Karen Hutton v. Kenneth S. Apfel, Commissioner, Social Security Administration

WOLLMAN, Chief Judge.

Karen Hutton appeals from the district court’s² judgment affirming the denial of her application for social security disability benefits under Title II of the Social Security Act, 42 U.S.C. §§ 416® and 423, and supplemental security income under Title XVI of the Social Security Act, 42 U.S.C. §§ 1381a and 1382c(a)(3)(A). We affirm.

I.

Hutton, who was born on January 30, 1964, has a high-school education. Her past relevant work includes work as an assembler, stainer, molder, and spot welder. Hutton filed an application for disability insurance benefits and supplemental security income on April 1, 1992. She alleged a disability onset date of January 13, 1992, claiming that she was unable to work due to Hodgkin’s disease and the secondary effects of chemotherapy.

The Social Security Administration denied Hutton’s application initially and again on reconsideration. On September 27, 1995, the district court remanded her case for consideration of additional evidence. A second hearing was held before an Administrative Law Judge (ALJ) on April 11,1996.

The ALJ evaluated Hutton’s claim according to the five-step analysis prescribed by the Social Security Regulations. See 20 C.F.R. §§ 404.1520(a)-(f); see also Bowen v. Yuckert, 482 U.S. 137, 140-42, 107 S.Ct. 2287, 96 L.Ed.2d 119 (1987) (describing the five-step process). He determined that Hutton had severe impairments, including neuropathy and fibromyalgia, but that she did not have an impairment or combination of impairments listed in the regulations. See Appendix 1, Subpart P, Regulations No. 4. The ALJ discredited her subjective complaints of pain, finding that they were inconsistent with the overall record. At step four, the ALJ concluded that Hutton was. not capable of performing her past relevant work as a welder. At step five, the ALJ found that Hutton could perform a full range of sedentary work with the following restrictions: no jobs requiring foot controls, requiring work at heights, around moving hazardous machinery, involving the operation of automotive equipment, or jobs requiring continuous fine dexterous movements of either hand. Accordingly, the ALJ denied Hutton’s claim.

The Appeals Council denied Hutton’s request for further review, and the ALJ’s decision thereby became the final decision of the Commissioner. Hutton subsequently appealed to the district court pursuant to 42 U.S.C. § 405(g). The district court granted the Commissioner’s motion for summary judgment, finding that substantial evidence supported the Commissioner’s decision.

II.

We will uphold the Commissioner’s determinations if they are supported by substantial evidence in the record as a whole. See Spradling v. Chater, 126 F.3d 1072, 1073-74 (8th Cir.1997). Substantial evidence is relevant evidence which a reasonable mind would accept as adequate to support the Commissioner’s conclusion. See Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir.1993). In determining whether the existing evidence is substantial, “we must consider evidence that detracts from the [Commissioner’s] decision as well as evidence that supports it.” Id. We may not reverse the Commissioner’s decision merely because substantial evidence exists in the record that would have supported a contrary outcome. See Smith v. Shalala, 987 F.2d 1371, 1374 (8th Cir.1993).

Hutton contends that debilitating pain prevents her from working and that the ALJ improperly discounted her subjective complaints. “As is true in many disability cases, there is no doubt that the claimant is experiencing pain; the real issue is how severe that pain is.” Spradling, 126 F.3d at 1074 (quoting Woolf, 3 F.3d at 1213). The ALJ concluded that Hutton’s subjective complaints of pain were not supported by the evidence and not credible to the extent alleged.

In order to properly evaluate a claimant’s subjective complaints of pain, the ALJ is required to make a credibility determination by taking into account the following factors: (1) the claimant’s daily activities; (2) the duration, frequency, and intensity of the pain; (3) the dosage, effectiveness, and side effects of medication; (4) precipitating and aggravating factors; and (5) functional restrictions. See Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir.1984) (subsequent history omitted). Other relevant factors include the claimant’s relevant work history and the absence of objective medical evidence to support the complaints. See id. The ALJ may discount subjective complaints of pain if inconsistencies are apparent in the evidence as a whole. See Spradling, 126 F.3d at 1075.

The record supports the ALJ’s determination that Hutton’s subjective complaints of disabling pain were not credible to the extent alleged. William E. Wilkins, Ph.D., a specialist in neuroelinical and forensic psychology, to whom Hutton was referred by her attorney, opined that Hutton’s symptoms were a result of psychological rather than physical distress. Hutton testified that her daily activities included making breakfast, washing dishes, washing clothes, visiting with friends, watching television, and driving an automobile. The ALJ noted that Hutton’s daily activities were inconsistent with a claim of total disability. See Pena v. Chater, 76 F.3d 906, 908 (8th Cir.1996); Nguyen v. Chater, 75 F.3d 429 (8th Cir.1996); Novotny v. Chater, 72 F.3d 669, 671 (8th Cir.1995). The ALJ also found that no doctor had placed Hutton on any physical restrictions or advised that she participate in physical therapy. The lack of physical restrictions militates against a finding of total disability. See Smith, 987 F.2d at 1374. The ALJ further noted that Hutton’s work history indicated a lack of motivation to return to work activity. See Woolf, 3 F.3d at 1214 (stating that a claimant’s credibility is lessened by a poor work history).

Hutton argues that she is disabled because of pain related to fibromyalgia. See Cline v. Sullivan, 939 F.2d 560, 567-68 (8th Cir.1991) (recognizing that fibromyalgia can be disabling). We disagree. The evidence shows that Hutton received seventy-five trigger point injections over a two year period. She testified that the trigger point injections relieved the pain and “made the knots go down.” Impairments that are controllable or amenable to treatment do not support a finding of total disability. See Kisling v. Chater, 105 F.3d 1255, 1257 (8th Cir.1997); but cf. Kelley v. Callahan, 133 F.3d 583, 589 (8th Cir.1998) (noting that trigger point injections may provide substantial evidence to support a finding of disability due to fibromyalgia). Accordingly, the evidence as a whole supports the ALJ’s conclusion that Hutton’s testimony was credible to the extent that it establishes that she has some pain, but not to the extent that it would support her claim that she cannot perform any type of work. See Woolf, 3 F.3d at 1214.

Hutton also argues that the ALJ failed to consider the effects of somatoform pain disorder, a mental disorder that causes a belief that physical ailments are more serious than the clinical data would suggest. See Merck Manual 1590-91 (16th ed.1992). There is little or no objective medical evidence to support a finding of total disability based on Hutton’s mental impairments, however. The ALJ found that she had failed to maintain a consistent treatment pattern for her alleged mental impairments and that her daily activities were not indicative of one suffering from a severe mental impairment, findings that we conclude are supported by substantial evidence in the record.

Because the ALJ found that Hutton cannot perform her past relevant work, the burden shifted to the Commissioner to prove that a significant number of jobs existed in the regional economy that Hutton was capable of performing. To meet this burden, the ALJ called as a witness a vocational expert, asking the expert to consider a hypothetical individual of Hutton’s age, education, and past work experience with a history of Hodgkin’s disease, residual neuropathy due to chemotherapy, and myalgia of unknown origin, all of which produce the following limitations: “the inability to perform prolonged standing or walking, no lifting or carrying more than ten pounds on an occasional basis, no jobs requiring foot controls, no jobs requiring work at heights, around hazardous machinery, or involving automotive equipment, and no jobs requiring continuous fíne dexterous movements of either hand.” Admin.Tr. at 427-28. The vocational expert responded that such an individual could perform the work of a cashier, of which approximately 8,000 jobs were located in Arkansas.

“Testimony from a VE based on a properly-phrased hypothetical question constitutes substantial evidence.” Roe v. Chater, 92 F.3d 672, 675 (8th Cir.1996). A proper hypothetical question presents to the vocational expert a set of limitations that mirror those of the claimant. See id. at 676. Hutton contends that the ALJ’s hypothetical question failed to state precisely her physical limitations. She argues that the medical evidence indicates that she is prevented from performing any fine dexterous hand movements, rather than from only those tasks requiring continuous fine dexterous hand movements. Although Dr. Scroggin and Dr. Hughes, two of her treating physicians, indicated that Hutton’s ability to perform fine manipulation was restricted, the ALJ found that their opinions were highly inconsistent with the objective medical evidence, especially as to the extent of the limitations alleged.

The ALJ gave greater weight to the opinion of Dr. Peggy Brown, a board certified member of the American Academy of Neurological and Orthopedic Medicine and Surgery, who examined Hutton at the request of the Social Security Administration. Although Dr. Brown’s sensory examination revealed “Decreased to light touch, pin and temperature distally, mainly in her feet, but to some degree in her hands,” Dr. Brown reported that she could not “make any judgment on [Hutton’s] motor strength because her effort was so poor and inconsistent throughout [the] examination.” Dr. Brown noted that “Ms. Hutton is taking a very unusual combination of multiple medications,” (eight in number by our count) and that “I think at least some of what I am seeing is side effects of medication today.” Dr. Brown continued by reporting,

I think her main problem today is that she needs to be detoxified from all of these drugs and she may need to go to an inpatient setting to do that. She may have fibromyalgia. She probably has a sensory neuropathy secondary to the vincristine. Those do take months to resolve. I do note that she has had return of her reflexes, which were previously documented as absent, so that is a positive sign indicating that she has had some recovery.

In addition to Dr. Brown’s observations, Dr. Wilkins found, after subjecting her to a finger tapping test (as well as to a number of other tests), that Hutton’s finger tapping scores “were approximately 2 standard deviations above the average. [Hutton’s] grip strength is about 2 standard deviations below the average on both the right and left hand. We see a reduction in general gross motor strength but no reduction in fine motor skills.”

As noted earlier, Dr. Wilkins was of the opinion that Hutton’s symptoms were the result of psychological rather than physical distress. He recounted at some length the relationship between Hutton’s psychological makeup and her physical complaints, noting that persons with her makeup “evidence multiple physical complaints. A wide variety of physical symptomology is apt to be presented including back pain, headaches, gastrointestinal difficulties, numbness, tremors, etc.”

It was for the ALJ to resolve conflicts in the evidence and to decide which evidence was best supported by the record. See Bentley v. Shalala, 52 F.3d 784, 785 (8th Cir.1995). We conclude that the ALJ’s finding that Hutton was restricted from only those sedentary jobs that require continuous fine dexterous movement of either hand finds support in the record and that his decision that Hutton is not disabled is thus supported by substantial evidence in the record as a whole.

The judgment is affirmed.

2 . The Honorable Henry Jones, United States Magistrate Judge for the Eastern District of Arkansas, to whom the case was submitted pursuant to the consent of the parties under 28 U.S.C. § 636(3).