Larry Conner v. Comm'r of Soc. Sec. , 658 F. App'x 248 ( 2016 )

NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 16a0452n.06
Case No. 16-5175
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
FILED
LARRY CONNER, ) Aug 05, 2016
) DEBORAH S. HUNT, Clerk
Plaintiff-Appellant, )
) ON APPEAL FROM THE UNITED
v. ) STATES DISTRICT COURT FOR
) THE WESTERN DISTRICT OF
COMMISSIONER OF SOCIAL SECURITY, ) TENNESSEE
)
Defendant-Appellee. ) OPINION.
)
)
BEFORE: MOORE, MCKEAGUE, and DONALD, Circuit Judges.
BERNICE BOUIE DONALD, Circuit Judge. Larry Conner appeals the denial of
disability benefits, making two arguments on appeal: (1) the ALJ erred in discounting the weight
of the May 2013 opinion of his treating physician without good reason; and (2) the ALJ erred in
finding that substantial evidence supported the Social Security Commissioner’s finding that he is
capable of performing other work. We find that both arguments fail and AFFIRM the district
court’s decision.
I.
A. Procedural History
On September 25, 2012, Conner applied for disability insurance benefits under Title II of
the Social Security Act, alleging that he has been disabled since July 21, 2010. (R. 7-6, PageID
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138.) Conner contends that he developed a disability due to degenerative back disease, diabetes,
heart problems, and high blood pressure, and had to stop working on July 21, 2010. (R. 7-4,
PageID 71; R. 7-7, PageID 157, 161.) On October 31, 2012, the Social Security Administration
(“SSA”) denied Conner’s application for benefits. (R. 7-5, PageID 93, 100.) Upon
reconsideration of Conner’s claim on November 19, 2012, the SSA again denied his application.
(R. 7-5, PageID 99–100.)
At Conner’s request, the Administrative Law Judge (“ALJ”) held a hearing on September
18, 2013. (R. 7-3, PageID 62.) On November 6, 2013, the ALJ issued a decision denying
Conner’s request for benefits after finding that Conner was not under a disability because he
retained the residual functional capacity (“RFC”) to perform past relevant work, as well as other
medium work. (R. 7-3, PageID 50–57.) On January 9, 2015, the SSA’s Appeals Council denied
Conner’s request for review, and the ALJ’s decision became the final decision of the
Commissioner. (Id. at 32–36.)
On February 23, 2015, Conner filed a complaint in the United States District Court for
the Western District of Tennessee, requesting that the court remand the case for further
administrative proceedings. The district court denied Conner’s claims, affirming the
Commissioner’s decision, and this appeal timely followed. (R. 18, PageID 678.)
B. Factual Background
Conner was sixty years old at the time of his hearing before the ALJ. (R. 18, PageID
679.) During a hospital visit on August 1, 1994, Conner complained of chest tightness, heart
palpitations, bilateral arm numbness, and left-arm pain. (R. 18, PageID 680.) Dr. Todd Edwards
conducted a cardiac catheterization. (Id.) The results ruled out coronary artery disease and
revealed minimal luminal irregularity in Conner’s mid-LAD (left anterior descending artery).
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(Id.) Upon discharge, Dr. Edwards instructed Conner to follow up with a visit in one year, to
find an internal medicine doctor, and to begin a low sodium diet. (Id.)
On September 4, 1994, Conner reported to the hospital for another cardiac catheterization
conducted by Dr. Edwards. (Id.) The test produced normal results. (R. 7-9, PageID 312–13.)
On August 7, 2005, Conner was admitted to the Emergency Room with complaints of
sharp chest pain radiating down his left arm, chest tightness, and heart palpitations. (R. 18,
PageID 681.) Conner underwent a cardiac workup, which was negative for an acute cardiac
event. The next day, Conner underwent a treadmill thallium stress test, which was negative for
ischemia. On August 9, 2005, Conner was deemed stable for discharge. (R. 7-9, PageID 301–
02.)
On August 11, 2005, Conner reported to the hospital for another cardiac catheterization,
which was completed by Dr. Stacy Smith. (R. 18, PageID 681.) Dr. Smith opined that Conner’s
chest pain most likely was not a result of coronary ischemia. (Id.) She noted that Conner did
have frequent ectopy, but because he had normal left ventricle function and no obstructive
disease, she recommended continued management. (Id.)
On September 21, 2009, Conner underwent another cardiac catheterization, which, this
time, Dr. David Wolford conducted. Dr. Wolford noted that Conner had mildly elevated left
ventricular end-diastolic pressure and mild coronary artery disease, principally involving the left
anterior descending coronary and circumflex arteries. (R. 18, PageID 681.) Dr. Wolford
concluded, however, that Conner had “[n]o significant disease.” (Id.)
On May 8, 2011, complaining of thigh, leg, and chest pain, Conner was admitted for
cardiac catheterization, which Dr. Frank McGrew completed. (Id.) Dr. McGrew concluded that
the catheterization revealed “moderately severe coronary artery disease to be managed
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medically.” (Id.) He also noted that he planned a “conference” with another doctor to discuss
with Conner how to manage his disease. However, Conner signed out of the hospital before the
conference. (R. 18, PageID 681–82.)
i. Treatment at OrthoMemphis and Stern Cardiovascular Center
Throughout most of this time period, Conner also saw an orthopedic specialist, Dr.
Samuel Murrell, at OrthoMemphis. Conner told Dr. Murrell that he “has had difficulty with his
back for some time.” (R. 7-8, PageID 230.) Conner returned to Dr. Murrell on January 14, 2011
to review MRI (magnetic resonance imaging) results, which showed a disc protrusion at L4-L5.
(Id. at 229.) Dr. Murrell updated his impression to degenerative disc disease of L4-L5 with left
sciatica. (Id.) When Conner returned to see Dr. Murrell on February 11, 2011, he continued to
complain of discomfort in his back and in his legs despite physical therapy. Dr. Murrell
recommended an epidural steroidal injection, which he subsequently performed on February 25,
2011. (Id. at 227.) On March 18, 2011, Conner saw Dr. Murrell with continued complaints
about discomfort in his leg and left hip. (Id. at 226.) When Conner returned one month later, Dr.
Murrell gave Conner another epidural injection. (R. 18, PageID 688.)
Conner continued to make follow-up visits with Dr. Murrell and consistently complained
of low back pain. (R. 7-8, PageID 215.) The following year, Conner complained about
increasing low back and left leg pain, describing it as “much [more] severe than he had
previously.” (Id. at 219.) Dr. Murrell advised Conner to undergo an MRI scan and receive an
epidural steroid injection. (Id. at 220.) Shortly afterwards, Conner was admitted to a surgical
center for an L5-S1 interlaminar epidural steroid injection, which Dr. Michael Sorenson
performed. (Id. at 218.) On one examination, Dr. Murrell advised: “I have told him that I
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would not recommend surgery, and he is in agreement . . . He has inquired about applying for
Social Security Disability, and I have encouraged him in his efforts.” (Id. at 215.)
On March 7, 2012, Conner underwent a CT (computed tomography) angiography
examination. Dr. Edwards concluded from the exam results that Conner did “not have any
significant above the ankle disease at all on CT angiography.” (R. 7-9, PageID 264, 314–15.)
Conner also underwent a CT scan of his head on June 24, 2013. The results indicated no acute
abnormality. (R. 7-19, PageID 563.)
ii. Treatment at the Foundation Medical Group
Conner was treated at Foundation Medical Group (“Foundation”) from 2009 until 2013.
At Conner’s first recorded visit on August 12, 2009, nurse practitioner Carol Simmons assessed
him with hypertension, gastroesophageal reflux disease, and hyperlipidemia. (R. 7-12, PageID
428–29.)
On December 17, 2009, Conner visited Simmons at Foundation with complaints of back
pain. Simmons gave him trial medication and offered to refer him to a specialist. (R. 18, PageID
684.)
On February 19, 2010, Conner was treated by Dr. Lynda Freeland at Foundation. Conner
described to Dr. Freeland his sharp pain between his shoulder blades, and, upon examination, Dr.
Freeland discovered an abdominal mass and ordered a CT scan of his abdomen. The CT scan
results were unremarkable. (Id. at 685.) Dr. Freeland diagnosed Conner with chest pain, benign
essential hypertension, gastroesophageal reflux disease, hyperlipidemia, and backache. (R. 7-11,
PageID 358; R. 7-12, PageID 421–23.)
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On February 22, 2010, Conner returned to Foundation and underwent an x-ray of his
thoracic spine. Dr. Freeland indicated that the x-ray “showed no compression fractures, just
degenerative changes.” (Id. at 419–20.)
On June 1, 2010, Conner visited Dr. Freeland and stated that he had weakness on his left
side, drooping in his left eye, and “a little trouble” finding words. (R. 18, PageID 685.) Dr.
Freeland assessed Conner with benign essential hypertension, hyperlipidemia, and probable
CVA (cerebrovascular accident), and ordered an MRI of his head. The MRI did not indicate
signs of a stroke. (Id.) Dr. Freeland informed Conner that he had diabetes or reactive
hypoglycemia and instructed him to follow up with her. (R. 7-11, PageID 352; R. 7-12, PageID
416–17.)
On June 22, 2010, Dr. Freeland examined Conner and diagnosed him with type II
diabetes mellitus, in addition to his previous diagnoses. (R. 18, PageID 685.) She instructed him
to lose weight, to eat a controlled carbohydrate diet, and to test his blood sugars at home. (R. 7-
12, PageID 413–14.)
Conner reported for diabetes, hypertension, and cholesterol check-ups with Dr. Freeland
on the following dates: July 23, 2010, September 20, 2010, February 22, 2011, March 28, 2011,
June 27, 2011, September 27, 2011, June 19, 2012, and September 17, 2012. The records from
these visits indicate that Conner’s diagnoses and recommended treatment remained the same.
(R. 18, PageID 686.) On October 16, 2012, Dr. Freeland, Conner’s treating physician,
completed an SSA form titled “Medical Source Statement of Ability to Do Work-Related
Activities.” (R. 18, PageID 689–90.) He opined that Conner can occasionally lift/carry up to
twenty pounds, can sit for fifteen to twenty minutes at a time without interruption, and can
stand/walk for two hours at a time without interruption. (Id.) Dr. Freeland concluded that
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Conner can never push/pull with his hands or climb stairs, ramps, ladders, or scaffolds because
of his back pain. (Id. at 690.) She further reported that Conner can occasionally stoop/kneel and
can frequently balance/crawl. Last, she indicated that Conner should never be exposed to
extreme cold. (R. 7-12, PageID 454–59.)
On October 23, 2012, Tennessee Disability Determination Services (“DDS”) medical
consultant Dr. James Gregory completed an RFC assessment regarding Conner’s physical
limitations. (R. 18, PageID 690.) Dr. Gregory concluded that Conner can occasionally lift/carry
twenty pounds, can frequently lift/carry ten pounds, can stand/walk for about six hours in an
eight-hour workday, and can sit for about six hours in an eight-hour workday. (Id.) Dr. Gregory
further opined that Conner has unlimited ability to push/pull, but needs to be able to alternate
between sitting and standing to relieve pain and discomfort every thirty minutes. (Id.)
Additionally, Dr. Gregory noted that Conner can occasionally climb ramps/stairs, balance, stoop,
kneel, crouch, and crawl, but can never climb ladders/ropes/scaffolds. (Id.) Dr. Gregory further
opined that Conner needs to avoid concentrated exposure to extreme cold and heat. In
conclusion, Dr. Gregory stated, “[Conner] has pain out of proportion to his physical findings or
imaging findings. Symptoms are considered partially credible.” (R. 7-4, PageID 75–77.)
On November 28, 2012, DDS medical consultant Dr. Christopher Fletcher also
completed an RFC assessment regarding Conner’s physical limitations. Dr. Fletcher opined that
Conner can occasionally lift/carry twenty pounds, can frequently lift/carry ten pounds, can
stand/walk for about six hours in an eight-hour workday, and can sit for about six hours in an
eight-hour workday. Additionally, Dr. Fletcher concluded that Conner can frequently climb
ramps/stairs, kneel, and crawl, can occasionally climb ladders/ropes/scaffolds, stoop, and crouch,
and can balance and push/pull without limitation. Dr. Fletcher noted that Conner needs to avoid
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concentrated exposure to extreme cold and heat. Dr. Fletcher concluded as follows: “[Conner]
has pain out of proportion to his physical findings or imaging findings. Symptoms are
considered partially credible. [Conner] failed to attend physical therapy as prescribed further
reducing credibility . . . No basis to support need for frequent position changes.” (Id. at 85–87.)
On January 16, 2013, Conner went to Foundation for a wellness exam. (Id.) Conner
complained of ongoing and worsening back pain. Dr. Freeland diagnosed Conner with benign
essential hypertension, esophageal reflux, gastroesophageal reflux disease, blood in the stool,
hyperlipidemia, type II diabetes mellitus, and backache. (Id.) Conner followed up with Dr.
Freeland at Foundation on June 24 and July 22, 2013. (R. 7-20, PageID 572–78.)
On May 22, 2013, Dr. Freeland completed another medical assessment regarding
Conner’s impairments. (R. 18, PageID 691.) She noted that she had seen Conner every three
months for a period of over ten years, and listed his diagnoses as degenerative disc disease,
diabetes, angina, and hypertension. (Id.) She stated that Conner’s prognosis was fair, but that no
improvement in his condition was expected. (Id. at 692.) Dr. Freeland opined that Conner’s
constant and severe back pain, as well as the sedating effects of his medications, would
constantly interfere with the attention and concentration needed to perform even simple work
tasks. (Id.) She further indicated that Conner was incapable of tolerating even “low stress” jobs.
(Id.) She concluded that Conner needs a job that permits him to shift among sitting, standing,
and walking at-will. (Id.) She also stated that Conner needs to be able to take unscheduled work
breaks every thirty minutes to an hour, and to rest for ten to fifteen minutes before returning to
work. (Id.) Last, Dr. Freeland opined that Conner was likely to be absent from work more than
four days per month as a result of his physical impairments. (R. 7-13 PageID 401–03; R. 7-20,
PageID 584–88.)
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II.
We take this appeal directly from the magistrate judge pursuant to 28 U.S.C. § 636(c)(3)
and Federal Rule of Civil Procedure 73(c). We review district court decisions regarding social
security disability benefits de novo. Cole v. Astrue, 661 F.3d 931, 937 (6th Cir. 2011).
“However, [our] review ‘is limited to determining whether the Commissioner’s decision is
supported by substantial evidence and was made pursuant to proper legal standards.’” Id.
(quoting Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007)).
Substantial evidence constitutes “such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.” Cutlip v. Sec’y of Health & Human Servs., 25 F.3d
284, 286 (6th Cir. 1994). In determining whether substantial evidence exists, we examine the
evidence in the record as a whole and “take into account whatever in the record fairly detracts
from its weight.” Abbott v. Sullivan, 905 F.2d 918, 923 (6th Cir. 1990). This means that if we
find substantial evidence to support the Commissioner’s decision, we must affirm and may not
inquire whether the record could support a different decision. Barker v. Shalala, 40 F.3d 789,
794 (6th Cir. 1994). Therefore, we may not resolve conflicts in evidence or decide questions of
credibility. Ulman v. Comm’r of Soc. Sec., 693 F.3d 709, 713 (6th Cir. 2012) (citing Bass v.
McMahon, 499 F.3d 506, 509 (6th Cir. 2007)).
A.
Conner first argues that the ALJ erred in not discussing the 2013 medical opinion of
treating physician Dr. Lynda Freeland. (Appellant’s Br. 18–23.) Specifically, Conner contends
that the ALJ gave the May 2013 statement of Dr. Freeland “no weight” in its determination of
Conner’s entitlement to benefits. (Appellant’s Br. 19.) This argument fails.
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The entitlement to social security benefits is determined by a five-step analysis as
determined by the ALJ:
(1) The claimant must not be engaged in substantial gainful activity;
(2) The claimant suffers from a severe impairment;
(3) The impairment must meet or equal the severity criteria contained in the
Social Security Regulations;
(4) The claimant must not have the RFC to return to any past relevant work; and
(5) The claimant must be unable to perform other work.
See 20 C.F.R. §§ 404.1520(b), 416.920(b).
The Commissioner imposes certain standards on the treatment of medical source
evidence, 20 C.F.R. § 404.1502, one of which requires the ALJ to assign a treating source
opinion controlling weight if it is “well-supported by medically acceptable clinical and
laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in
[the claimant’s] case record.” 20 C.F.R. § 404.1527(c)(2); Wilson v. Comm’r of Soc. Sec.,
378 F.3d 541, 544 (6th Cir. 2004). If an ALJ does not grant controlling weight to the opinion of
a treating physician, the ALJ must provide good reasons for that decision. Gayheart v. Comm’r
of Soc. Sec., 710 F.3d 365, 376 (6th Cir. 2013). An example of a good reason is that the treating
physician’s opinion is “unsupported by sufficient clinical findings and is inconsistent with the
rest of the evidence.” Morr v. Comm’r of Soc. Sec., 616 F. App’x 210, 211 (6th Cir. 2015)
(citing Bogle v. Sullivan, 998 F.2d 342, 347–48 (6th Cir. 1993)). For instance, in Keeler v.
Comm’r of Soc. Sec., 511 F. App’x 472, 473 (6th Cir. 2013), we held that the ALJ properly
discounted the subjective evidence gleaned from a treating physician’s opinion because it too
heavily relied on the patient’s complaints.
Here, nothing Conner asserts persuades us that the ALJ did not properly evaluate the
evidence of the record as a whole. The ALJ sufficiently explained that Dr. Freeland’s records
failed to reveal the type of significantly abnormal findings that would qualify a patient as
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disabled. (R. 7-3, PageID 54.) Further, Dr. Freeland’s 2012 opinion conflicted with objective
findings in the record, including those in her own notes as well as those of Conner’s other
treating doctors. The ALJ identified the discrepancies: “[a]lthough [Dr. Freeland] noted several
diagnoses in treatment notes, it was repeatedly indicated during her physical examinations that
the claimant was in no acute distress, had normal lung and heart function, and the only physical
back examination by [Dr. Freeland] was noted in February 2011 which was normal.” (Id. at 54–
55.) The ALJ further stated that “[e]ven physical findings by OrthoMemphis in May 2012 were
minimal with decreased sensation, tenderness of the paraspinal muscles, but full strength in the
lower extremities and no need for surgery . . . Stern Cardiovascular examination in February
2012 also showed normal back and normal gait . . . Therefore, no weight can be given to [Dr.
Freeland’s] opinion.” (Id.)
Admittedly, the ALJ did not discuss the 2013 opinion of Dr. Freeland. However,
discussion of that opinion was unnecessary for the reasons explained in our analysis of Conner’s
second argument.
B.
Second, Conner contends that the ALJ erred in finding that he could perform other work.
(Appellant’s Br. 23.) Because Dr. Freeland’s 2013 opinion was not discussed in the ALJ’s
decision, Conner contends that a court cannot then find that substantial evidence supported the
Commissioner’s decision that he could perform other work because, according to Conner, the
record was incomplete. (Appellant’s Br. 25.) This claim also fails, because we do not require an
ALJ to discuss every piece of evidence in the record to substantiate the ALJ’s decision. Thacker
v. Comm’r of Soc. Sec., 99 F. App’x 661, 665 (6th Cir. 2004).
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It is true that the ALJ’s failure to evaluate all opinions of record may denote a lack of
substantial evidence to support the decision. See Cole, 661 F.3d at 937. However, here, the ALJ
notes that Dr. Freeland’s May 2013 medical source statement was prepared after Conner’s
insured status expired. “[E]vidence of disability obtained after the expiration of insured status is
generally of little probative value.” Strong v. Soc. Sec. Admin., 88 F. App’x 841, 845 (6th Cir.
2004) (citing Cornette v. Sec’y of Health & Human Servs., 869 F.2d 260, 264 n.6 (6th Cir.
1988)). Also, noteworthy is that the evidence from the October 2012 and May 2013 opinions
does not support Dr. Freeland’s assessment of an increased debilitating state. Rather, it only
indicates ongoing treatment for the consistently same conditions with continued normal findings.
(R. 7-13, PageID 470, 485–86.) The May 2013 opinion was not relevant because the evaluation
process requires an assessment of Conner’s condition during the relevant insured period. (R. 7-
3, PageID 53–55.) We therefore hold that the Commissioner’s decision was supported by
substantial evidence.
III.
Accordingly, we AFFIRM the district court’s judgment.
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