Kanella Karen Hantzis v. Commissioner of Social Security , 686 F. App'x 634 ( 2017 )

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[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 14-14311
Non-Argument Calendar
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D.C. Docket No. 8:13-cv-01711-EAK-MAP
KANELLA KAREN HANTZIS,
Plaintiff-Appellant,
versus
COMMISSIONER OF SOCIAL SECURITY,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Middle District of Florida
________________________
(April 19, 2017)
Before HULL, JULIE CARNES and JILL PRYOR, Circuit Judges.
PER CURIAM:
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Kanella Hantzis pro se appeals the district court’s order affirming the
decision of the Commissioner of the Social Security Administration
(“Commissioner”) to deny her application for disability insurance benefits
(“DIB”), pursuant to 42 U.S.C. § 405(g). On appeal, Hantzis argues that the
Administrative Law Judge (“ALJ”) failed to apply the correct legal standards in
weighing the opinions of her treating physicians. Upon careful review of the
record, we find no reversible error in the ALJ’s evaluation of the medical source
opinions.
I. FACTUAL BACKGROUND
Hantzis began experiencing chronic back and leg pain after she fell and
injured her back twice in 1989. By 1993, Hantzis had stopped working.
In 2009, Hantzis applied for benefits due to vertigo, degenerative disc
disorder, and hip dysfunction with an onset date of July 1, 1993. In 2011, Hantzis
and a vocational expert (“VE”) testified at a hearing before an ALJ. Afterward, the
ALJ denied Hantzis’s application.
Following the five-step evaluation process, the ALJ found that: (1) Hantzis
had not engaged in substantial gainful employment between July 1, 1993 and
December 31, 1998, her date of last insured; (2) she had the severe impairments of
light L5 radiculopathy with bilateral lumbar paraspinal myofascial pain syndrome,
degenerative disc disease at CS-6 with resulting cervical spine pain, tibia fracture,
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vertigo, and migraine headaches; (3) her impairments, alone and in combination,
did not meet or medically equal a listed impairment; and (4) she was not disabled
because she had the residual functional capacity (“RFC”) to perform a full range of
light work; which included her past relevant work as a waitress and a
cosmetologist. See 20 C.F.R. § 404.1520(a)(4)(i)-(iv). Alternatively, the ALJ
found that Hantzis was not disabled because a significant number of light work and
sedentary work jobs existed in the national economy that she could perform,
including housekeeper, mail clerk, electronic worker, charge account clerk, order
clerk, and ticket seller. See id. § 404.1520(a)(4)(v).
The Appeals Council denied Hantzis request for review, making the ALJ’s
decision the final decision of the Commissioner. See Doughty v. Apfel, 245 F.3d
1274, 1278 (11th Cir. 2001).
II. DISCUSSION
On appeal, Hantzis’s pro se brief, liberally construed, argues that the ALJ, in
assessing her RFC at steps four and five, should have assigned more weight to the
opinions of Drs. Robert Ho and Mark Brennan, who had treated her for several
years. 1
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In the district court, plaintiff Hantzis also argued that the ALJ erred by: (1) disregarding
the 2009 retrospective opinion of Dr. Gaurav Malhotra and (2) by failing to include Hantzis’s
vertigo and migraine symptoms in the RFC assessment and the hypothetical questions posed to
the VE. Hantzis failed to raise these two issues in her appeal brief and thus has abandoned them.
See Sapuppo v. Allstate Floridian Ins. Co., 739 F.3d 678, 681-82 (11th Cir. 2014); Timson v.
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A. Evaluating Medical Opinions
In considering at the fourth and fifth steps whether a claimant can perform
her past relevant work or can perform other work in the economy, the ALJ must
determine a claimant’s RFC by considering all relevant medical and other
evidence. See Phillips v. Barnhart, 357 F.3d 1232, 1238-39 (11th Cir. 2004); see
also 20 C.F.R. §§ 404.1520(e), 416.920(e). RFC is a medical assessment of what
the claimant can do in a work setting despite any mental, physical, or
environmental limitations caused by the claimant’s impairments or related
symptoms. 20 C.F.R. §§ 404.1545(a), 416.945(a).
The ALJ must consider the different medical opinions found in the record in
assessing the claimant’s RFC. In determining how much weight to give each
medical opinion, the ALJ considers such factors as the examining or treating
relationship, whether the opinion is well-supported, whether the opinion is
consistent with the record, and the doctor’s specialization. See 20 C.F.R.
§ 404.1527(c). A treating physician’s medical opinion “must be given substantial
or considerable weight unless ‘good cause’ is shown to the contrary.” Crawford v.
Comm’r of Soc. Sec., 363 F.3d 1155, 1159 (11th Cir. 2004) (quotation marks
omitted); see also 20 C.F.R. §§ 404.1527(c)(2) (requiring the ALJ to give “good
Sampson, 518 F.3d 870, 874 (11th Cir. 2008). Further, to the extent Hantzis now challenges the
ALJ’s weighing of the opinions from medical sources other than Drs. Brennan and Ho, we do not
address these arguments because Hantzis did not raise them in the district court. See Stewart v.
Dep’t of Health & Human Servs., 26 F.3d 115, 115 (11th Cir. 1994).
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reasons” for not giving controlling weight to the treating physician’s opinion).
This Court has found “good cause” to exist where: (1) the opinion was not
bolstered by the evidence; (2) the evidence supported a contrary finding; or (3) the
opinion was conclusory or inconsistent with the doctor’s own medical records.
Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1179 (11th Cir. 2011). The ALJ
must “clearly articulate the reasons for giving less weight” to a treating physician’s
opinion. See Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997).
However, an ALJ may reject any medical opinion if the evidence supports a
contrary finding. Sryock v. Heckler, 764 F.2d 834, 835 (11th Cir. 1985). When
the ALJ’s articulated reasons for assigning limited weight to a treating physician’s
opinion are supported by substantial evidence, there is no reversible error. See
Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005).
B. Hantzis’s Claim
Here, in his May 1995 treatment notes, Dr. Ho listed functional impairments
of “[r]estricted bending, lifting and twisting,” and stated that Hantzis “remains
unable to work due to her chronic symptomatology.” In August 1995, Dr. Brennan
opined that Hantzis needed vocational rehabilitation and had the following work
restrictions: (1) lifting no more than 20 pounds; (2) no frequent bending and
twisting at the back; and (3) short rest periods of less than a minute to perform
exercises when her symptoms significantly increase. In July 1997, Dr. Brennan
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noted an additional “functional loss of being unable to tolerate prolonged sitting or
standing activities.”
In determining Hantzis’s RFC, the ALJ declined to give controlling weight
to the opinions of Drs. Ho and Brennan about Hantzis’s functional limitations.
Instead, the ALJ gave “significant weight” to Dr. Brennan’s lifting restriction of 20
pounds, but “little weight” to the doctors’ other restrictions on Hantzis’s ability to
sit, stand, bend, and twist. By way of explanation, the ALJ stated:
In determining the amount of weight to accord these opinions, the
undersigned had considered various factors including, the examining
relationship, the treating relationship, supportability, consistency, and
specialization. The undersigned notes that these opinions are not
supported by the doctors’ own internal notes whereby improvement is
documented in the claimant’s condition with continued conservative
management. The undersigned finds these limitations are inconsistent
with the record when considered in its entirety. Furthermore, the
undersigned notes that the ultimate issue of disability is a finding of
fact reserved to the Commissioner.
The ALJ concluded that his RFC assessment—the ability to perform a full range of
light work—was “supported by the longitudinal treatment record and the
effectiveness of [Hantzis’s] conservative treatment, physical therapy, and
medication regimen.”
We conclude that the ALJ applied the correct legal standards when
evaluating Drs. Brennan’s and Ho’s opinions, and that substantial evidence
supports the ALJ’s decision to grant little weight to Drs. Brennan’s and Ho’s
opinions regarding Hantzis’s ability to sit, stand, bend, and twist. The ALJ
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provided good cause for discounting these opinions when he explained that they
were unsupported by the doctors’ own internal notes and inconsistent with the
entire record. See Winschel, 631 F.3d at 1179.
Furthermore, substantial evidence supports the ALJ’s conclusion that these
opinions were not supported by Drs. Brennan’s and Ho’s notes or the rest of the
record. Medical records showed that Hantzis experienced improvement with
medication and therapies, such as physical therapy and strengthening exercise.
Though Hantzis’s subjective report of her pain did not consistently or greatly
improve, she showed gains in flexibility and strength. For example, at
examinations, Dr. Brennan generally noted only a mild to moderate amount of
splinting and tenderness. Also, in February 1995, Dr. Brennan noted Hantzis could
flex forward to a position where her hands were approximately three feet from the
floor, but the distance had decreased to two feet in March, April and June 1995,
and to one foot in August 1995. In April and June 1995, Dr. Brennan described
Hantzis’s L5 radiculopathy as “gradually resolving.” Many objective diagnostic
tests results, such as x-rays, CT scans, electromyography, and nerve conduction
studies were normal. For these reasons, the ALJ provided good cause for
according little weight to Drs. Brennan’s and Ho’s functional limitations in sitting,
standing, bending, and twisting, and substantial evidence supports the ALJ’s
determination.
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Hantzis suggests that the ALJ improperly discounted the opinions of Drs.
Brennan and Ho based on the opinion of another treating physician, Dr. Jerrilyn
Wetzel. Hantzis stresses that Drs. Brennan and Ho treated her chronic back pain
for years, while Dr. Wetzel saw her only three times.
In March and June 1997, Dr. Wetzel treated Hantzis for episodes of vertigo,
facial numbness, chest pain, and shortness of breath. In her June treatment notes,
Dr. Wetzel noted, among other things, that (1) Hantzis kept trying to get Dr.
Wetzel to relate all of her current symptoms back to a 1989 fall; (2) except for a
passing reference to a steroid injection, Hantzis had not disclosed her fall or her
history of chronic low back pain at her earlier visit in March 1997; and (3) Hantzis
was difficult to follow when describing her history of complaints and contradicted
herself while describing her symptoms. Dr. Wetzel made clear to Hantzis that she
thought Hantzis’s current complaints of dizziness and loss of consciousness were
unrelated to her 1989 back injury or her chronic low back pain. Dr. Wetzel
explained to Hantzis that her current symptoms might be related to heart disease
and would need to be worked up separately, and Dr. Wertzel advised Hantzis to
continue therapy for her chronic back pain with Drs. Brennan and Ho. Dr. Wetzel
expressed no opinion about Hantzis’s ability to sit, stand, twist or bend.
Contrary to Hantzis’s argument, the record does not reflect that the ALJ
discounted Drs. Brennan’s and Ho’s opinions of Hantzis’s functional limitations
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based on Dr. Wetzel’s statements in her treatment notes or based on any
misunderstanding about whether Hantzis’s chronic back and leg pain dated back to
her 1989 falls. Indeed, the ALJ found that the medical evidence established that
Hantzis sustained two falls in 1989 that were the genesis of her complaints of
chronic back pain, leg pain, and headaches. In reviewing the medical evidence, the
ALJ noted Dr. Wetzel’s statements in her treatment notes, but the ALJ did not
express that these statements carried more weight with him than other parts of the
record documenting the effectiveness of Hantzis’s physical therapy and medication
regimens, which the ALJ discussed at length. Nor did the ALJ point to Dr.
Wetzel’s statements in explaining his decision to discount the opinions of Drs.
Brennan and Ho.
In sum, substantial evidence supports the ALJ’s articulated reasons for
assigning little weight to the opinions of Drs. Brennan and Ho about Hantzis’s
sitting, standing, bending and twisting restrictions. For this reason, we affirm the
ALJ’s denial of Hantzis’s application for DIB benefits.
AFFIRMED.
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