United States District Court, D. Massachusetts
OPINION AND ORDER
A. O'TOOLE, JR. UNITED STATES DISTRICT JUDGE
plaintiff, Karen Krol, appeals the denial of her application
for Social Security Disability Benefits (“DIB”)
and Supplemental Security Income (“SSI”) by the
Commissioner of Social Security (“Commissioner”).
Before the Court are Krol's Motion for Order Reversing
the Commissioner's Decision (dkt. no. 11) and the
Commissioner's Motion to Affirm the Commissioner's
Decision (dkt. no. 14). After consideration of the
administrative record and the parties' memoranda, the
Court now affirms the Commissioner's decision because
there is substantial evidence in the administrative record to
support the decision and no error of law was made.
applied for DIB on June 14, 2012 and applied for SSI on July
31, 2012. Both applications alleged disability beginning
January 13, 2012. (Administrative Tr. at 120-26, 159, 750-60
[hereinafter R.]). Her application for DIB was denied
initially on December 21, 2012 (id. at 64-66), and
again upon reconsideration on August 7, 2013, (id.
at 68-70). Krol's application for SSI was denied on
August 15, 2012, (id. at 761-69), and was then
“escalated to the hearing level” and associated
with the application for DIB, (id. at 119A). Krol
requested a hearing, (id. at 71-72), which was held
before Administrative Law Judge Stephen C. Fulton on May 1,
2014, (id. at 789-829). The ALJ subsequently issued
an unfavorable decision, finding that Krol could perform her
past relevant work as a medical records clerk based on her
residual function capacity (“RFC”). (Id.
at 15-33.) Accordingly, the ALJ found that Krol was
“not disabled” pursuant to the Social Security
Act. (Id. at 33.) On August 11, 2015, the Appeals
Council denied Krol's request for review. (Id.
at 9-11.) This denial rendered the ALJ's decision the
final decision of the Commissioner, and made the case
suitable for review by this Court pursuant to 42 U.S.C.
Court's review of a denial of social security disability
benefits is limited to an evaluation as to whether the
“ALJ used the proper legal standards and found facts
upon the proper quantum of evidence.” Ward v.
Comm'r of Soc. Sec., 211 F.3d 652, 655 (1st Cir.
2000). The Commissioner's findings of fact are conclusive
if supported by substantial evidence. 42 U.S.C. §
405(g); accord Manso-Pizarro v. Sec'y of Health &
Human Servs., 76 F.3d 15, 16 (1st Cir. 1996). The
evidence is considered substantial when it is “more
than a mere scintilla, ” Richardson v.
Perales, 402 U.S. 389, 401 (1971), and an ALJ's
determination supported by substantial evidence must be
upheld “even if the record arguably could justify a
different conclusion, ” Rodriguez Pagan v.
Sec'y of Health & Human Servs., 819 F.2d 1, 3
(1st Cir. 1987). Further, deciding issues of credibility is
the “prime responsibility” of the ALJ.
Rodriguez v. Celebrezze, 349 F.2d 494, 496 (1st Cir.
appeal, Krol argues that the ALJ's decision should be
overturned both for legal error and for lack of substantial
evidence in the record to support the decision. Specifically,
Krol argues that the ALJ erred by: (1) inadequately
considering the opinions of certain of Krol's therapists
and nurse practitioners; (2) finding that none of Krol's
mental impairments were severe; (3) failing to consider
Krol's testimony regarding pain; (4) inaccurately citing
the record regarding Krol's activities of daily living
(“ADLs”); (5) citing evidence in a biased manner;
and (6) finding that Krol could do light work.
is no reason to outline the details of Krol's medical
history or of the DIB and SSI application process here except
as is necessary to discuss the specific objections made to
the Commissioner's decision.
The ALJ's Decision Properly Weighed the Evidence of
Krol's Treating Therapist and Nurses
first contends that the ALJ failed to properly weigh the
medical evidence when he gave “less weight” to
the opinions of Krol's treating therapist, Helen
Ekmekchi, a licensed social worker, and nurse practitioners
Kathryn Kieran and Michele Adam. (R. at 23.)
the relevant regulations, therapists and nurse practitioners
are not among the recognized “acceptable medical
sources.” 20 C.F.R. §§ 404.1513(a),
416.913(a). Their opinions therefore are not afforded
“controlling weight” under the treating
physician's rule. See id. § 404.1513(c).
The ALJ must nevertheless evaluate every medical opinion
received. Id. § 404.1527(c). When a treating
source is not given “controlling weight, ” the
weight attributed to the opinions is to be determined by the
ALJ based on the application of the following factors: (1)
the examining and/or treatment history between the treating
source and the claimant; (2) the length and frequency of that
relationship; (3) the nature and extent of the relationship;
(4) the strength and sufficiency of the evidence forming the
basis for the opinion; (5) the consistency of the opinion
with the record as a whole; (6) the specialty, if any, of the
source; and (7) any other factors the claimant brings to the
ALJ's attention. See id., § 416.927(c).
Ultimately, in determining how much weight to give a
therapist's opinion, “an ALJ is only constrained by
the duty to reach a conclusion supported by substantial
evidence in the record.” Gagnon v. Astrue,
Civil Action No. 11-CV-10381-PBS, 2012 WL 1065837, at *5 (D.
Mass. Mar. 27, 2012) (citation omitted).
the ALJ considered therapist Ekmekchi's opinion as
required by § 404.1527(c), and the ALJ's treatment
of that opinion is supported by substantial evidence. In her
March 31, 2014, opinion, Ms. Ekmekchi concluded that Krol
exhibited symptoms of anxiety, difficulty being around
people, moderate difficulty in maintaining social
functioning, and a marked deficiency of concentration. (R. at
681-87.) The ALJ gave the opinion “less weight”
because it was inconsistent with the overall weight of the
record, including the claimant's treatment history, her
daily activities, and her own statements. (Id. at
claimant's treatment history demonstrates that many of
her mental impairments have been treated effectively with
medication. For example, the claimant herself stated in the
hearing before the ALJ that the medication she takes to
combat her Attention Deficit Hyperactivity Disorder
(“ADHD”), which impacts her ability to
concentrate, is “a miracle thing” that helps
reduce her symptoms. (Id. at 812-13.) She also noted
in her function report that with medications she can pay
attention “pretty well” and “usually”
finishes what she starts. (Id. at 188.) The
claimant's medical records also contains evidence that
Krol's anxiety was reduced with medication. (See,
e.g., id. at 612, 629.) Furthermore, the record
indicates that the claimant is able to carry out daily tasks
such as making quick meals, doing laundry, and shopping for
groceries with assistance from her brother. (Id. at
185-86.) The ALJ therefore did not err in his decision to
give Ms. Ekmekchi's opinion “less weight” in
light of the inconsistencies in the opinion with other
information and assessments in the record as a whole.
the ALJ's consideration of the treatment records of nurse
practitioners Kieran and Adams satisfied the requirement that
the ALJ reach a conclusion supported by substantial evidence
in the record. See Gagnon, 2012 WL 1065837, at *5.
These nurse practitioners' findings include that Krol
suffered from anxiety, trouble concentrating, insomnia, and
depression. As discussed, the record provides ample evidence
that the claimant's symptoms were controlled and improved
with medication. (See, e.g., R. at 401, 603, 612,
659.) Furthermore, ALJs are permitted “to piece
together the relevant medical facts from the findings and
opinions of multiple physicians.” Evangelista v.
Sec'y of Health & Human Servs., 826 F.2d 136,
144 (1st Cir. 1987). It is an ALJ's responsibility, and
was therefore within his discretion, to consider the evidence
as a whole, including evidence ...