Pyle v. Colvin

• Decision Date: 14 March 2014
• Docket Number: Case No. SACV 12-2058 AJW
• Court: U.S. District Court — Central District of California
• Parties: CYNTHIA A. PYLE, Plaintiff, v. CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.

CYNTHIA A. PYLE, Plaintiff, v. CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.

Case No. SACV 12-2058 AJW

UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA SOUTHERN DIVISION

March 14, 2014

MEMORANDUM OF DECISION

Plaintiff filed this action seeking reversal of the decision of defendant, the Acting Commissioner of the Social Security Administration (the "Commissioner"), denying plaintiff's application for disability insurance benefits. The parties have filed a Joint Stipulation ("JS") setting forth their contentions with respect to each disputed issue.

Administrative Proceedings

The procedural facts are summarized in the joint stipulation. [JS 2-3]. Plaintiff filed an application for disability insurance benefits on September 21, 2009 alleging that she had been disabled since November 15, 2007 due to complex regional pain syndrome that originated in her upper extremities and eventually involved her entire body; depression; fatigue; and bilateral carpal, radial, and cubital tunnel syndrome, status post-surgery. [JS 2; Administrative Record ("AR") 29-37, 163]. In a written hearing decision that constitutes the Commissioner's final decision in this matter, an administrative law judge ("ALJ") concluded that plaintiff was not disabled because she retained the residual functional capacity to perform her pastrelevant work as a general office worker and receptionist. [AR 36-37].

Standard of Review

The Commissioner's denial of benefits should be disturbed only if it is not supported by substantial evidence or is based on legal error. Stout v. Comm'r, Social Sec. Admin., 454 F.3d 1050, 1054 (9th Cir. 2006); Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). "Substantial evidence" means "more than a mere scintilla, but less than a preponderance." Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th Cir. 2005). "It is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005) (internal quotation marks omitted). The court is required to review the record as a whole and to consider evidence detracting from the decision as well as evidence supporting the decision. Robbins v. Social Sec. Admin, 466 F.3d 880, 882 (9th Cir. 2006); Verduzco v. Apfel, 188 F.3d 1087, 1089 (9th Cir. 1999). "Where the evidence is susceptible to more than one rational interpretation, one of which supports the ALJ's decision, the ALJ's conclusion must be upheld." Thomas, 278 F.3d at 954 (citing Morgan v. Comm'r of Social Sec. Admin., 169 F.3d 595, 599 (9th Cir. 1999)).

Discussion

Medical opinion evidence

Treating physician's opinion

Plaintiff contends that the ALJ erred in rejecting the opinion of her treating physician, John Dimowo, M.D., in favor of the opinion of the nonexamining medical expert, Steven Gerber, M.D. [JS 4-24].

The ALJ found that plaintiff , then 45 years old, had severe impairments consisting of complex regional pain syndrome ("CRPS"); bilateral carpal tunnel release, radial release, and cubital tunnel release surgeries; and degenerative disc disease of the lumbar spine. [AR 31]. Based on his evaluation of the medical evidence and plaintiff's subjective symptoms, the ALJ determined that plaintiff retained the RFC to perform light work that did not require constant, repetitive manipulative tasks bilaterally. [AR 32-36].

CRPS, also known as Reflex Sympathetic Dystrophy Syndrome ("RSDS" or "RSD"), refers to "a unique clinical syndrome" that may develop following even a minor injury to bone or soft tissue, most often following trauma to a single extremity. It may also be precipitated by surgical procedures, drug exposure, stroke with hemiplegia, and cervical spondylosis. Social Security Ruling ("SSR") 03-02p, 2003 WL22399117, at *1.

Many individuals with CRPS are between 18 and 49 years old. SSR 03-02p, 2003 WL 22399117, at *8. The "most common acute clinical manifestations" of CRPS

include complaints of intense pain and findings indicative of autonomic dysfunction at the site of the precipitating trauma. Later, spontaneously occurring pain may be associated with abnormalities in the affected region involving the skin, subcutaneous tissue, and bone. It is characteristic of this syndrome that the degree of pain reported is out of proportion to the severity of the injury sustained by the individual.

SSR 03-02p, 2003 WL 22399117, at *1. When left untreated or when treatment is delayed, the signs and symptoms of the disorder may worsen over time, and may spread to involve an entire limb or remote parts of the body. SSR 03-02p, 2003 WL 22399117, at *1, *2.

The Commissioner has promulgated policy guidelines for developing and evaluating CRPS claims. CRPS can be established by the persistence of pain complaints "that are typically out of proportion to the severity of any documented precipitant and one or more of the following clinically documented signs in the affected region at any time following the documented precipitant": swelling; autonomic instability (including changes in skin color, texture, or temperature; change in degree of sweating; and abnormal pilomotor erection (goosebumps)); abnormal hair or nail growth; osteoporosis; or involuntary movements of the affected region of the initial injury. SSR 03-02p, 2003 WL 22399117, at *4.

"[L]ongitudinal clinical records reflecting ongoing evaluation and treatment . . . especially [from] treating sources are extremely helpful" in evaluating a disability claim based on CRPS, and if the evidence of record is inadequate, the adjudicator "must first recontact the [claimant's] treating or other medical source(s)," and "[o]nly after" determining that the needed information or clarification cannot readily be obtained from the claimant's health care providers should the adjudicator order one or more consultative examinations. SSR 03-02p, 2003 WL 22399117, at *4 (italics added).

The signs and symptoms of CRPS "may remain stable over time, improve, or worsen." SSR 03-02p, 2003 WL 22399117, at *5. "[C]onflicting evidence in the medical record is not unusual in cases of RSDS due to the transitory nature of its objective findings and the complicated diagnostic process involved. Clarification of any such conflicts in the medical evidence should be sought first from the individual'streating or other medical sources." SSR 03-02p, 2003 WL 22399117, at *5. Furthermore, because chronic pain is an "expected symptom" of CRPS, "careful consideration" must be given evaluation of the credibility of the claimant's pain. SSR 03-02p, 2003 WL 22399117, at *6-*7. A mental evaluation may shed light on whether "any undiagnosed psychiatric disease is present that could potentially contribute to a reduced pain tolerance," but "such evaluations are not based on concern that RSDS/CRPS findings are imaginary or etiologically linked to psychiatric disease." SSR 03-02p, 2003 WL 22399117, at *3. Additionally, in cases involving CRPS, "third-party information, including evidence from medical practitioners who have provided services to the individual, and who may or may not be 'acceptable medical sources,' is often critical in deciding the individual's credibility." SSR 03-02p, 2003 WL 22399117, at *7.

The ALJ noted that beginning in December 2007, shortly after her alleged onset date, plaintiff underwent a total of six surgeries on her upper extremities. [AR 33]. The last surgery was performed in October 2008. Post-operatively, she was prescribed medication and physical therapy two or three times a week for periods of several weeks. [AR 284-476]. Plaintiff's surgeon, Dr. Mark Montgomery, saw her for a follow-up visit on December 16, 2008, after the last of those surgeries, a left cubital tunnel release. Plaintiff reported that her pain and numbness were improving with physical therapy, and she had full mobility in the affected extremity. Dr. Montgomery prescribed six more weeks of physical therapy and instructed her to return in six weeks. [AR 385].

Between February 2009 and June 2009, plaintiff began treatment with Andre Chaves, M.D., a hand surgeon to whom she was referred by her workers' compensation attorney, for complaints of persistent pain bilaterally in her upper extremities. Plaintiff reported that she experienced significant temporary improvement after her bilateral carpal tunnel release surgeries but slight or no benefit from her bilateral radial tunnel release and ulnar nerve transposition surgeries. She complained of radiating pain and numbness in her hands, fingers, wrists, forearms, and elbows, as well as weakness in her hands and arms. Dr. Chaves opined that plaintiff was precluded from activities that require keyboarding more than 45 minutes per hour and from speaking on the phone for long periods of time, and that she should avoid repetitive elbow motion and acute flexion of the elbow for long periods. [AR 475]. He concluded thatplaintiff was temporarily totally disabled.¹ Dr. Chaves also requested, but apparently did not receive, authorization from the workers' compensation carrier to perform a more extensive release of the right radial nerve. [See AR 449-476].

In May 2009 Mark Brown, M.D. examined plaintiff in the capacity of a qualified medical examiner in plaintiff's workers' compensation case. In addition to examining plaintiff, he conducted a detailed review of her medical records. He agreed with Dr. Chaves that plaintiff required further surgery for her hand, wrist, and arm pain and related symptoms. He also recommended a cortisone and xylocaine injection. Dr. Brown opined that plaintiff remained temporarily totally disabled. [AR 412-448].

Plaintiff underwent a consultative orthopedic examination with Carlos Gonzalez, M.D., on November 21, 2009. [AR478-482]. Dr. Gonzalez noted that plaintiff's complex regional pain specialist "feels that multiple surgeries to her upper extremities have triggered [CRPS] throughout her body." Plaintiff reported that she received monthly nerve block injections...