, the sequential
process ends. ''A finding that a claimant is disabled
or is not disabled at any point in the five-step review is
conclusive and terminates the
analysis.''[25]
Before
going from step three to step four, the Commissioner assesses
the claimant's residual functional capacity[26] by
determining the most the claimant can still do despite his
physical and mental limitations based on all relevant
evidence in the record.[27] The claimant's residual
functional capacity is used at the fourth step to determine
if he can still do his past relevant work and at the fifth
step to determine whether he can adjust to any other type of
work.[28]
The
claimant bears the burden of proof on the first four
steps.[29] At the fifth step, however, the
Commissioner bears the burden of showing that the claimant
can perform other substantial work in the national
economy.[30] This burden may be satisfied by
reference to the Medical-Vocational Guidelines of the
regulations, by expert vocational testimony, or by other
similar evidence.[31] If the Commissioner makes the necessary
showing at step five, the burden shifts back to the claimant
to ...