Caseflicks

Court of Appeals for the Eleventh Circuit • 2004

Billy D. Crawford v. Comm. of Social Security

363 F.3d 1155 | 2004 U.S. App. LEXIS 5723 | 96 Soc. Serv. Rev. 262

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Takeaway

In short, this case confirms that an ALJ may discount medical-source opinions that are conclusory, unsupported by objective evidence, or inconsistent with the source's own records, so long as substantial evidence supports the resulting residual-functional-capacity finding.

Background

Billy D. Crawford, a 53-year-old man with a ministerial college education, sought disability insurance benefits and supplemental security income. He alleged that he became disabled on March 1, 1999, because of spinal conditions, including bilateral spondylolysis, an annular tear, and degenerative disc disease.

After the agency denied his claims initially and on reconsideration, Crawford received a hearing before an Administrative Law Judge (ALJ). The ALJ found that Crawford had severe spinal degenerative joint disease and reactive depression and could no longer perform his past work. But the ALJ concluded that he retained the residual functional capacity to perform a significant range of light work, limited to simple, repetitive, routine, low-stress, safe work in clean surroundings, with a sit-or-stand option and no overhead reaching. Based on vocational-expert testimony, the ALJ found that jobs fitting those limits existed in significant numbers.

The ALJ discounted disability opinions or restrictive assessments from treating physicians Drs. Pedro Ruiz, Stanley Zemankiewicz, and Nicholas Blavatsky, as well as chiropractor Mabbett Reckord. The ALJ also declined to give controlling weight to consultative psychologist Tracy Hartig's finding of marked psychological limitations. The Appeals Council denied review, and the district court affirmed the Commissioner's denial of benefits. Crawford appealed to the Eleventh Circuit.

Issues

Issue #1

Whether the ALJ had good cause to discount the opinions of Crawford's treating physicians that he was disabled or too limited to perform sedentary work.

Holding

Yes. Substantial evidence supported the ALJ's decision to give less weight to the opinions of Drs. Ruiz, Zemankiewicz, and Blavatsky.

Reasoning

A treating physician's opinion ordinarily receives substantial or considerable weight, but an ALJ has good cause to discount it when it is conclusory, lacks objective medical support, or conflicts with the physician's own treatment records. The court reviewed the Commissioner's decision only for proper legal standards and substantial evidence, meaning relevant evidence that a reasonable person could accept as adequate, even if other evidence might point the other way.

Dr. Ruiz's opinion that Crawford was permanently and totally disabled conflicted with his own records and the objective testing. Within three weeks of reporting that Crawford could not work because of back pain, Ruiz recorded that Crawford was improved, doing well, and saying that he was doing great. Later examinations showed no acute distress or musculoskeletal abnormalities, and referred testing found no fracture, dislocation, bony destruction, or metastatic disease. Crawford also repeatedly declined prescribed medication, a fact that further supported the ALJ's assessment.

Dr. Zemankiewicz's records did not establish long-term disability. The record showed a disability finding for only nine days; his initial treatment plan included exercise and a 25-pound lifting restriction rather than a complete work prohibition. Moreover, the MRI showed only very minimal degenerative disc disease, with no bulge, protrusion, stenosis, nerve-root impingement, neural-foramen narrowing, or canal compromise.

Dr. Blavatsky's disability conclusion was similarly conclusory and inconsistent with his clinical records. Those records described negative MRI and bone-scan results, no protrusion or neural abnormality, no spondylolisthesis or segmental instability, and negative nerve-conduction studies shortly after the disability finding. The ALJ therefore had substantial evidentiary support for treating Blavatsky's conclusion as unsupported.

The ALJ was also entitled to credit consulting physician Dr. James Melton's more limited restrictions. Melton's conclusion that Crawford should avoid lifting more than 20 to 25 pounds, or frequent lifting over 15 pounds, fit the objective evidence and was consistent with Dr. Zemankiewicz's 25-pound lifting restriction. Crawford's assertion that Melton stood against the weight of the evidence therefore failed.

Issue #2

Whether the ALJ improperly discounted chiropractor Reckord's opinion that Crawford was disabled and unable to return to his past work.

Holding

No. The ALJ properly gave Reckord's opinion limited weight.

Reasoning

Under the applicable Social Security regulations, a chiropractor was not an acceptable medical source for establishing the existence of a medically determinable impairment. Reckord's opinion therefore could not carry the same status as an acceptable medical source's opinion on that foundational question.

In addition, Reckord's disability assessment rested on Crawford's subjective pain complaints and conflicted with Reckord's own treatment notes. About two weeks after finding Crawford unable to work, Reckord reported an immediate 50 percent reduction in pain, spasm, and limited motion, and noted that Crawford consistently felt better after chiropractic treatment.

Reckord also later recorded that Crawford babysat his grandchildren and helped his wife and children around the house. That activity conflicted with Reckord's earlier assessment that Crawford could not carry, lift, stand, sit, climb, balance, stoop, crouch, kneel, or crawl. These inconsistencies supplied substantial evidence for the ALJ's decision.

Issue #3

Whether the ALJ failed to consider or improperly rejected consultative psychologist Tracy Hartig's opinion that Crawford had marked psychological limitations.

Holding

No. The ALJ expressly considered Hartig's opinion and substantial evidence supported the more limited mental residual-functional-capacity finding.

Reasoning

The record disproved the claim that the ALJ ignored Hartig's assessment. The ALJ expressly considered her opinion that Crawford was markedly limited in coping with change or stress, but concluded that the opinion did not merit controlling or great weight.

Hartig examined Crawford only once and thus was not a treating source. The ALJ was consequently permitted to give greater weight to the evidence from treating psychiatrist Dr. J.K. Mehta, who examined Crawford twice and provided findings that were less restrictive.

Mehta described Crawford as cooperative, clear, and spontaneous, without loose associations, flight of ideas, or pressured speech. Crawford reported feeling better, and Mehta recommended vocational rehabilitation to determine whether he could learn skills for gainful employment. Those findings supported the ALJ's conclusion that Crawford could perform limited, simple, routine, low-stress work requiring moderate concentration.

The district court likewise expressly addressed both Hartig's and Mehta's reports and found substantial evidence for the ALJ's mental-capacity determination. Crawford therefore could not establish either an overlooked psychological opinion or prejudicial error in the district court's review.

Issue #4

Whether the ALJ's hypothetical question to the vocational expert was inadequate because it omitted Hartig's marked limitations.

Holding

No relief was available because Crawford did not raise this argument in the district court; in any event, the ALJ did not have to include limitations properly rejected as unsupported.

Reasoning

The Eleventh Circuit generally does not consider an argument presented for the first time on appeal. Crawford had not challenged the vocational-expert hypothetical in the district court, so the court declined to address the issue as a preserved appellate claim.

Even on the merits, a vocational-expert hypothetical need not incorporate limitations that the ALJ properly found unsupported by the record. Because substantial evidence supported the ALJ's decision not to adopt Hartig's marked limitations, their omission did not undermine the vocational evidence.