United States District Court, D. Arizona
ORDER
HONORABLE DEBORAH M. FINE UNITED STATES MAGISTRATE JUDGE.
Plaintiff
Stephanie Ann Stanhope (“Claimant”) appeals the
Commissioner of Social Security Administration's decision
to adopt the Administrative Law Judge's (ALJ's)
ruling denying her applications for Disability Insurance
Benefits under Title II of the Social Security Act and for
Supplement Security Income under Title XVI of the Social
Security Act. (Doc. 1, Doc. 15-3 at 20)[1] Claimant argues
that ALJ Ted W. Armbruster erred by: (1) assigning little
weight to the opinions of John Porter, M.D., within a
Physical Residual Functional Capacity Questionnaire dated May
2018; and (2) improperly rejecting Claimant's testimony
regarding her pain, symptoms, and level of limitation. (Doc.
18 at 4-16)
This
Court has jurisdiction pursuant to 42 U.S.C. § 405(g)
and with the parties' consent to Magistrate Judge
jurisdiction pursuant to 28 U.S.C. § 636(c). For the
reasons set forth below, the Court will affirm the
Commissioner's decision.
I.
BACKGROUND
A.
Application and Social Security Administration
review
Claimant
was 51 when she filed her applications for disability
insurance benefits and supplemental security income on April
10, 2015, alleging a disability onset date of March 3, 2014.
(Doc. 15-6 at 2-3, 9; Doc. 15-3 at 17) The state agency
initially determined Claimant was not disabled in September
2015 (Doc. 15-4 at 2-12, 13-21), and again on reconsideration
in March 2016 (Id. at 24-34, 35-45). After
conducting a hearing on Claimant's applications on May 3,
2018 (Doc. 15-3 at 83-143), the ALJ filed a notice of an
unfavorable decision on July19, 2018. (Id. at 14-29)
Claimant then filed an appeal with the Appeals Council, which
was denied by notice dated October 22, 2018. (Id. at
2-5) At that point, the Commissioner's decision became
final. Brewes v. Comm'r of Soc. Sec. Admin., 682
F.3d 1157, 1162 (9th Cir. 2012).
B.
Relevant medical treatment and imaging
1.
Maricopa Integrated Health Systems
Claimant
reported thoracic spine pain on May 31, 2014. (Doc. 15-8 at
5-14) X-rays indicated an unremarkable thoracic spine.
(Id.) Her blood oxygenation (“SpO2”) was
measured at 99%.[2] (Id. at 7) On July 3, 2014,
Claimant was seen for shortness of breath. (Id. at
17-25) Her physical examination documented normal range of
motion, a normal psychiatric assessment, and SpO2 reading of
96%. (Id. at 20) In November 2014, Claimant
complained of musculoskeletal pain and it was noted she took
Tylenol and Ultram for it. (Id. at 27) Although she
displayed diffuse mild wheezes and scattered rhonchi, her
SpO2 was measured at 98%. (Id. at 28)
In
February 2017, Claimant complained of chest congestion and
cough with shortness of breath. (Doc. 15-11 at 7) Her SpO2
reading was 95%. (Id. at 7) Claimant exhibited
normal range of motion and normal mood and affect.
(Id. at 8) In March 2017, it was reported that her
cough had been treated with antibiotics with good results,
but that her “illness came back.” (Id.
at 12) Her SpO2 saturation level was 99%. (Id. at
14) She was noted to complain of pain in her back radiating
down her legs, but her review of systems was negative for
musculoskeletal issues. (Id.at 16-17) She exhibited
a normal range of motion and normal mood and affect.
(Id. at 17) She was not in any respiratory distress
but had “wheezes.” (Id.) In April 2017,
Claimant complained of memory loss and decreased
concentration. (Id. at 33) Her SpO2 level was
measured at 99%. (Id.) She was noted to have no
pain, and demonstrated normal mood, affect, and behavior.
(Id. at 33-34) During a sleep study, Claimant tested
negative for obstructive sleep apnea. (Id. at 45)
A
pulmonary function test conducted in May 2017 identified a
baseline SpO2 level of 94%. (Id. at 54) Claimant
denied leg edema. (Id. at 70) She demonstrated a
normal gait. (Id.at 72) Her musculoskeletal review
was negative, with a normal range of motion. (Id. at
80) She exhibited normal mood and affect. (Id.) On
May 15, 2017, Claimant complained of chronic back pain, but
she displayed normal gait and station. (Id. at 84)
In July 2017, Claimant's SpO2 was measured at 99%. (Doc.
15-9 at 10) She was encouraged to perform aerobic exercise
and walking. (Id. at 11) No. lower extremity edema
was observed, and Claimant's mood and affect were normal.
(Id. at 15) On July 18, 2017, while being evaluated
for bradycardia, Claimant reported no shortness of breath, no
swelling in her hands or feet, and no dizziness, headaches,
fatigue or pain. (Id. at 28) She reported memory
issues such as forgetting where she placed her keys or
wallet. (Id. at 29) She had a normal gait.
(Id. at 30) On July 21, 2017, Claimant's
physical examination indicated a SpO2 level of 96% and she
reported hip pain. (Id. at 34) She exhibited a
normal range of motion but displayed an anxious mood.
(Id.) She was implanted with a pacemaker on
September 13, 2017, to address symptoms of bradycardia.
(Id. at 45) Two weeks post-implant, Claimant
reported she felt better, slept better, had less anxiety, and
thought her memory was improving. (Id. at 79)
In
October 2017, Claimant exhibited normal range of motion,
normal behavior, mood, affect, thought content and judgment.
(Id. at 89) In November 2017, her SpO2 measured 100%
and she was reported to be in no pain. (Id. at 95)
In February 2018, Claimant was seen at urgent care for a
headache lasting one week. (Id. at 99) Her treatment
notes included her reports of back pain radiating to her
flanks and abdomen that worsened with walking. (Id.
at 99) The review of symptoms indicated decreased range of
motion and tenderness in her neck. (Id. at 101)
Later in February 2018, Claimant complained about feeling
overwhelmed, her desire to not leave home, and forgetfulness.
(Id. at 106) She was seen in March 2018 for her
complaint of memory changes. (Id. at 113-114) Her
assessment indicated: normal attention span, concentration,
and fund of knowledge; good immediate memory and recall of 2
out of 3 items after 5 minutes; a mini-mental examination
score of 24/30, including loss of 4 points for counting
numbers backwards; normal muscle tone; 5 of 5 muscle strength
throughout; and normal gait and stance. (Id.) The
doctor noted memory changes that he attributed to depression
and anxiety. (Id. at 114) Claimant also reported
pain in her back and neck at a level of 3 out of 10 and said
she was using ibuprofen and baths to relieve her pain.
(Id. at 115)
On
March 21, 2018, Claimant presented complaining of chest pain
and shortness of breath on exertion and when lying on her
back, but without edema, fainting or heart palpitations.
(Id. at 119) Her SpO2 level was 98%. (Id.)
She was nervous and anxious. (Id.) On March 27,
2018, Claimant's SpO2 was 99%. (Doc. 15-11 at 122) She
displayed a normal range of motion in her musculoskeletal
system and normal mood and affect. (Id.) On April 9,
2018, a functional status assessment indicated that Claimant
reported she did not have serious difficulty walking or
climbing stairs, or “difficulty doing errands alone
such as visiting a doctor's office or shopping, ”
or difficulty remembering, concentrating, or making
decisions. (Doc. 15-12 at 20, 27)
2.
Sun Pain Management & Spine Specialists
Claimant
was seen for pain management in this practice between April
2017 and March 2018. (Doc. 15-8 at 52-84) In April 2017,
Claimant complained of pain in her neck, back, and bilateral
legs, knees, and shoulders. (Id. at 81) David Towns,
M.D., recorded that Claimant said her pain had begun
approximately 4 years previously, when she was still working,
and that she had been prescribed a muscle relaxant, a
narcotic, ibuprofen, and a nerve pain medication.
(Id.) Claimant reported she had tried physical
therapy two years before but “did not find it
helpful” and was not interested in “injection
therapy as she has heard bad things about it.”
(Id.) Dr. Towns stated he would continue to educate
her about the potential benefits of injection therapy.
(Id.) Claimant declared her pain was aggravated by
standing, sitting, walking, bending, stooping, twisting and
lying on her side, but denied balance difficulty, anxiety or
depression. (Id. at 82-83) Her physical examination
indicated full range of motion and normal strength in her
bilateral upper and lower extremities. (Id. at 83)
In May
2017, she said she had balance issues and felt lightheaded
first thing in the morning. (Id. at 79) She
requested a walker because of this lightheadedness and
because she had fallen. (Id.) She advised the doctor
that her medications were helping to keep her “active
and functional throughout the day” without side
effects. (Id.) In August 2017, Claimant reported
repeated falls. (Id. at 69-70) Her SpO2 level was
99%. (Id. at 66) In November 2017, Claimant
complained of headaches and was told that her self-reported
failure to consistently take medications could cause
headaches. (Id. at 64) In December 2017, her
provider noted Claimant had been out of town on a family
emergency, had missed her appointment and was out of her
medications. (Id. at 59) Her SpO2 saturation was
97%. (Id. at 60) Claimant's general appearance
was observed to be “normal, pleasant, alert,
well-hydrated/nourished, comfortable, in no acute distress,
calm and relaxed, cooperative.” (Id. at 60)
She had a normal neurologic exam, including normal gait.
(Id.) In February 2018, Claimant was referred for
physical therapy and was counseled to increase her activity
level gradually and to consider proceeding with injection
therapy. (Id. at 55-56) In March 2018, Claimant
complained of bilateral wrist pain with bilateral Tinel's
sign. (Id. at 53)
Overall,
while Claimant was treated at this practice, her
psychological assessments consistently indicated good
judgment and insight, good thought content, and that she was
alert and oriented. (Id. at 52-84) She also
consistently exhibited focal tenderness cervical/lumbar facet
loading maneuvers, left knee tenderness but also a full range
of motion, and full strength bilaterally in her upper and
lower extremities. (Id.) She denied anxiety and
depressed mood. (Id.)
3.
Terros, Inc.
Claimant
was first seen on April 5, 2018, for a core assessment and
risk assessment of her complaints of depression and anxiety
in order to obtain medication to reduce her symptoms. (Doc.
15-12 at 10-17) Claimant reported she would like to “be
happier as she needs to take care of grandchildren and that
requires a lot of work.” (Id. at 12) She
stated she was prone to anxiety attacks and that she was
often tired. (Id.) Impressions of her assessment
included: unremarkable thought process; normal motor movement
and gait; fair judgment; oriented to person, place and time;
fair attention span and concentration; and depressed mood and
tearful affect. (Id. at 15) She was prescribed
medications for depression and anxiety. (Id. at 16)
4.
Medical records dated after ALJ's decision
After
her May 3, 2018, hearing, Claimant submitted medical records
dated between June 11 and July 20, 2018. (Doc. 15-3 at 37-39,
51-57, 59-82) In its October 22, 2018, denial of
Claimant's request for review of the ALJ's July 19,
2018 decision, the Appeals counsel reviewed this record and
determined it “did not show a reasonable probability
that it would change the outcome of the decision.”
(Id. at 3) The evidence included Dr. Cory
Bushmann's July 19, 2018, order for a motorized power
scooter on a diagnosis of Claimant's gait instability
(Id. at 39), and instructions for use of a
medication intended to help patients quit smoking
(Id. at 59-63). The records also included
Claimant's office visits with the Banner Health Internal
Medicine Office. On June 30, 2018, Claimant was seen for a
“lobular mass on the left parapharyngeal space
depression” in the neck, and for memory loss.
(Id. at 64-67) She reported that her forgetfulness
had “been getting worse within the past month to where
her . . . daughter and her daughter's husband have moved
in to help her take care of the house.”[3] (Id. at
64) A mini-mental examination resulted in a score of 28 out
of 30. (Id.) Her physical exam indicted an SpO2
level of 97%, normal range of motion and full strength in her
musculoskeletal system with, no tenderness or swelling, and
appropriate mood and affect. (Id. at 65) It was
noted that Claimant's depression was
“controlled” but that she “would like to
see psychiatry to follow up with her medications.”
(Id. at 66) On July 9, 2018, Claimant's SpO2
level measured 97%, she demonstrated appropriate mood and
affect, and she exhibited normal range of motion and strength
with no tenderness or swelling. (Id. at 73)
The
Appeals Council also advised Claimant that the medical
records she had submitted that were dated between August 1
and October 12, 2018, and which post-dated the ALJ's July
19, 2018 decision, did not “impact the decision about
whether [Claimant was] disabled beginning on or before July
19, 2018.” (Id. at 3) These records consisted
of 13 pages of medical records including: a statement from a
surgeon with Banner Health who planned to remove the mass in
her neck in October 2018 (Id. at 36); impressions
from a CT scan of Claimant's neck conducted in September
2018 (Id. at 40-41); records of an August 2018
office visit after Claimant apparently fainted (Id.
at 42-50); and what appears to be a receipt for the delivery
to Claimant of a motorized scooter (Id. at 58).
5.
Imaging
On June
20, 2017, Claimant underwent a cervical spine MRI. (Doc. 15-8
at 85-86) The impressions from the imaging included: (1)
spondylosis and disc bulging at the C3-4, C5-6, and C6-7
levels; (2) a congenitally small spinal cord canal without
impingement on the cord; and (3) “left paramedian to
lateral extending broad-based disc protrusion and osteophyte
complex, C5-6 level without nerve root displacement or
central canal narrowing[, and] [m]oderate left foraminal
stenosis.” (Id. at 86)
On June
20, 2017, imaging also was performed on Claimant's lumbar
spine. (Id. at 88-89) The impressions on review of
the MRI included: (1) “Grade 1 anterolisthesis of
approximately 8 mm at the L5-S1 level with probable bilateral
pars intra-articularis defects[ and] [d]isc uncovering with
slight disc herniation in conjunction with mild facet
arthropathy [which] results in moderate bilateral neural
foraminal stenosis at this level[, along with] . . . mass
effect on the ventral thecal sac without overt
stenosis”; (2) mild to moderate spondylosis in the
lower lumbar spine and slight herniation and desiccation and
slight herniation of the L3-4 and L4-5 discs without
significant central canal or neural foraminal stenosis; and
(3) “slight gentle levoscoliosis of the lumbar
spine.” (Id. at 89)
Claimant's
left knee was x-rayed on August 16, 2017 and was reviewed as
“unremarkable.” (Id. at 87)
On
April 24, 2018, Claimant underwent an MRI of her brain. (Doc.
15-12 at 98) Findings included “mild chronic
microvascular changes involving subcortical and
periventricular white matter.” (Id.)
Also on
April 24, 2018, an MRI procedure of Claimant's left knee
indicated “a complex tear of the medial meniscus with
displacement of the anterior horn tear into the anterior
aspect of the intercondylar notch.” (Id. at
99) Additionally, the imaging indicated “significant
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