United States District Court, E.D. Arkansas
Loretta Peoples, Plaintiff.
Carolyn W. Colvin, Acting Commissioner, Social Security Administration, Defendant.
ORDER AFFIRMING THE COMMISSIONER
J. THOMAS RAY, Magistrate Judge.
Loretta Peoples seeks judicial review of the denial of her application for disability insurance benefits (DIB) and supplemental security income (SSI). Peoples previously applied for disability and was denied in July 2005. Peoples last worked in February 2009 as a substitute teacher. She applied for DIB and SSI on May 16, 2007, with an alleged onset date of August 19, 2004. Peoples's date last insured (DLI) is September 30, 2009. She bases disability on fibromyalgia, degenerative disc disease, reflux, tendinitis of wrists and elbows, right foot and ankle pain, neuropathy, depression, anxiety, and personality disorder.
The Commissioner's decision. The Commissioner's ALJ determined that Peoples has not engaged in substantial gainful activity since the alleged onset date. Peoples has severe impairments - degenerative disc disease of the spine with mild sensory neuropathy of the left foot; status-post right foot injury; mood disorder; anxiety disorder; personality disorder and dissociative disorder. None of Peoples's severe impairments meet the Listings,  and Peoples can perform a reduced range of light work - lifting, carrying, pulling or pulling 15-20 pounds occasionally and 10 pounds frequently; sitting or standing a total of 6 hours each in an 8 hour workday, 1 to 2 hours at a time; walking no more than 1 or 2 blocks at a time; occasional climbing, stooping, crouching, kneeling and crawling, but no climbing of scaffolds or ladders and no work requiring her to balance; frequent or occasional, but not constant, reaching and grasping; no work at temperature extremes; and simple unskilled or low-level semi-skilled work, which requires her to understand, remember and carry out concrete instructions and interact only superficially with supervisors, coworkers and the public. The ALJ held that Peoples cannot perform any past relevant work,  but can perform the positions of price marker, cafeteria attendant and library clerk, positions identified by the vocational expert (VE) as available in the state and national economies. In the alternative, if Peoples was limited to sedentary work with a sit-stand option and the additional non-exertional limitations, the ALJ determined that she can perform the positions of charge account clerk and document preparer. Peoples's application was denied.
After the Commissioner's Appeals Council denied a request for review, the ALJ's decision became a final decision for judicial review. Peoples filed this case to challenge the decision. In reviewing the decision, the Court must determine whether substantial evidence supports the decision and whether the ALJ made a legal error.
Peoples's allegations. Peoples maintains that the ALJ's denial of disability benefits should be reversed because (1) the credibility determination is not supported by substantial evidence; and (2) the ALJ erred in assigning limited weight to the opinions of Peoples's treating physicians.
Substantial evidence is "less than a preponderance but... enough that a reasonable mind would find it adequate to support the conclusion." For substantial evidence to exist in this case, a reasonable mind must accept the evidence as adequate to support the ALJ's denial of benefits.
Credibility. Peoples asserts that the ALJ erred in the credibility determination with respect to her allegations of disabling pain and symptoms related to her physical and mental impairments. After reviewing the medical record, the ALJ determined that Peoples was not credible to the extent that her statements were inconsistent with the RFC.
An ALJ must evaluate the claimant's credibility because subjective complaints play a role in determining the claimant's ability to work. To evaluate Peoples's credibility, the ALJ followed the required two-step process and considered the required factors,  so the dispositive question is whether substantial evidence supports the credibility evaluation. The ALJ's determination that Peoples's subjective complaints of pain and limitations were not credible to the extent that they conflict with the assigned RFC is supported by substantial evidence.
The treatment of Peoples's back and foot/ankle pain has been conservative, consisting primarily of pain medications, muscle relaxers, and steroid injections. On multiple occasions, Peoples was prescribed treatment as simple as hiking boots, braces, physical therapy, and, during one appointment, yoga and tai chi. Never once has a physician recommended or even suggested surgical options. The use of such conservative treatment weighs against Peoples's allegations.
The records further establish that Peoples did not always follow recommendations from treating physicians. This provides further support for the ALJ's credibility determination. As cited above, physical therapy was recommended by at least two physicians. There is not one record indicating that Peoples attended physical therapy. Further, on multiple occasions Peoples never followed up on instructions from physicians to return for further evaluation.
There are multiple extended periods of time during which Peoples sought no medical treatment. Following an August 8, 2008, appointment with her PCP,  Peoples went six months without any medical treatment. Another large break in medical treatment occurred between April 2009 and June 2011. The only treatment sought by Peoples during that period was emergency room care following a fall. Peoples maintains that she did not seek medical care following April 2009 because she no longer received Medicaid. There is, however, nothing in the record establishing that Peoples sought low cost or no cost medical care during this period. Therefore, her allegations of financial impediments to medical care are not persuasive. The lack of medical care for long periods of time weighs against Peoples's allegations of disabling pain and symptoms.
Perhaps most importantly, the diagnostic testing does not support Peoples's allegations. The record is replete with x-rays, MRIs, and CTs, among other things. The reports consistently find only minimal, if any, abnormalities. In 2005, two x-rays and a CT were performed on Peoples's right foot and ankle. The tests showed no acute abnormalities of Peoples's foot or ankle. There was, however, some question as to whether Peoples had an accessory navicular.,  After review by a podiatrist, however, it was determined that there was no accessory navicular. The podiatrist confirmed that there were no acute or chronic abnormalities in Peoples's right foot or ankle. He diagnosed her with tendinitis and foot pain.
As to Peoples's complaints of back and neck pain, diagnostic tests revealed only minor issues. Although a 2004 x-ray of Peoples's cervical spine noted a straightened curvature of the spine, it also indicated no acute subluxation,  dislocation, fracture or loss of alignment. A 2007 MRI of the cervical spine noted no straightened curvature. A central protrusion of the C6-C7 intervertebral disc was identified, but it was not causing any significant cord compression. In 2011, another x-ray was performed of Peoples's cervical spine. No straightened curvature was noted. The report identified mild loss of disc height and a small posterior osteophyte at C4-C5, but found nothing acute. Thoracic spine images also failed to detect more than minor abnormalities. A 2007 MRI of the thoracic spine showed mild degenerative disc disease with some mild bulging disc, but no evidence of any soft disc rupture producing foraminal impingement.
Multiple MRIs were performed on Peoples's lumbar spine. In 2007, an MRI indicated mild degenerative disc disease with no clear evidence of stenosis. An MRI of the lumbar spine performed in 2008 concluded that there were "some mild degenerative changes in the lumbar spine, but not severe. No acute causes of low back pain detected." The last MRI of the lumbar spine was conducted in 2011. Although the report identified "tiny old fractures" at the endplate of L1, it concluded that ...