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Purdy v. Berryhill

United States District Court, D. Hawaii

January 17, 2018

NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.


          Derrick K. Watson Judge


         Plaintiff Mary Ku‘uipo Purdy brings this action under 42 U.S.C. § 405(g), challenging a final decision of the Acting Commissioner of Social Security, Nancy A. Berryhill, which denied her application for disability insurance benefits and supplemental security income based upon a finding that she was not disabled. Purdy asks this Court to review whether the Administrative Law Judge (“ALJ”) properly weighed the medical opinions of the treating, examining, and non-examining physicians in determining impairments, as part of her assessment of Purdy's residual functional capacity. After carefully reviewing the record, the Court concludes that the ALJ correctly determined that Purdy was not disabled at Steps 4 and 5 of the five-step sequential evaluation process. The ALJ considered, weighed, and addressed all of the medical source opinions in the record and provided appropriate reasons supporting her findings and resolving the conflicting opinions and medical evidence. Because the ALJ's decision was supported by substantial evidence and was not legally erroneous, the Court affirms the ALJ's July 20, 2015 decision.


         I. Factual Background

         Purdy filed applications for disability insurance benefits and supplemental security income on August 8, 2013. Admin. R. (“AR”) 164-72. Purdy last worked as an area supervisor for a gas station and alleged disability from October 30, 2010, due to neuropathy and numbness in her feet, diabetes, depression, sciatic nerve damage, back injury, and chronic kidney failure. AR 187-89. Her claims were denied twice-once on January 22, 2014 and again upon reconsideration on May 12, 2014. AR 51-52, 75-76, 109-12, 114-119. On June 18, 2014, Plaintiff filed a request for a hearing. AR 120. ALJ Nancy Lisewski conducted the hearing on June 11, 2015, at which Purdy and Vocational Expert (“VE”) Alice L. Thomas testified. AR 35-60 (6/11/15 Hrg. Tr.). In her July 20, 2015 decision, the ALJ employed the five-step sequential disability evaluation process to determine whether Purdy was disabled within the meaning of the Social Security Act. See 20 C.F.R. § 404.1520(a)(4).[1]

         The ALJ found that Plaintiff had the following severe impairments: diabetes type II, neuropathy, chronic back pain, hypertension, status post knee surgery, obesity, and chronic kidney disease. AR 23-24. The ALJ ultimately determined that Purdy had “the residual functional capacity to perform light work” and “was capable of performing past relevant work” as an area supervisor, or alternatively that she “is also capable of making a successful adjustment to other work.” AR 28-29. Consequently, she concluded that Purdy was “not disabled” under Sections 216(i), 223(d), or 1614(a)(3)(A) of the Social Security Act. AR 29.

         Purdy disputes the findings relating to her impairments and the subsequent residual functional capacity (“RFC”) finding that her limitations (resulting from those severe impairments) were not extensive enough to qualify her for benefits. Thus, the Court first discusses the evidence relevant to the RFC finding, and then turns to the RFC finding itself.

         A. The Medical Evidence Before the ALJ

         The ALJ considered medical source opinions from Purdy's treating physicians, a consultative psychological examiner, and several non-treating physicians, in addition to Purdy's medical records.

         1. Treating Physicians Heslinga And Horn

         Purdy began seeing Dan Heslinga, M.D. in January 2011. AR 867. Dr. Heslinga completed a Residual Functional Capacity Questionnaire and a Mental Capacity Assessment, AR 867-74, opining that Purdy's symptoms-“hand cramps and pain, pain in both feet, low back pain, fatigue”-were “frequently” severe enough to interfere with the attention and concentration required to perform simple work-related tasks. AR 867. He checked boxes indicating that Purdy would need a job which permits “shifting positions at will from sitting, standing, or walking, ” and that she would “need to take unscheduled breaks during an 8-hour work day” and “15 min[ute] breaks . . . every hour.” AR 867. Dr. Heslinga also checked boxes to indicate that Purdy: (1) can occasionally lift and carry ten pounds or less; (2) cannot lift or carry 20 pounds or more; (3) has limitations in doing repetitive reaching, handling or fingering; (4) could stand and walk only two hours per day and 45 minutes at one time, and sit for six hours per day and 45 minutes at a time; and (5) is not physically capable of working an eight-hour day, five days a week, on a sustained basis. AR 867-68. He also checked a box indicating that Purdy was likely to be absent from work more than four times a month as a result of her impairments or treatments. AR 868.

         The mental capacity evaluation completed by Dr. Heslinga noted “moderate” limitations in handling detailed instructions, performing activities within a schedule, and sustaining an ordinary routine without special supervision. AR 871. He checked off “marked” limitations in completing a “normal workday” and “normal workweek, ” and ability to perform at a consistent pace with a standard number and length of rest periods, and selected the box indicating that Purdy would likely have four or more absences per month. AR 872. Dr. Heslinga checked “moderate” limitations in accepting instructions and responding appropriately to criticism and getting along with coworkers, AR 872, and “marked” limitations in traveling to unfamiliar places. AR 873. He indicated that Purdy can manage benefits in her own best interest. AR 873.

         Purdy's treating psychologist, Mary Horn, Psy.D. completed a Report of Treating Mental Health Provider, dated February 2014, indicating a diagnosis of “major depressive disorder, moderate to severe.” AR 679. Dr. Horn's responses to the functional analysis questions opined that Purdy would “not regularly” be able to maintain “regular job attendance and persist[] at repetitive work tasks on a consistent basis under ordinary supervision.” AR 681. She responded “not sure” to the question: “Is the patient capable of adapting/coping with a low-demand, entry-level job?” AR 682. She opined that Purdy could manage any benefits. AR 682. Dr. Horn noted that Purdy's visits and treatment were sporadic. AR 679.

         Dr. Horn completed a second Report of Treating Mental Health Provider, dated March 28, 2014, again reporting Purdy's history of depression, “trauma, [and] stressful life events.” AR 684. She reported Purdy's cognitive status as “normal, ” affective status as “depressed, ” noted that her compliance with treatment was “sporadic” and that her response to treatment was “good when she is able to come.” AR 685. In response to the question, “Is the patient capable of maintaining regular job attendance and persisting at simple repetitive work tasks on a consistent basis under ordinary supervision, ” Dr. Horn answered, “no.” AR 686. On this second report, Dr. Horn responded “yes” to the question: “Is the patient capable of adapting/coping with a low-demand, entry-level job?” AR 687.

         2. Examining Psychologist Luke

         On January 4, 2014, Stanley Luke, Ph.D. conducted an examination for the State of Hawaii Department of Human Services (“State Agency”). AR 516-19. As consultative psychological examiner, Dr. Luke diagnosed Purdy with depression and generalized anxiety disorder. Purdy self-reported a history of depression, grief, and anxiety, and indicated that she had been seeing Dr. Horn in the past and desired to restart sessions. AR 516-17. Purdy reported that Dr. Heslinga prescribed Wellbutrin and Alprazolam for her depression and anxiety, and she complained of panic attacks and poor sleep. AR 516. She told Dr. Luke that she had been admitted to the emergency room frequently due to chronic kidney problems and related medical conditions. AR 516. Purdy explained that she last worked in 2010, managing five gas stations, and was currently homeschooling her seven year old son. AR 516.

         Dr. Luke conducted several assessments. IQ testing showed that Purdy had a full-scale IQ of 89, verbal IQ of 93, and performance IQ of 87. AR 516-17. Dr. Luke opined that Plaintiff was depressed, but readily engaged during the interview, and put forth good effort on testing, although she “struggled with her stress and anxiety.” AR 517. Dr. Luke observed that Purdy was polite and cooperative, and able to complete all tasks, but presented as sad and anxious, distressed about an inability to work, worried about finances, and depressed due to the death of her mother. AR 517.

         With respect to her functional assessment, Dr. Luke noted Purdy's report that she was able to do her own chores, hygiene, and cook without assistance, homeschool her son, and enjoy interests, including watching TV, the outdoors, walking, swimming, and family activities. AR 518. Dr. Luke opined that Plaintiff could understand and remember simple work instructions; maintain regular job attendance and perform a simple work routine on a sustained basis under ordinary supervision; get along with supervisors and coworkers; and was able to adapt and cope with the usual demands of a low-stress job. AR 518. He observed that she “likely could benefit from psychotherapy and dealing with grief and other issues. . . .

         Many of her difficulties appear to be medical in nature.” AR 518. Dr. Luke also opined that Purdy seemed capable of managing her own benefits and finances. AR 518

          3. Non-Examining Physicians Fujikami and Shibuya, and Non-Examining Psychologists Lam and Fo

         The State Agency medical consultants, Raymond Fujikami, M.D. and D. Lam, Ph.D., conducted an RFC assessment by reviewing Purdy's medical records. On January 22, 2014, Dr. Fujikami determined that Purdy had a “light” RFC, specifically finding that she could: (1) occasionally lift and carry 20 pounds; (2) frequently lift and carry 10 pounds; (3) stand and walk for six hours in an eight-hour workday; and (4) sit for six hours in an eight-hour workday. AR 59-61. He opined that she could occasionally climb ladders, ropes, and scaffolds, and perform other postural activities frequently; but should avoid concentrated exposure to hazards and machinery due to polyneuropathy in her feet. AR 60-61. Dr. Fujikami noted that although Purdy had neuropathy in her feet, she showed a normal gait during all examinations. AR 61.

         State agency psychologist D. Lam, Ph.D. also reviewed Purdy's historical medical records and Dr. Luke's report from the January 4, 2014 consultative examination. AR 56-58. Dr. Lam opined that Purdy would have “mild” restrictions in activities of daily living, and “mild” difficulties in social functioning and concentration, persistence, or pace. AR 57. Dr. Lam noted that Plaintiff had no treatment for many months, but continued to get prescriptions from her primary care provider (Dr. Heslinga), homeschooled her son, socialized with friends, went on family outings, exercised regularly, and cooked and cleaned without assistance. AR 58. Dr. Lam noted that Dr. Luke's examination showed adequate appearance, good effort on testing, good eye contact, that Purdy was sad and anxious, but her activities of daily living (“ADLs”) were “generally intact mentally, ” and she showed no significant concentration impairment. AR 58. Dr. Lam agreed with a “non-severe” finding with respect to her mental impairments, AR 56, and determined that her “[l]imitations are primarily physical.” AR 58. Purdy's initial claims were accordingly denied on January 22, 2014. AR 51-52.

         Upon Purdy's request for reconsideration, State Agency medical consultants Neil Shibuya, M.D. and W. Fo, Ph.D. reviewed the prior assessment and Purdy's medical records. AR 75-106. They considered additional evidence, including Purdy's January 2014 hospitalizations for complications due to chronic kidney issues, her reports of worsening right-side neuropathy, and additional lab results. AR 83. On May 8, 2014, Dr. Shibuya conducted another RFC assessment, and came to the same conclusion as Dr. Fujikami, with some additional restrictions. Dr. Shibuya opined that Plaintiff could lift and carry up to 20 pounds occasionally and 10 pounds frequently; stand and walk six hours and sit six hours per day; and perform postural activities occasionally. AR 87-88. Dr. Shibuya affirmed the prior RFC of “light work, ” concluding that the earlier determination regarding physical impairment was “substantively and technically correct given the objective findings.” AR 83.

         State Agency psychologist W. Fo, Ph.D. reviewed Purdy's records in May 2014 and assigned “great weight” to Dr. Luke's report, noting that Dr. Luke's opinion was supported by objective tests and clinical findings. AR 83. Dr. Fo observed that Dr. Horn's “somewhat more restrictive opinion of current work capacity” was not consistent with the “clinical and lay source evidence and is from a source that may not be entirely objective, ” and accordingly, Dr. Fo did not afford it “much weight.” AR 83-84. He noted that, at the reconsideration phase, Purdy did not report any worsening of her mental impairment and the updated medical evidence did not reveal other significant changes, nor did Purdy report any worsening in her “conditions or limits on a mental basis.” AR 85. Dr. Fo affirmed that Purdy would have “mild” restrictions in activities of daily living, and “mild” difficulties in social functioning and concentration, persistence, or pace, and likewise affirmed the prior finding of non-severe mental impairment. AR 84-85.

         B. The ALJ's RFC Finding

         In her July 20, 2015 decision, the ALJ considered and weighed the medical evidence and concluded that although Purdy has a non-severe adjustment disorder with mild restrictions and difficulties based upon the assessments of the State Agency medical consultants, the limitations are no more than “mild, ” and Purdy does not have a severe mental impairment. AR 24. The ALJ afforded substantial weight to the opinions of the State Agency medical consultants “because they are consistent with the medical evidence.” AR 24. The ALJ explained that she did not give as much weight to the opinions of Dr. Horn, including that Purdy had significant mental functional limitations, because “they are not supported by the treatment record.” AR 24. Likewise, the ALJ did not give any weight to Dr. Heslinga's mental functional assessment because he is not a mental health specialist and because although he recommended psychotherapy, there was no evidence of regular formal mental health treatment such as counseling. AR 24. Overall, reviewing Purdy's primary care progress notes, the ALJ found that “Dr. Heslinga's mental medical source statement is not supported by the treatment record.” AR 25.

         Considering Purdy's symptoms, their limiting effects, and the credibility of statements regarding the same in light of the objective medical evidence, the ALJ found that Purdy had the residual functional capacity to perform light work, except that she can only occasionally operate foot controls, climb, kneel, crouch, crawl, stoop, and balance. AR 25. The ALJ did not fully credit Purdy's testimony regarding her physical symptoms in light of the evidence that she was homeschooling her son, she “walked daily and swam regularly, ” and her admissions that “she had few problems performing personal care activities, she was able to perform household chores, and she could grocery shop, ” all of which led the ALJ to conclude that Purdy's “activities of daily living are not consistent with her allegations of disabling pain and symptoms, and her activities of daily living do not justify a more restrictive residual functional capacity (such as a limitation to sedentary work).” AR 26.[2]

         In determining Purdy's RFC, the ALJ gave greater weight to the medical opinions of the non-treating physicians, rather than to those of Dr. Heslinga and Dr. Horn. AR 23-26. She found the RFC assessment conducted upon reconsideration by Dr. Shibuya and Dr. Fo compelling, acknowledging that although it was based “on nonexamining relationships, [it nevertheless was entitled to greater weight] because [it] adequately consider[ed] the claimant's subjective complaints, and [is] consistent with the treatment record.” AR 26.

         At Step 4, the ALJ found Purdy “not disabled” because she can perform some of her past relevant work as an Area Supervisor. AR 28. Based on the ALJ's RFC determination, the ALJ concluded at Step Five that Plaintiff is not disabled because there were jobs that existed in significant numbers in the national economy that she could perform. AR 28. Alternatively, even if Purdy had been “limited to simple, routine work (assuming her adjustment disorder is severe and justifies [such] mental functional limitations) and thus could not perform her skilled past relevant work at Step Four, ” the ALJ found that “there are a significant number of other jobs existing in the national economy at the unskilled level that she would also be able to perform (rendering her also ‘not disabled' at Step Five).” AR 28. The ALJ then accepted the VE's uncontradicted testimony that Purdy is capable of making a successful adjustment to other work that exists in significant numbers in the national economy, ...

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