West v. Comm Social Security

NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 07a0483n.06
Filed: July 5, 2007
Case No. 06-5763
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
JAMES T. WEST, )
)
Plaintiff-Appellant, )
) ON APPEAL FROM THE
v. ) UNITED STATES DISTRICT
) COURT FOR THE EASTERN
COMMISSIONER SOCIAL SECURITY ) DISTRICT OF KENTUCKY
ADMINISTRATION, )
)
Defendant-Appellee. )
)
_______________________________________ )
BEFORE: BOGGS, Chief Judge; BATCHELDER, and GRIFFIN, Circuit Judges.
ALICE M. BATCHELDER, Circuit Judge. Appellant James T. West (“West”) appeals
the decision of the Commissioner of the Social Security Administration (“Commissioner”) denying
his application for supplemental security income benefits. West argues that he should have been
classified as disabled under the Social Security Act because (1) he suffers from hypothyroidism and
heart palpitations that cause debilitating weakness and fatigue and (2) he meets or equals the
requirements of mental retardation as defined under the Commissioner’s Listing of Impairments.
Finding no merit in West’s arguments, we AFFIRM the Commissioner’s denial of benefits.
I.
James T. West has a seventh-grade education; he reads and writes at a third-grade level; and
his most recent IQ tests reveal a verbal IQ of 67, performance IQ of 72, and full-scale IQ of 66.
Before his physical health deteriorated, West worked full-time for the City of Wilmore, performing
various types of maintenance and construction work. In August 1998, West began visiting Dr.
Thomas Coburn for his thyroid problems and irregular heartbeat. Over the next few years, Dr.
Coburn prescribed medicine for West’s condition, continually altering the dosage as his condition
changed. In early 2001, Dr. Coburn noted that West’s “thyroid ha[d] [become] very difficult to
manage [causing him to] miss[] many days of work from severe fatigue.” In April 2001, because
of work limitations imposed by his doctor, West reduced his full-time position with the City of
Wilmore, working two eight-hour days each week as a garbage truck driver.
In May 2001, West filed his application for supplemental security income with the
Commissioner. During the pendency of his application, he continued treatment with Dr. Coburn.
Throughout the remainder of 2001, West’s thyroid tests continued to show irregularities, but by April
2002, his test results returned to the normal range, and West indicated that he was “having more
energy” with no thyroid symptoms. In July 2002, Dr. Coburn wrote a letter in defense of West’s
disability claim, in which he stated:
[West] has a long-standing history of severe hypothyroidism and palpitations with
an irregular heart rate. . . . His thyroid has been very difficult to keep under control
and this has often caused him to miss work. He has at times had such severe
hypothyroidism that he really had difficulty leaving his house at all. . . . I believe it
would be very difficult for him to be employed while he is still trying to get his
hypothyroidism under control, especially in lieu [sic] of the fact that he often has
associated palpitations when his thyroid is uncontrolled.
Over the next few years, West’s thyroid levels continued to fluctuate erratically.
After the Commissioner denied West’s disability application initially and on reconsideration,
the Administrative Law Judge (“ALJ”) held a hearing on his claim. In September 2002, the ALJ
affirmed the denial of West’s application, finding that he engaged in substantial gainful activity and
therefore was not disabled. The Appeals Council remanded to the ALJ with instructions to
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reevaluate whether West was truly engaging in substantial gainful activity. In July 2003, the ALJ
again denied West’s application; this time concluding that West was not disabled because he did not
suffer from a severe impairment. The Appeals Council denied West’s request for review, and West
appealed to the district court. In July 2004, the district court found that West presented evidence of
a severe impairment and remanded to the Commissioner for further consideration.
Meanwhile, West filed another disability application, which was also denied initially and on
reconsideration. Thereafter, West’s two disability applications were consolidated, and the ALJ held
a joint hearing in June 2005. The ALJ again found that West was not disabled, concluding that
West’s hypothyroidism was a severe physical impairment, but refusing to find that he experienced
severe “problem[s] with symptoms of fatigue, lethargy, or weakness” because Dr. Coburn’s
treatment notes indicated that West “routinely denie[d] problems with symptoms of fatigue or
weakness.” Based in part on the inconsistencies between West’s statements to his doctor and his
representations to the Social Security Administration, the ALJ concluded that West’s “allegations
regarding his limitations [were] not totally credible.” The ALJ also afforded “little probative weight
to Dr. Coburn’s . . . statement that ‘it would be very difficult for [West] to be employed while he is
still trying to get his hypothyroidism under control.’” After discounting this medical opinion, the
ALJ looked to the objective evidence of West’s activities and found that West’s ability to work two
eight-hour workdays each week and to maintain a “fairly robust regimen of daily activities”
“support[ed] a finding that [he] continue[d] to possess a residual functional capacity capable of
performing significant [light exertion] work.” The ALJ then concluded that West “retain[ed] the
capacity for work that exists in significant numbers in the national economy” and therefore did not
qualify as disabled under the Social Security Act.
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Turning to West’s mental deficiencies, the ALJ concluded that West’s borderline intellectual
functioning and adjustment disorder were severe impairments because “they impose[d] moderate
limitations on [his] ability to maintain concentration, persistence, and pace.” Even though these
impairments were severe, the ALJ found that West did not meet or equal any of the Mental Disorder
Listings because he did not exhibit “marked” limitations in his “daily living activities, social
functioning, or ability to maintain attention and concentration”; he did not indicate an “inability to
function outside of a highly supportive living arrangement”; and he did not produce “qualifying IQ
scores before age 22.”
West appealed the ALJ’s opinion to the district court, and the court affirmed. West then filed
a timely notice of appeal to this court.
II.
We will uphold the Commissioner’s decision if it is supported by substantial evidence.
Willbanks v. Sec’y of Health and Human Servs., 847 F.2d 301, 303 (6th Cir. 1988). “Substantial
evidence is ‘more than a mere scintilla. It means such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.’” Buxton v. Halter, 246 F.3d 762, 772 (6th Cir. 2001)
(quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)). When evaluating whether substantial
evidence supports the Commissioner’s conclusion, we must examine the administrative record as
a whole. Kirk v. Sec’y of Health and Human Servs., 667 F.2d 524, 536 (6th Cir. 1981). “If the
[Commissioner’s] decision is supported by substantial evidence, it must be affirmed even if the
reviewing court would decide the matter differently, and even if substantial evidence also supports
the opposite conclusion.” Cutlip v. Sec’y of Health and Human Servs., 25 F.3d 284, 286 (6th Cir.
1994) (internal citations omitted).
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The ALJ’s task is to determine whether a claimant is disabled under the Social Security Act.
“Disability” for Social Security purposes is defined as “the inability to do 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 12 months.” 20 C.F.R. § 404.1505(a). “In determining whether the claimant is
disabled, the [ALJ] will look at all material facts.” Walker v. Sec’y of Health and Human Servs., 980
F.2d 1066, 1070 (6th Cir. 1992).
III.
West argues that the objective medical testing evidence and Dr. Coburn’s medical opinion
uniformly support a finding of disabling weakness and fatigue, and the ALJ erred in relying on
nonprobative, non-medical opinion evidence to find he was not disabled. We reject this argument,
first, because the medical evidence does not uniformly support a disability finding, and second,
because the non-medical opinion evidence relied upon by the ALJ — West’s own characterization
of his symptoms as contained in Dr. Coburn’s treatment notes — is highly probative of the issue of
West’s weakness and fatigue.
We begin with Dr. Coburn’s medical opinion. “The medical opinion of the treating physician
is to be given substantial deference — and, if that opinion is not contradicted, complete deference
must be given.” Walker, 980 F.2d at 1070. “The [Commissioner], however, is not bound by treating
physicians’ opinions, especially when there is substantial medical evidence to the contrary.” Cutlip,
25 F.3d at 287; accord Bogle v. Sullivan, 998 F.2d 342, 347-48 (6th Cir. 1993); 20 C.F.R. §
404.1527(d)(2). The Commissioner may reject a treating physician’s determinations “when good
reasons are identified for not accepting them.” Hall v. Bowen, 837 F.2d 272, 276 (6th Cir. 1988).
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In this case, Dr. Coburn wrote that “it would be very difficult for [West] to be employed while he
is still trying to get his hypothyroidism under control[.]” This is not a specific, medically supported
opinion on the nature and severity of West’s impairments; rather it is an assessment on the ultimate
issue of whether West could continue to work with his medical condition. We have repeatedly
rejected such conclusory statements from treating physicians. See, e.g., Houston v. Sec’y of Health
and Human Servs., 736 F.2d 365, 367 (6th Cir. 1984) (holding that a “brief conclusory letter from
[claimant’s] treating physician[] was not dispositive of the [disability] issue”); Cutlip, 25 F.3d at 287(rejecting the opinions of treating physicians because “they were conclusory and inconsistent with
the other evidence”). Moreover, because “the [ultimate] determination of disability is the
prerogative of the [Commissioner], not the treating physician,” we need not accept Dr. Coburn’s
opinion on this issue. Houston, 736 F.2d at 367; see also 20 C.F.R. § 404.1527(e).
In addition to being conclusory, Dr. Coburn’s opinion is contradicted by substantial medical
evidence, including the opinions of virtually every other doctor who has reviewed West’s treatment
history. In May 2001, Dr. James T. Ramsey reviewed West’s medical records and concluded that
West was “treated successfully” for hypothyroidism and his condition was “not expected to prevent
. . . work related activity.” At least two other consulting physicians similarly found West’s
hypothyroidism-related impairments to be less than severe. While reports from treating physicians
generally are given more weight than reports from consulting physicians, see Kirk, 667 F.2d at 536,
the Commissioner may reject conclusory treating-physician opinions in favor of consulting-physician
opinions that are supported by substantial evidence. See Hardaway v. Sec’y of Health and Human
Servs., 823 F.2d 922, 927 (6th Cir. 1987) (discounting the treating physician’s opinion and finding
that there was substantial evidence to support the Commissioner’s denial of disability benefits
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because “other consulting physicians ha[d] concluded that [the claimant was] still capable of
working”).
Dr. Coburn’s opinion is also contradicted by West’s own statements as contained in Dr.
Coburn’s treating notes. In April 2002, West indicated that he had “no” thyroid symptoms and was
“now having more energy.” In July 2002, West “[r]eported that his thyroid seem[ed] to be under
decent control[.]” In December 2003, West stated that his “[t]hyroid symptoms ha[d] been under
good control . . . [and] [h]e [was] in good health and ha[d] no concerns.” In August 2004, West
informed Dr. Coburn that even though he was experiencing thyroid symptoms including fatigue, he
maintained “good thyroid control,” was “[i]n good health for the most part,” and was “doing well
at [his part-time] job.” We find that the ALJ did not err in refusing to give probative weight to a
treating physician’s opinion that is contradicted by statements from the claimant himself. See Wright
v. Sullivan, No. 91-5992, 1992 WL 75218, at *5 (6th Cir. April 15, 1992) (refusing to credit a
physician’s assessment of the claimant’s condition because it “was supported by no clinical findings
and [it was] contradicted by claimant’s own statements”).
Having found Dr. Coburn’s opinion unpersuasive, we turn next to the objective medical
evidence, which consists of West’s thyroid test results. This objective evidence consistently shows
(with the exception of test results in April 2002) that West’s thyroid-stimulating hormone levels
were out of the normal range, but this evidence alone does not demonstrate the severity of West’s
purported weakness and fatigue. A claimant seeking to establish disability from weakness or fatigue
must introduce both objective evidence and subjective complaints. See Buxton, 246 F.3d at 773(quoting 42 U.S.C. § 423 (d)(5)(a)); see also 20 C.F.R. § 404.1529(c)(1) (“In evaluating the intensity
and persistence of . . . symptoms, [the Commissioner] consider[s] all of the available evidence,
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including [claimant’s] history, the signs and laboratory findings, and statements from [claimant] .
. . .”). The ALJ rejected West’s subjective complaints of limitations from weakness and fatigue,
finding that such allegations were “not totally credible,” and West has not challenged these
credibility findings on appeal. See Gaffney v. Bowen, 825 F.2d 98, 101 (6th Cir. 1987)
(acknowledging that “the determination of credibility related to subjective complaints of pain [and
fatigue] rest[s] with the ALJ”). Because West has not established the subjective component of his
disabling fatigue, he cannot succeed on this argument, regardless of what the objective medical
evidence demonstrates. We therefore affirm the ALJ’s finding that West did not suffer from
disabling weakness and fatigue.
IV.
West next argues that the ALJ erred by finding that he did not meet or equal Section 12.05(C)
of the Social Security Administration’s Listing of Impairments, which defines mental retardation.
Listing 12.05(C) provides:
Mental retardation refers to significantly subaverage general intellectual functioning
with deficits in adaptive functioning initially manifested during the developmental
period; i.e., the evidence demonstrates or supports onset of the impairment before age
22.
The required level of severity for this disorder is met when . . .
(C) [The claimant has demonstrated] a valid verbal, performance, or full scale IQ of
60 through 70 and a physical or other mental impairment imposing an additional and
significant work-related limitation of function[.]”
20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.05(C). In essence, then, a claimant must make three
showings to satisfy Listing 12.05(C): (1) he experiences “significantly subaverage general
intellectual functioning with deficits in adaptive functioning [that] initially manifested during the
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developmental period” (i.e., the diagnostic description); (2) he has a “valid verbal, performance, or
full scale IQ of 60 through 70”; and (3) he suffers from “a physical or other mental impairment
imposing an additional and significant work-related limitation of function.” Id. See also Foster v.
Harris, 279 F.3d 348, 354-55 (6th Cir. 2001); 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.00(A).
The ALJ found that West had not satisfied the first element — the diagnostic description of
mental retardation — because he did not produce a qualifying IQ score before age 22 and he did not
demonstrate deficits in adaptive functioning. We begin with the ALJ’s implied requirement that a
claimant must introduce a qualifying IQ score before age 22 to satisfy the diagnostic description of
mental retardation. While the claimant may use a qualifying IQ score before the age of 22 to
demonstrate that his subaverage intellectual functioning initially manifested during his
developmental period, see Daniels v. Comm’r of Soc. Sec., 70 F. App’x 868, 873 (6th Cir. 2003)
(unpublished decision), a claimant is by no means required to produce an IQ score obtained prior
to age 22. Thus, the ALJ erred to the extent he implied that the claimant must produce such
evidence.
We nevertheless affirm the ALJ’s decision because West introduced absolutely no evidence
that he experienced deficiencies at all in “adaptive functioning,” let alone that any such deficiencies
arose during the developmental period. See Foster, 279 F.3d at 355; Carmack v. Barnhart, 147 F.
App’x 557, 560-61 (6th Cir. 2005) (unpublished opinion). Adaptive functioning includes a
claimant’s effectiveness in areas such as social skills, communication, and daily living skills. See
Heller v. Doe by Doe, 509 U.S. 312, 329 (1993). The ALJ found that West did not exhibit “marked”
limitations in his “daily living activities, social functioning, or ability to maintain attention and
concentration,” and that West did not demonstrate an “inability to function outside of a highly
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supportive living arrangement.” Substantial evidence supports the ALJ’s conclusion that West did
not experience deficiencies in adaptive functioning. Prior to the deterioration of his physical health,
West held a long-term, full-time position with the City of Wilmore, demonstrating his ability to
interact socially on a daily basis. Even after his health diminished, West continued to drive a
garbage truck on a part-time basis, to care for his daily needs, to pay bills, to shop for groceries, to
interact with friends and families, and to engage in numerous other daily activities.
The medical evidence also supports the ALJ’s conclusion. Both Mr. I.T. Baldwin and Dr.
Gary Dunn performed psychological examinations of West, and neither diagnosed him with any form
of mental retardation. In fact, Mr. Baldwin did not diagnose West with any mental disorder,1 and
Dr. Dunn’s evaluation revealed only borderline intellectual functioning and adjustment disorder, not
mental retardation. Dr. Dunn’s report specifically discussed areas impacting on West’s adaptive
functioning, noting that West “appear[ed] to be capable of understanding and retaining simple
instructions” and “maintaining concentration and attention skills necessary to complete basic tasks
in a work environment.” Dr. Dunn also indicated that West would not have difficulty “interacting
effectively with co-workers and supervisors” nor would he “experience significant difficulty dealing
with a reasonable amount of work stress.” This medical evidence indicates that West did not exhibit
deficiencies in adaptive functioning, and thus supports the ALJ’s conclusion that West did not meet
1
W est urges us to ignore completely Mr. Baldwin’s evaluation, contending that Mr. Baldwin is “not
credible,” is “not a psychologist,” and is “not an acceptable medical source.” Other than bald assertions, W est has
not provided legal authority indicating why we should reject Mr. Baldwin’s test results. The basis for W est’s
assertion that Mr. Baldwin is not a psychologist or an acceptable medical source is not at all clear from the record,
which shows that Baldwin has a master’s degree, is a consultant with “Psychological Associates, Ltd.,” and
undertook the consultative examination at the request of the Commissioner. W e fail to see why the ALJ should have
entirely ignored M r. Baldwin’s evaluation, and, in any event, the ALJ did not rely on M r. Baldwin’s evaluation, but
only mentioned it in a footnote, choosing instead to “grant[] more probative weight” to Dr. Dunn’s report because of
his “superior credentials and more recent testing.”
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or equal Listing 12.05(C).
V.
For the foregoing reasons, we AFFIRM the decision of the Commissioner of the Social
Security Administration.
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