UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE

Crystal Guzman

v. Case No. 15-cv-230-PB Opinion No.

Carolyn W. Colvin, Acting Commissioner, U.S. Social Security Administration

MEMORANDUM AND ORDER

Crystal Guzman challenges the Social Security

Administration’s denial of her claim for Disability Insurance

Benefits (“DIB”) and Supplemental Security Income (“SSI”)

benefits. The Acting Commissioner, in turn, moves for an order

affirming her decision. For the reasons that follow, I grant

the Commissioner’s motion to affirm.

I. BACKGROUND

In accordance with Local Rule 9.1, the parties have

submitted a joint statement of stipulated facts (Doc. No. 12).

See LR 9.1. Because that joint statement is part of the court’s

record, I need not recount it here. I discuss facts relevant to

the disposition of this matter as necessary below. II. STANDARD OF REVIEW

Under

(g), I have the authority to review

the pleadings submitted by the parties and the administrative

record, and to enter a judgment affirming, modifying, or

reversing the “final decision” of the Commissioner. That review

is limited, however, “to determining whether the [Administrative

Law Judge] used the proper legal standards and found facts

[based] upon the proper quantum of evidence.” Ward v. Comm’r of

Soc. Sec.,

(1st Cir. 2000). I defer to the

Administrative Law Judge’s (ALJ’s) findings of fact, so long as

those findings are supported by substantial evidence.

Substantial evidence exists “‘if a reasonable mind, reviewing

the evidence in the record as a whole, could accept it as

adequate to support his conclusion.’” Irlanda Ortiz v. Sec’y of

Health & Human Servs.,

(1st Cir. 1991) (per

curiam) (quoting Rodriguez v. Sec’y of Health & Human Servs.,

(1st Cir. 1981)).

If the substantial evidence standard is met, the ALJ’s

factual findings are conclusive, even where the record “arguably

could support a different conclusion.” Id. at 770. Findings

are not conclusive, however, if the ALJ derived his findings by

“ignoring evidence, misapplying the law, or judging matters

entrusted to experts.” Nguyen v. Chater,

(1st

Cir. 1999) (per curiam). The ALJ is responsible for determining 2 issues of credibility and for drawing inferences from evidence

in the record. Irlanda Ortiz,

. It is the role

of the ALJ, not the court, to resolve conflicts in the evidence.

III. ANALYSIS

Crystal Guzman is a Dover woman who was 48 years old as of

December 2013. She has past work experience as a cook, fish

market clerk, receptionist, and school custodian. Doc. No. 12

at 1-2. She filed for DIB and SSI benefits in September 2012,

claiming disability as of April 3, 2012. Id. at 1. The Social

Security Administration denied Guzman’s application, and in

November 2013 a hearing was held before ALJ Paul F. Kelly. Id.

Following that hearing, the ALJ issued a written decision

denying Guzman’s application. Tr. at 22-33 (ALJ’s written

decision).

In his decision, the ALJ found at step one that Guzman had

not engaged in substantial gainful activity since April 3, 2012,

her alleged onset date. Tr. at 24. At step two, the ALJ found

that Guzman suffered from the “severe impairments” of

fibromyalgia, depression, and panic disorder. Tr. at 24-25. At

step three, however, the ALJ determined that Guzman’s

impairments did not meet or medically equal any of the

impairments listed in the relevant regulations. Tr. at 25-26.

3 The ALJ then decided that Guzman retained the Residual

Functional Capacity (“RFC”) to perform sedentary work with

certain restrictions, such as only occasionally climbing ramps

or stairs, avoiding concentrated exposure to extreme heat and

cold, and limiting her work to “simple, routine tasks in a low

stress job.” Tr. at 26. Based on this RFC, the ALJ then found

at step four that Guzman could not perform her past work. Tr.

at 31. Lastly, at step five, the ALJ consulted a vocational

expert and determined that Guzman could perform work in the

national economy. Tr. at 31-32. The ALJ therefore concluded

that Guzman was not disabled. Tr. at 32.

Guzman requested review of the ALJ’s decision, but in May

2015, the Appeals Council denied her request. Tr. at 1. As a

result, the ALJ’s decision constitutes the Commission’s final

decision, and this case is now ripe for review.

Guzman filed this appeal in June 2015, asserting two challenges

to the ALJ’s decision. First, she claims that the ALJ erred by

using his lay knowledge to create Guzman’s RFC, rather than

relying on the expert medical opinions. Specifically, she

argues that the ALJ considered two divergent medical opinions,

and rather than rely on one or the other, impermissibly crafted

a “middle path” between the two. Second, Guzman asserts that

the ALJ failed to give proper reasons for assigning little

weight to the opinion of Dr. Dmitri Dmytruk, her treating

4 physician. For the reasons that follow, these arguments are

unpersuasive.

A. Challenges to the ALJ’s RFC Finding

Guzman first argues that the ALJ incorrectly fashioned a

“middle path” between two divergent medical opinions when he

determined her RFC. In general, the ALJ is a “lay person” and

is “simply not qualified to interpret raw medical data in

functional terms.” Nguyen,

. An ALJ must

therefore rely “to some degree on RFC evaluations from a

physician or another expert.” Delafontaine v. Astrue,

. This does not mean, however, “that there must

always be some super-evaluator, a single physician who gives the

factfinder an overview of the entire case.” Evangelista v.

Sec'y of Health & Human Servs.,

(1st Cir.

1987). Rather, an ALJ “may piece together the relevant medical

facts from the findings and opinions of multiple physicians,”

see

and render “common-sense judgments about functional

capacity based on medical findings.” Gordils v. Sec'y of Health

& Human Servs.,

(1st Cir. 1990). So long as

“the [ALJ] does not overstep the bounds of a lay person's

competence and render a medical judgment,” the ALJ’s conclusion

is permissible.

Here, the ALJ considered the opinions of several medical

professionals and identified an RFC that encompassed Guzman’s

5 physical and mental limitations. As to her physical RFC, the

ALJ concluded that Guzman had the capacity to perform “sedentary

work” with certain restrictions, including only occasionally

climbing ramps or stairs, balancing, stooping, kneeling,

crouching, or crawling; never climbing ladders, ropes or

scaffolds; and avoiding concentrated exposure to extreme cold,

heat, wetness, humidity, unprotected heights and hazardous

machinery. Tr. at 26. For Guzman’s mental RFC, the ALJ

determined that Guzman would be limited to “simple, routine

tasks in a low stress job, meaning only occasional decision-

making required and occasional changes in the work setting,” and

“only occasional interaction with the public and co-workers.”

Tr. at 26. Guzman challenges both the physical and mental

aspects of the RFC, and I consider each in turn.

Guzman criticizes the RFC’s physical limitations by arguing

that they are unsupported by the medical evidence of record.

Doc. No. 8-1 at 6. She fails, however, to identify which

divergent medical opinions the ALJ ignored and how exactly the

RFC took a “middle path” between them.1 Moreover, the record

1 The root of Guzman’s difficulty may stem from a mistake she makes about the way in which the ALJ assigned weight to opinion evidence. In her brief, Guzman asserts that “[t]he ALJ stated he issued ‘little weight’ to all opinions of physical limitations in the [medical evidence of record],” and therefore “[w]ithout the support of medical opinion, the ALJ only had his own lay knowledge to craft functional limitations from a raw medical record.” Doc. No. 8-1 at 6 (emphasis added). This is 6 shows that the ALJ relied largely on the opinion of consulting

physician Peter Loeser and supplemented Loeser’s opinion with

treatment notes and other evidence to determine Guzman’s RFC.

As explained below, because he was entitled to “piece together

the relevant medical facts” from multiple sources, the ALJ’s

finding was permissible. See Evangelista,

.

The ALJ crafted Guzman’s RFC by drawing principally from

the opinion of Dr. Loeser, which the ALJ assigned “significant

weight.” Dr. Loeser examined Guzman and concluded that although

Guzman “seemed honest and genuine in the description of the

related symptoms,” including “significant aches and pain, there

were not significant area [sic] of point tenderness during this

visit and there is not any documentation to determine the extent

of the workup done to solidify the diagnosis of fibromyalgia.”

Tr. at 521. Dr. Loeser also noted that Guzman “is able to sit

down and stand up without difficulty, get on and off the exam

table without difficulty, don and doff shoes without difficulty,

squat and rise from a squat without difficulty, and step up and

down without difficulty.” Tr. at 521. Based on these findings,

incorrect: the ALJ assigned “little weight” to the opinions of two doctors opining on physical limitations – Drs. Jaffe and Dmytruk – but assigned “significant weight” to the opinion of consulting physician Peter Loeser. See Tr. at 27-30. The ALJ then relied on Dr. Loeser’s opinion to craft Guzman’s physical RFC.

7 Dr. Loeser noted that he “would expect a mild effect on

[Guzman’s] functional capacity.” Tr. at 521.

In addition to Dr. Loeser’s opinion, the ALJ also

considered a number of other factors to create the physical RFC,

including Guzman’s history of pain and “tender trigger points;”

signs that her symptoms had been “improving;” and her indication

that she “did not work due to pain while standing.” Tr. at 27.

He also noted that her “pain levels were reduced because her

activity level was low.” Tr. at 27. Extrapolating from these

observations, the ALJ concluded that a sedentary exertional

level would not result in excessive activity – which would

presumably increase Guzman’s pain beyond a tolerable level – and

crafted an RFC that reflected that she could perform sedentary

work with certain limitations. See Tr. at 26-27.

The ALJ did not “overstep the bounds of a lay person's

competence” here. Gordils,

. The medical

evidence the ALJ relied upon was not “raw medical data,” but

rather simple statements about actions Guzman could perform.

For example, Dr. Loeser noted that Guzman was “able to sit down

and stand up without difficulty, get on and off the exam table

without difficulty, don and doff shoes without difficulty, squat

and rise from a squat without difficulty, and step up and down

without difficulty.” Tr. at 521. This is not inscrutable

medical terminology that required an expert to interpret.

8 Rather, Dr. Loeser’s comments were medically-informed

observations about what basic activities Guzman could perform;

the treatment notes and patient statements that the ALJ

consulted were similarly straightforward. See Tr. at 27. As a

neutral adjudicator, the ALJ was entitled to “piece together the

relevant medical facts” such as these and render “common-sense

judgments about functional capacity” based on those facts.

Gordils,

; Evangelista,

. This

represents such a common-sense judgment, and was therefore

permissible. Cf. Manso-Pizarro v. Sec'y of Health & Human

Servs.,

(1st Cir. 1996) (“If [the medical]

evidence suggests a relatively mild physical impairment posing,

to the layperson's eye, no significant exertional restrictions,

then we must uphold the ALJ's finding . . . .”).

The ALJ’s mental RFC determination was also permissible.

The ALJ concluded that Guzman “would be limited to simple,

routine tasks in a low stress job, meaning only occasional

decision-making required and occasional changes in the work

setting . . . [and] only occasional interaction with the public

and co-workers.” Tr. at 26. Guzman attacks this finding by

making three arguments. First, she argues that there was an

“absence of a medical opinion for mental health limitations.”

Doc. No. 8-1 at 5. Second, she states that “the only acceptable

medical source” for mental functional limitations was Dr.

9 Patricia Salt, whose opinion the ALJ assigned little weight.

And third, she criticizes the opinion of Dr. Robert

Prescott, which the ALJ assigned “significant weight,” for

“failing to put [Guzman’s] conditions in plain functional

terms.” Id. at 6.

None of these arguments are persuasive. First, to the

extent Guzman argues that there was an “absence of a medical

opinion for mental health limitations,” that argument is

unsupported by the record. In fact, the ALJ considered four

medical opinions of mental health professionals: Dr. Prescott,

Dr. Thomas Lynch, therapist Kathryn Rodger, and Dr. Salt. Tr.

at 28-31. The ALJ assigned little weight to the opinions of

Lynch, Rodger, and Salt, for various reasons explained in his

opinion, and significant weight to the opinion of Dr. Prescott.

Tr. at 28-31. To the extent Guzman challenges the weight that

the ALJ assigned to these opinions, she fails to articulate a

reason why the ALJ erred in doing so.

Guzman’s assertion that Dr. Salt was “the only acceptable

source” for mental “functional limitations” is conclusory and

unaccompanied by explanation. She does not explain why Dr.

Salt’s opinion was more acceptable than, say, Dr. Prescott’s,

10 let alone why Dr. Salt was “the only acceptable source.”2 As

such, I find this argument unpersuasive.

Guzman last argues that Dr. Prescott’s opinion failed to

put her condition in “plain functional terms.” To the contrary,

however, Dr. Prescott’s opinion uses simple terminology to

describe Guzman’s functional capacity. For example, Dr.

Prescott indicated that Guzman “is able to take her medications

regularly;” “appears generally able to maintain adequate hygiene

and grooming;” “appears able to go shopping;” “appears generally

able to interact and communicate appropriately and politely;”

and “appears able to adequately manage low to moderate though

not moderate to high levels of stress and change,” among other

things. Tr. at 527. These are plain descriptions of Guzman’s

capacity to function. The ALJ was allowed to rely on simple

statements such as these to render a “common-sense judgment”

about Guzman’s mental health capacity. As such, Guzman’s

objections are unavailing and the ALJ’s RFC stands.

B. Dr. Dmytruk’s Opinion

Guzman next claims that the ALJ failed to give “good

reasons” for assigning little weight to the opinion of Dr.

2

(a) explains what constitutes an “acceptable medical source” and includes “licensed or certified psychologists” like Dr. Prescott. See Tr. at 528 (noting that Dr. Prescott is a “New Hampshire Licensed Psychologist”).

11 Dmytruk, her treating physician. See

(c)(2)

(requiring the ALJ to give “good reasons” to support the weight

they give to a treating source).

The “treating physician rule” requires the ALJ to give

“controlling weight” to the opinion of a claimant’s treating

physician, provided it is “well-supported by medically

acceptable clinical and laboratory diagnostic techniques and is

not inconsistent with the other substantial evidence in [the]

record.”

If an ALJ declines to give a treating source’s

opinion controlling weight, she must give “good reasons” for

doing so.

To meet this standard, the ALJ’s reasons must be

“supported by the evidence in the case record” and “sufficiently

specific to make clear to any subsequent reviewers the weight

the adjudicator gave to the treating source's medical opinion

and the reasons for that weight.” SSR 96–2p,

, at

*5 (July 2, 1996).

Here, the ALJ gave three reasons for assigning little

weight to Dr. Dmytruk’s opinion. First, the ALJ noted that Dr.

Dmytruk stated that Guzman’s condition would substantially

affect her ability to sit, stand, and engage in postural

activities and cause her to miss more than four days of work per

month, but also indicated that her symptoms were under good

control with medication, revealing his opinion to be internally

inconsistent. Tr. at 29-30. Second, the ALJ noted that Dr.

12 Dmytruk said that it was “difficult to assess the claimant’s

work capacity given the chronic nature of her condition,” which,

according to the ALJ, presumably rendered his assessment of her

work capacity less reliable. Tr. at 30. And third, the ALJ

claimed that Dr. Dmytruk’s opinion was “inconsistent with the

record as a whole and poorly support [sic] by the evidence given

the general lack of objective findings.” Tr. at 30. These

reasons were “sufficiently specific” and adequately supported by

the evidence of record, and I therefore uphold the ALJ’s

finding.

First, the ALJ noted that Dr. Dmytruk’s conclusion that

Guzman had “disabling functional limitations” was “inconsistent”

with his indication that her “symptoms were under good control

with medication.” Tr. at 30. This statement finds support in

the record. As the Commissioner points out, in his “Physical

Impairment Medical Source Statement,” Dr. Dmytruk notes that

Guzman experienced “chronic, constant, diffuse, moderate[] to

severe” pain. Tr. 585. In that same document, however, Dr.

Dmytruk indicates that Guzman experienced “good symptom control”

with “Savella 50mg.” Tr. at 585. Moreover, in the treatment

documents that underpin the Medical Source Statement, Dr.

Dmytruk made similar inconsistent statements. For example, in a

January 2013 treatment note, Dr. Dmytruk noted that Guzman’s

“[s]ymptoms include widespread pain,” but are “relieved by rest

13 and non-opioid analgesics [like Savella].” Tr. at 581. In that

same document, he notes that Guzman “reports improvement with

Savella,” “responseded [sic] nicely to Savella,” and that a

“[r]ecent intervention included adding Savella with significant

benefit.” Tr. at 581. Elsewhere, in a March 2013 treatment

note, Dr. Dmytruk wrote that Guzman “reports doing really well

on Savella,” increasing “her level of physical activity.” Tr.

at 577. These statements reveal an inconsistency in Dr.

Dmytruk’s opinion which lends credence to the ALJ’s assignment

of little weight. See

(c)(3); see also Ford

v. Barnhart,

(“One strong indication of the

credibility of an individual's statements is their consistency,

both internally and with other information in the case

record.”).

The ALJ next noted that Dr. Dmytruk wrote that “it was

difficult to assess the claimant’s work capacity given the

chronic nature of her condition,” rendering his opinion less

reliable. Tr. at 30. This too appears to be a supportable

rationale for assigning Dr. Dmytruk less weight, because Dr.

Dmytruk himself acknowledges that he had a hard time analyzing

Guzman’s functionality. The difficulty of assessing a chronic

condition might be allayed by a doctor treating a claimant over

a long period of time, but that was not the case here: Dr.

Dmytruk only treated Guzman for nine and a half months, by his

14 own admission. See

(c)(2) (noting that the

length of the treatment relationship is a factor in deciding the

weight to give a medical opinion); Tr. at 585. As such, the ALJ

reasonably concluded that Dr. Dmytruk’s opinion was less

reliable.

Finally, the ALJ criticizes Dmytruk’s opinion for being

“inconsistent with the record as a whole and poorly support[ed]

by the evidence given the general lack of objective findings.”

Tr. at 30. Guzman attacks this statement by citing Johnson v.

Astrue, which holds that “trigger points are the only

‘objective’ signs of fibromyalgia,” and therefore the ALJ may

not “require[e] objective evidence beyond the clinical findings

necessary for a diagnosis of fibromyalgia.”

(1st Cir. 2009) (emphasis in original). While this may be true

– trigger points may serve as objective evidence of fibromyalgia

– Dmytruk’s opinion about trigger points directly conflicted

with Dr. Loeser’s, which noted that “there were not significant

area [sic] of point tenderness” and “no objective physical

findings.” Tr. at 521. Faced with an inconsistency between two

opinions, the ALJ must resolve the conflict by weighing a host

of factors, including the supportability and consistency of the

opinion and “other factors.” See

(c).

Here, the ALJ examined both opinions and found Dr. Loeser’s to

be more internally consistent, more supported by the weight of

15 the medical evidence, and generally more reliable. See Tr. at

27-28. This conclusion was not erroneous. Accordingly, the

ALJ’s decision may stand.

IV. CONCLUSION

For the foregoing reasons, the Commissioner’s motion to

affirm (Doc. No. 11) is granted, and Guzman’s motion to reverse

(Doc. No. 8) is denied. The clerk is directed to enter judgment

accordingly and close the case.

SO ORDERED.

/s/Paul Barbadoro Paul Barbadoro United States District Judge April 1, 2016

cc: Laurie Smith Young, Esq. T. David Plourde, Esq.

16