in late 1989 or early 1990, by following the advice of Dr. Brandfonbrener (R. 1196). Despite plaintiff's characterization, it is clear that ALJ Kohler found plaintiff incredible because his testimony concerning a specific point in time changed over the course of these proceedings.
For example, Schmidt testified at his first hearing on October 8, 1987 that he experienced severe angina pains four to six times a week. However, Dr. Brandfonbrener's progress reports indicate that Schmidt experienced angina two to three times a week in August 1987, and three to four times a week in October 1987. Similarly, at his hearing in 1993, Schmidt claimed that he experienced angina three to four times a day in 1988, while Dr. Brandfonbrener's 1988 reports note that Schmidt experienced angina a few times a week. In December 1989, Schmidt reported a "severe increase in both frequency and intensity of angina" to the defendant (R. 829). His treadmill test just one month earlier, however, revealed that his cardiac condition had improved.
We are unpersuaded by Schmidt's attempts to explain away these discrepancies as "picayune," the result of confusion, or mere semantics. In addition, ALJ Kohler did not totally discredit plaintiff's accounts of his symptoms. The ALJ acknowledged that Schmidt suffered from a number of medical infirmities that caused "significantly vocationally relevant limitations." (R. 829). ALJ Kohler merely concluded that Schmidt had a tendency to exaggerate his condition when he reported his symptoms to the defendant, which, as demonstrated in these examples, was well founded.
IV. ALJ KOHLER'S DENIAL OF BENEFITS WAS SUPPORTED BY SUBSTANTIAL EVIDENCE
Schmidt argues that ALJ Kohler's determination that Schmidt was not disabled is not supported by substantial evidence. Before evaluating the medical evidence and vocational testimony, we must first set forth the parameters of our inquiry, as it is bound by the concept of "substantial evidence."
A. Standard Of Review
Section 205(g) of the Social Security Act ("Act"), 42 U.S.C. § 405(g), authorizes judicial review of an ALJ decision.
As a reviewing court, we are not permitted to decide facts anew, reweigh the evidence, or substitute our judgment for the defendants'. Walker v. Bowen, 834 F.2d 635, 643 (7th Cir. 1987). We will find that the Commissioner's decision is supported by substantial evidence even if reasonable minds would differ as to whether the claimant is disabled. Id. at 640. As such, we may reverse the Commissioner's ruling "only if the evidence compels reversal, not merely because the evidence can support a contrary decision." Gutierrez v. Apfel, 1998 U.S. Dist. LEXIS 993, 1998 WL 30690 at *3 (N.D. Ill. Jan. 23, 1998); see also Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990) ("If there is evidence to justify a refusal to direct a verdict were the case before a jury, then there is substantial evidence.") However, "if the [Commissioner] committed an error of law, reversal is required without regard to the volume of the evidence in support of the factual findings." Imani v. Heckler, 797 F.2d 508, 510 (7th Cir. 1986); cert denied, 479 U.S. 988, 107 S. Ct. 580, 93 L. Ed. 2d 583 (1986). With these standards in mind, we address Schmidt's challenge to the Commissioner's disability determination.
To qualify for disability benefits, a claimant must be "disabled." The Act defines "disabled" as the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1)(A). A "physical or mental impairment" is an impairment resulting "from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques." 42 U.S.C. § 423(d)(3).
Social Security regulations set forth a five-step inquiry to determine whether a claimant is disabled. The Commissioner must determine (1) whether the claimant is presently employed; (2) whether he has a severe impairment; (3) whether his impairment meets or equals one of the Commissioner's listed impairments; (4) whether the claimant can perform his past relevant work; and (5) whether he is capable of performing any work within the economy. 20 C.F.R. § 404.1520; Schroeter v. Sullivan, 977 F.2d 391, 393 (7th Cir. 1992). A claimant must always satisfy the first two factors, but a finding of disability results if he has a listed impairment or can do neither his previous work nor any other work. Schroeter, 977 F.2d at 393.
In reviewing Schmidt's claim, ALJ Kohler noted that Schmidt had not been gainfully employed since 1986. Turning to the medical evidence, ALJ Kohler determined that Schmidt suffers from coronary artery disease, high blood pressure (which was controlled with exercise and medication), angina, minimal bilateral carpal tunnel syndrome, post TIA, a 50% to 75 % stenosis right internal carotid artery, emotional problems, and arthritis. ALJ Kohler found that while these impairments would cause significant vocationally relevant limitations, they did not meet or equal a listing.
In so ruling, ALJ Kohler rejected Dr. Brandfonbrener's and Dr. Reich's ultimate conclusions that Schmidt possibly met or equaled a medical listing. Schmidt argues that ALJ Kohler erred because he did not give "good reason" for discounting the opinions of Dr. Reich and Dr. Brandfonbrener. The reason ALJ Kohler supplied for rejecting Dr. Brandfonbrener's and Dr. Reich's opinions were that their conclusions were not supported by a careful reading of the Listings or the opinions of medical advisor Dr. Sommers and the state agency physicians.
Schmidt contends that the ALJ should have fully credited the opinions of his treating physicians, and not the opinions of the reviewing physicians.
Initially, we note that the power to determine whether the plaintiff meets or equals the Listing of Impairments resides solely with the Commissioner. 20 C.F.R. § 404.1527(e) ("A statement by a medical source that you are disabled or unable to work does not mean you are disabled.") When confronted with conflicting medical opinions, it is within the ALJ's discretion to determine which doctor to believe. Books v. Chater, 91 F.3d 972, 979 (7th Cir. 1996). The ALJ must consider whether the witness is a treating physician, the duration and extent of the treatment relationship, and the veracity of the physician's opinion. 20 C.F.R. § 404.1527(a)-(d). The ALJ may discount medical opinions that contain internal inconsistencies, or that are inconsistent with other evidence. Id. at 979. In addition, the ALJ need not accord a treating physician's opinions great weight if is not supported by clinical or diagnostic data. Id. The ALJ may even reject a treating physician's opinion in favor of a non-treating physician's conflicting findings. As the Seventh Circuit has stated
The patient's regular physician may want to do a favor for a friend and client, and so the treating physician may too quickly find disability. The regular physician also may lack an appreciation of how one case compares with other related cases. A consulting physician may bring both impartiality and expertise.
Books v. Chater, 91 F.3d 972, No. 95-2794, slip op. at 12 (7th Cir. Jan. 19, 1996) (quoting Stephens v. Heckler, 766 F.2d 284, 287 (7th Cir. 1985)).
However, if the ALJ declines to give a medical opinion substantial weight, he must articulate legitimate reasons constituting good cause for doing so. Knight v. Chater, 55 F.3d 309, 313 (7th Cir. 1995). This is not to say that the ALJ is required to evaluate in writing every piece of the evidence presented. Carlson v. Shalala, 999 F.2d 180, 181 (7th Cir. 1993) (per curiam). Rather, the ALJ need only "sufficiently articulate his assessment of the evidence to 'assure us that the ALJ considered the important evidence . . . [and to enable] us to trace the path of the path of the ALJ's reasoning.'" Id. at 181 (quoting Stephens v. Heckler, 766 F.2d 284, 287 (7th Cir. 1985)).
In assessing Schmidt's physical condition, ALJ Kohler noted that Schmidt's treadmill tests consistently demonstrated his ability to sustain a medium work-exertion level. While Schmidt suffers from angina, Dr. Brandfonbrener had referred to the pain as mild. Interestingly, Dr. Sam Ho, the neurologist treating Schmidt following his 1986 transient cerebral ischemia attack, chose not to prescribe Schmidt the blood thinner coumadin, which requires close medical supervision. Instead, Dr. Ho felt that aspirin was sufficient. In reviewing Schmidt's 1986 stress test, Dr. Brandfonbrener found that Schmidt's functional capacity remained above average due to his long history of physical activity. In addition, ALJ Kohler noted a previous example where another physician's diagnosis of Schmidt's condition was less serious then Dr. Brandfonbrener's. Dr. Brandfonbrener found that Schmidt's condition in 1985 necessitated angioplasty and referred Schmidt to Dr. Gruentzig. Upon evaluating Schmidt's files, however, Dr. Gruentzig found that the procedure was unwarranted. Similarly, while Dr. Brandfonbrener believed that Schmidt's physical impairments rendered him unable to work, Dr. Sommers and the State Agency Physicians determined that Schmidt failed to meet any of the criteria of the listed impairments described in Appendix 1 of the Regulations. See 20 C.F.R., Part 404, Subpart P, Appendix 1.
Turning to Dr. Reich's opinion, we note that Dr. Reich offered testimony as to Schmidt's mental condition. Schmidt's counsel referred him to Dr. Reich, a clinical psychologist, in October of 1987. After examining Schmidt, Dr. Reich noted a disparity between Schmidt's verbal IQ (121) and his performance IQ (95). Dr. Reich testified that the disparity could indicate mild brain damage, possibly as a result of the transient cerebral ischemia attack suffered in 1986. However, Dr. Reich qualified this finding, noting that the tests alone were insufficient to support the conclusion that Schmidt's practical functioning was impaired. The MMPI results from the interview, Dr. Reich noted, reflected high percentile scores on somatization, obsessive compulsive behavior, and hostility.
In discussing Dr. Reich's testimony, ALJ Kohler noted that Schmidt stopped seeing Dr. Reich in March of 1988, "before a significant patient claimant [sic] relationship developed." (R. 835). ALJ Kohler then categorized Dr. Reich's relationship to Schmidt as a non-treating physician. In contrast to Dr. Reich's assessment of the MMPI results, ALJ Kohler stated that the global severity index of 70 indicated only mild symptoms, citing the DSM-III R Classification GAF Scale.
Schmidt takes issue with ALJ Kohler's labeling of Dr. Reich as a non-treating physician, thereby giving less weight to his opinions. However, ALJ Kohler found that Dr. Reich's assessment of a somatoform and obsessive compulsive disorder were valid. They simply were insufficient to meet a listed impairment. Moreover, ALJ Kohler was not required to accept Dr. Reich's statements that were not consistent or that were outside of the scope of the treatment. 20 C.F.R. § 404.1527(d)(3). For example, while Dr. Reich found that Schmidt had no difficulties with social functioning in 1987 and Schmidt testified that he was always aware of the need to get along with his supervisors, Dr. Reich stated in 1992 that plaintiff had difficulty in getting along with others, particularly those in supervisory roles. And while Dr. Reich testified that he believed plaintiff would put so much pressure upon himself at work that he could die, as a psychologist, Dr. Reich is not qualified to predict, nor had he observed, the physical consequences of plaintiff's psychological condition.
Schmidt goes on to argue that ALJ Kohler rejects the uncontradicted testimony of the medical experts in concluding that "in addition to Plaintiff's physical impairments, that emotional upset can cause the angina symptoms. . . ." Pl.'s Rp. At 29.
This statement belies ALJ Kohler's acknowledgment that Schmidt's "cardiac condition with occlusions of his coronary LAD and internal carotid artery with the psychological factor of severe stress could have caused severe complications such as a stroke and/or myocardial infarction." (R. 837). In so ruling, ALJ Kohler credited the evaluations of Dr. Brandfonbrener, Dr. Reich, and Dr. Nadler, giving them controlling weight. However, ALJ Kohler specifically rejected the doctors' ultimate conclusion that Schmidt is disabled based upon the unwarranted assumption that Schmidt could not handle any work stress. This ruling, if supported by substantial evidence, is well within the confines of ALJ Kohler's discretion as a hearing officer. See Dray v. Railroad Retirement Board, 10 F.3d 1306, 1313 (7th Cir. 1993) ("Whether a claimant is disabled is a legal, not a medical, question-- an ultimate conclusion for the hearing officer to make."); Castellano v. Secretary of Health & Human Services, 26 F.3d 1027, 1029 (10th Cir. 1994) ("the determination of disability is the ultimate responsibility of the Commissioner, a treating physician's opinion as to claimant's disability is not dispositive.")
D. Schmidt Could Perform Relevant Work Available In the Economy
ALJ Kohler determined that Schmidt was able to make a vocational adjustment to low-stress jobs that exist in significant numbers in the economy. This conclusion is consistent with Dr. Nadler's presentation of Schmidt's condition in the Social Security Administration's Medical Report on September 11, 1987. Dr. Nadler indicated that Schmidt could sit for six hours, stand for one hour, and walk for one hour in an eight hour workday. In addition, Schmidt was capable of occasionally lifting 20-25 lbs. and occasionally carrying 11-20 lbs. While Schmidt was unable to use either hand for repetitive actions such as pushing and pulling arm controls, he could perform simple grasping and fine manipulation with both hands. When asked to provide remarks on other functional limitations, Dr. Nadler noted that Schmidt has difficulty handling stressful situations that precipitate angina. Similarly, in his responses answers to the Bureau of Disability Determination Services' Medical Questionnaire on February 13, 1990, Dr. Nadler noted that Schmidt suffered from angina pectoris and that "anxiety reaction with executive duties exacerbate angina [therefore] unable to work at usual and customary employment." (R. 451, 453).
After the Seventh Circuit denied Schmidt's benefits, plaintiff's counsel provided Dr. Nadler with a copy of that opinion and requested that he "clarify [his] opinion of George Schmidt's physical capacities from March 28, 1986 through April 12, 1990." (R. 475). On February 8, 1991, Dr. Nadler composed a two page letter explaining that "when I commented that Mr. Schmidt can perform work related activities except for 'extreme exertion,' I certainly did not mean to imply that he could perform 'medium' work as defined by the SSA." (R. 475). Dr. Nadler went on to declare that:
Mr. Schmidt is unequivocally unable to meet the "prolonged" standing and/or walking requirements of "light" or "medium" exertion, which amounts to 4-6 hours out of an 8 hour day. Nor could he be expected to lift up to 50 pounds or even 25 pounds frequently. If he had forced himself to perform any of these above requirements it would certainly have exacerbated his cardiac condition and possibly proved fatal to his health, especially in the context of an 8 hour work day, 5 days a week, 2,000 hours per year. My comment was simply within the context of executive duties which are quite sedentary in nature. (R. 475-76).
In criticizing the Seventh Circuit's determination that Schmidt could perform cashier work in a retail store, Dr. Nadler stated,
Physically he could handle that job, just as he could physically handle a managers [sic] job. I have read the psychological report, and while I am not a psychiatrist, I am a physician trained in psychiatric medicine and I have dealt with Mr. Schmidt on a routine basis since 1984. In my opinion low-end jobs would not alleviate his emotional stress. (R. 476).