Taylor v. Astrue

FILED
United States Court of Appeals
Tenth Circuit
February 22, 2008
UNITED STATES COURT OF APPEALS Elisabeth A. Shumaker
Clerk of Court
FOR THE TENTH CIRCUIT
WENDY L. TAYLOR,
Plaintiff-Appellant,
v. No. 07-4165
(D.C. No. 2:06-CV-908-DAK)
MICHAEL J. ASTRUE, (D. Utah)
Commissioner of Social Security,
Defendant-Appellee.
ORDER AND JUDGMENT *
Before BRISCOE, BALDOCK, and LUCERO, Circuit Judges.
Plaintiff Wendy Taylor appeals from a district court order affirming the
Commissioner’s decision denying her application for Social Security Disability
benefits. She applied for benefits in January 2004, claiming an inability to work
since June 2002 due to severe lower-back, hip, and joint pain caused by
*
After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties’ request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
ordered submitted without oral argument. This order and judgment is not binding
precedent, except under the doctrines of law of the case, res judicata, and
collateral estoppel. It may be cited, however, for its persuasive value consistent
with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
degenerative disc disease and osteoporosis. The Social Security Administration
denied her application initially and on reconsideration, but granted Ms. Taylor’s
request for a de novo hearing before an administrative law judge (“ALJ”), which
took place on January 30, 2006.
The ALJ concluded that Ms. Taylor was not disabled within the meaning of
the Social Security Act. Although he found that she suffered from degenerative
disc disease of the lumbar spine, which he concluded was a severe impairment, he
nonetheless determined that she retained the residual functional capacity (“RFC”)
to perform the full range of light and sedentary unskilled work with some
important limitations, which we discuss below. On appeal, Ms. Taylor argues the
ALJ did not apply the correct legal standards in analyzing the opinions of her
orthopedic surgeon, Dr. Leslie Harris. Had the ALJ given proper weight to
Dr. Harris’s opinion regarding her functional limitations, she argues, he would
have concluded that Ms. Taylor is completely disabled. She also accuses the ALJ
of relying too heavily on his own observations during the hearing and argues
generally that the ALJ’s RFC determination was not supported by substantial
evidence.
We have jurisdiction over this appeal under 42 U.S.C. § 405(g). Because
we conclude the ALJ applied the correct legal standards in evaluating the medical
evidence and that substantial evidence supports his decision, we AFFIRM.
-2-
I. Background
A. Medical Evidence
Because Ms. Taylor argues that the ALJ’s RFC assessment is unsupported
by medical evidence, we discuss the medical records relating to her back
condition in some detail. The record reveals that she began experiencing back
pain sometime in 2002 after she left a desk job and began working at the customer
service deli department at Wal-Mart. Her family doctor, Robert Williams,
referred her to a sports medicine doctor, Paul Pilgram, who diagnosed “Grade II
spondylolisthesis at L5-S1 with secondary spinal stenosis,” “disc herniation at
T10-T11 with mild cord compression,” and “disc bulge L4-5 without thecal sac
compression.” App. at 117.
In October 2002, Dr. Pilgram referred Ms. Taylor to Dr. Harris, an
orthopedic surgeon. Since extensive conservative treatment had failed to alleviate
Ms. Taylor’s back pain, Dr. Harris recommended surgery, and on May 19, 2003,
he performed an L4-L5 and L5-S1 decompression and fusion. Ms. Taylor
reported having some pain immediately after the surgery, but by July 18, 2003,
Dr. Harris’s notes indicate that she was “actually doing quite well.” Id. at 164.
By September, he reported that her back was non-tender, and straight leg raising
tests were negative. By November 2003, however, Ms. Taylor’s pain had
resurfaced. Dr. Harris’s notes indicate that she was doing “reasonably well,” but
that she was experiencing “occasional soreness in her back” and “poor sitting
-3-
tolerance” plus “occasional numbness and tingling in her feet.” Id. On
examination, her back was tender over the sacral screw areas bilaterally and
x-rays revealed that “[t]he left pedicle screw bar . . . appear[ed] prominent
distally.” Id. Dr. Harris advised Ms. Taylor to continue with her medication
(Lortab, Soma, and Neurontin) and return in two months for repeat x-rays.
Over the next six months, Ms. Taylor’s back pain persisted. She did,
however, experience some relief with medication, particularly injections, and she
lost weight because she was able to exercise on a treadmill. On May 4, 2004, five
months after she filed her disability application, she was examined by Dr. Brian
Staley, an agency consulting physician. She reported to Dr. Staley that “she
continue[d] to have chronic aching back pain which is present all of the time.”
Id. at 142. But she also told him that she could perform her own activities of
daily living without assistance; that she could do the dishes; lift and carry
approximately 20 pounds; climb a flight of stairs; and drive a car. She said that
she could not, however, vacuum, sweep, or mop; sit for more than 20 minutes at a
time; stand for more than 60 minutes; or carry laundry up a flight of stairs.
Dr. Staley observed that Ms. Taylor was “in no acute distress” and was
“using no supportive devices to ambulate.” Id. at 143. His musculoskeletal exam
revealed “2+ tenderness to palpation of the left SI joint area, but . . . no apparent
tenderness in the vertebrae [and] [n]o muscle spasms.” Id. at 144. He also noted
that she had “mild difficulty” negotiating the exam table and that despite her
-4-
ability to sit for 20-30 minutes, “she appeared to be somewhat uncomfortable.”
Id. Ultimately, Dr. Staley concluded that Ms. Taylor had “put forth a good effort
on the exam.” Id. at 145. He indicated he would need her bone scan results and
recent x-rays to fully understand the current state of her lower back, including the
effects of osteoporosis. His general impression was as follows:
She does appear to have pain to palpation of the left SI joint area.
She seemed uncomfortable while sitting. She has good [range of
motion] in her spine, and there is no evidence of nerve root
impingement. She is steady on her feet, and she does not require a
supportive device to ambulate.
Id. He further noted that he did not detect any strength deficits. He did not,
however, offer an opinion regarding the functional limitations imposed by
Ms. Taylor’s impairments.
Two weeks later on May 19, 2004, another agency consulting physician,
Dr. Burrows, completed an RFC questionnaire based on his review of the medical
records. His most notable conclusion was that Ms. Taylor could stand, walk,
and/or sit for a total of six hours in an eight-hour work day. He also noted that
“[t]he severity or duration of [her] symptom(s), in [his] judgment, [was]
disproportionate to the expected severity or expected duration on the basis of
[Ms. Taylor’s] medically determinable impairment(s).” Id. at 151. This opinion
conflicts directly with a subsequent opinion of Dr. Harris. In a June 8, 2004,
letter, Dr. Harris stated that Ms. Taylor “ha[d] been unable to work for the past 11
months and most likely [would] be unable to work for the next year.” Id. at 160.
-5-
As a basis for this conclusion, he cited the persistent back pain that she
experienced “about the sacral screws” implanted during her surgery, noting that
she could not “tolerate sitting for more than 15 or 20 minutes at a time.” Id. He
opined that she likely would need a second surgery to remove the hardware. Id.Dr. Harris expounded upon this opinion in an October 7, 2004, RFC
questionnaire. There he indicated that Ms. Taylor could sit and stand for only 30
minutes at a time for a total of two hours each in an eight-hour work day.
Moreover, he indicated that she would need to lie down or sit in a recliner for two
hours a day and likely would be absent from work three or four times a month due
to her impairments. Dr. Harris further concluded, in direct conflict with Dr.
Burrows, that Ms. Taylor’s “impairments . . . [were] reasonably consistent with
the symptoms and functional limitations described in [his] evaluation.” Id. at
171.
There is no evidence that Dr. Harris actually examined Ms. Taylor between
July 2004 and May 2005. However, on May 5, 2005, he performed a second
surgery to remove the hardware in her back. The reports following this second
surgery mimic those from before. Ms. Taylor continued to experience some back
pain, particularly with prolonged sitting, but the pain was alleviated to some
degree with local injections. The record contains a second RFC questionnaire
from Dr. Harris dated January 6, 2006, bearing the same conclusions that he
reached in October 2004. He again stated that Ms. Taylor would need to lie down
-6-
or recline for two hours in an eight-hour work day and that she could sit and stand
or walk for only 30 minutes at a time. In this second questionnaire, however,
Dr. Harris opined that Ms. Taylor had the ability to sit and to stand or walk for a
total of four hours each in an eight-hour work day, as compared to the two-hour
limitation that he imposed before.
B. The ALJ’s Decision
The ALJ concluded at step four of the sequential evaluation process, see
Williams v. Bowen, 844 F.2d 748, 750-52 (10th Cir. 1988), that the medical
evidence did not support a finding of disability, particularly in light of
Ms. Taylor’s testimony and demeanor at the hearing. Most importantly, with
respect to this appeal, the ALJ concluded that Dr. Harris’s opinion was not
worthy of controlling weight. More specifically, he accepted his opinion
concerning “the medical issues relating to the nature and severity of the
claimant’s impairments” but not his opinion concerning Ms. Taylor’s residual
functional capacity or ability to work, matters that the ALJ noted were expressly
reserved to the Commissioner. App. at 32. He went on to state: “Dr. Harris’
statements have been carefully considered but are not given ‘controlling weight’
as they indicate extreme limitations that are unsupported by objective evidence
and inconsistent with the claimant’s activities of daily living.” Id.The ALJ concluded that Ms. Taylor’s activities of daily living were not
significantly restricted as a result of her back condition. Referring to
-7-
Ms. Taylor’s testimony, the ALJ noted that she was able to travel for relatively
long periods of time without lying down and that she was able to do light
housework, tend to her personal needs, attend church, and prepare church lessons.
The ALJ further found, based on the hearing testimony, that the side effects of
Ms. Taylor’s medication were not so disruptive as to prevent her from performing
work activities in any significant manner. Finally, he found that Ms. Taylor
“betrayed no real evidence of pain or discomfort while testifying at the hearing.”
Id. In this regard, he noted that Ms. Taylor declined the opportunity to stand
during her testimony and instead sat for about one hour without a break.
Based on the medical and non-medical evidence, the ALJ concluded that
Ms. Taylor had the RFC to perform the full range of light and sedentary unskilled
work, with several important limitations. As relevant here, those limitations
included a prohibition on jobs requiring the following: (i) standing or walking
more than 45 minutes at a time, or more than six hours in an eight-hour workday;
(ii) sitting more than 45 minutes at a time, or more than six hours in an eight-hour
workday; and (iii) sitting, standing, or walking more than 15-20 minutes at a time.
The ALJ referred to this third limitation as a “sit/stand option,” which, he held,
must be available to Ms. Taylor “on bad days.” Id. at 30.
II. Discussion
“We review the Commissioner’s decision to determine whether the factual
findings are supported by substantial evidence in the record and whether the
-8-
correct legal standards were applied.” Pisciotta v. Astrue, 500 F.3d 1074, 1075
(10th Cir. 2007). We consider substantial evidence to be “such relevant evidence
as a reasonable mind might accept as adequate to support a conclusion.” Hamlin
v. Barnhart, 365 F.3d 1208, 1214 (10th Cir. 2004) (quotation omitted). Evidence
is not substantial “if it is overwhelmed by other evidence in the record,” and a
decision cannot be upheld if “there is a mere scintilla of evidence supporting it.”
Id. (quotation omitted). We have also held that “[t]he agency’s failure to apply
correct legal standards, or show us it has done so, is . . . grounds for reversal.”
Id. Finally, it is not this court’s job to reweigh the evidence or substitute our
discretion for that of the Commissioner. Our task is simply to review the
Commissioner’s legal analysis and examine the record to ensure that the evidence
supporting the agency’s decision is substantial. See id.Ms. Taylor focuses her appeal primarily on the ALJ’s refusal to give
controlling weight to the opinion of her orthopedic surgeon regarding her
functional limitations. She also argues, however, that as a result of this decision,
the ALJ ultimately formulated an RFC that was not supported by substantial
medical evidence. Finally, she claims the ALJ placed too much significance on
her demeanor and apparent lack of pain at the hearing. We address each of these
arguments in turn.
-9-
A. Treating Physician Rule
Generally, the “treating physician rule” requires the ALJ to give greater
weight to the opinions of doctors who have treated the claimant than those who
have not. Hackett v. Barnhart, 395 F.3d 1168, 1173 (10th Cir. 2005). Moreover,
we have held that “[t]he ALJ is required to give controlling weight to the opinion
of a treating physician as long as the opinion is supported by medically acceptable
clinical and laboratory diagnostic techniques and is not inconsistent with other
substantial evidence in the record.” Hamlin, 365 F.3d at 1215. If either of these
requirements is not met, the ALJ is not required to give the opinion controlling
weight but he must still decide whether to reject the opinion altogether or assign
it some lesser weight. Pisciotta, 500 F.3d at 1077. If he rejects it, the ALJ “must
articulate specific, legitimate reasons for his decision.” Hamlin, 365 F.3d at 1215(quotation omitted). And if he merely assigns it a lesser weight, the ALJ must
consider specific regulatory factors in doing so. These include,
the length and nature of the treatment relationship, frequency of
examinations, the degree to which the opinion is supported by
relevant evidence, the opinion’s consistency with the record as a
whole, and whether the opinion is that of a specialist.
Id. n.7; see also 20 C.F.R. § 404.1527(d)(2)-(6).
The ALJ complied with the above requirements in this case. First, he did
not reject the opinion altogether. In fact, he accepted completely Dr. Harris’s
medical diagnoses and his opinion concerning the severity of Ms. Taylor’s
-10-
condition. His RFC determination also incorporated the “sit/stand option,” which
further narrowed the acceptable pool of “light work” jobs to those jobs that would
permit Ms. Taylor to sit and stand at will. This is consistent with Dr. Harris’s
most recent opinion that Ms. Taylor can only sit, stand, or walk for 30 minutes at
a time. The ALJ also explained that he could not accept Dr. Harris’s “extreme
limitations,” presumably the need to lie down and be absent from work, because
they were “unsupported by objective evidence and inconsistent with the
claimant’s activities of daily living.” App. at 32. Support for these conclusions
can be found earlier in his opinion where he discussed Ms. Taylor’s long car
trips; her ability to do light housekeeping, attend church, and prepare church
lessons; and the fact that her level of pain fluctuates daily. See id. at 31-32. The
ALJ also relied on medical evidence, including Dr. Staley’s report that
Ms. Taylor had “good range of motion in her spine, . . . no evidence of nerve root
impingement and [her] strength was within normal limits.” Id. at 28. He also
noted that Ms. Taylor’s pain was relieved somewhat by injections and that she
apparently did not see Dr. Harris at all from July 2004 to May 2005.
We do not mean to imply this was a clear-cut case. Ms. Taylor certainly
adduced evidence consistent with Dr. Harris’s functional limitations, including
her own testimony concerning her level of pain. And as she points out,
Dr. Staley’s report was not exactly rosy. He did note that she “had mild difficulty
getting up onto and down from the exam table,” and that “she appeared to be
-11-
somewhat uncomfortable” during the 20 to 30 minutes that it took to discuss her
medical history. Id. at 144. The record also reveals consistent complaints of pain
to Dr. Harris following both surgeries. But it is not the province of this court to
reweigh the evidence. “We review only the sufficiency of the evidence, not its
weight . . . .” Oldham v. Astrue, 509 F.3d 1254, 1257 (10th Cir. 2007). In
keeping with this task, we conclude that the ALJ relied on sufficient evidence in
rejecting Dr. Harris’s opinion concerning Ms. Taylor’s functional limitations. See
Pisciotta, 500 F.3d at 1080 (holding that substantial evidence supported ALJ’s
treatment of treating physician’s opinion).
His decision was also “sufficiently specific to make clear to [us] the weight
[he] gave to [Dr. Harris’s] medical opinion and the reasons for that weight.”
Oldham, 509 F.3d at 1258 (quotation omitted). Moreover, we are satisfied that
the ALJ relied on the relevant factors even if he did not specifically discuss them.
See id. (explaining that explicit discussion of all the § 404.1527(d) factors is not a
prerequisite to meaningful review). In short, this case is not like those cited by
Ms. Taylor, involving a wholesale failure on the part of the ALJ to give any
reasons for his decision. Cf. Hamlin, 365 F.3d at 1217 (noting that ALJ “failed to
provide any sufficiently specific reasons as to why he was rejecting [treating
physician’s] opinion”); Watkins v. Barnhart, 350 F.3d 1297, 1300 (10th Cir.
2003) (remanding where ALJ “offered no explanation for the weight, if any, he
gave to the opinion of [claimant’s] treating physician”).
-12-
B. The RFC Determination
This same reasoning convinces us that the ALJ’s RFC determination was
supported by substantial evidence. He concluded that Ms. Taylor could work in a
job that generally required her to stand or walk no more than 45 minutes at one
time for no more than a total of six hours a day. And he placed the same
limitation on the requirements as to sitting. These finding are not vastly
divergent from those of Dr. Harris, who opined that Ms. Taylor could sit, stand,
and walk for up to 30 minutes at a time for a total of 4 hours a day. Moreover,
with the “sit/stand option,” the ALJ made explicit his expectation that Ms. Taylor
would have days of extremely limited sitting tolerance. This RFC assessment is
fully consistent with the medical evidence in the record, much of which is
summarized above, as well as Ms. Taylor’s own description of her lifestyle. We
therefore reject this challenge to the ALJ’s opinion.
C. The ALJ’s Observations As Evidence
Finally, Ms. Taylor claims the ALJ erred in relying on her apparent comfort
at the hearing to bolster his credibility findings. This argument is without merit.
“Although an ALJ may not rely solely on his personal observations to discredit a
plaintiff’s allegations, he may consider his personal observations in his overall
evaluation of the claimant’s credibility.” Qualls v. Apfel, 206 F.3d 1368, 1373
(10th Cir. 2000). The ALJ specifically explained that his decision was not based
solely on Ms. Taylor’s demeanor at the hearing:
-13-
While the hearing was short-lived and cannot be considered a
conclusive indicator of the claimant’s overall level of pain on a day
to day basis, the apparent lack of discomfort during the hearing is
given some weight in reaching the conclusion regarding the
credibility of the claimant’s allegations and the claimant’s residual
functional capacity.
App. at 32 (emphasis added). Even without the prefatory remark, the ALJ’s
opinion, considered as a whole, makes clear that he relied on more than his own
observations in concluding that Ms. Taylor is not disabled. He acted well within
his discretion in considering Ms. Taylor’s demeanor, particularly in light of her
claim that she cannot sit comfortably for more than 15 to 20 minutes at a time. In
sum, “the ALJ properly considered his personal observations of plaintiff as part of
his overall assessment of plaintiff’s credibility.” Qualls, 206 F.3d at 1373.
III. Conclusion
For the foregoing reasons, the judgment of the district court affirming the
Commissioner’s denial of benefits is AFFIRMED.
Entered for the Court
Mary Beck Briscoe
Circuit Judge
-14-