Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-04-01113/USCOURTS-ca8-04-01113-0/pdf.json

Parties Involved:
Jo Anne B. Barnhart
Appellee
Mark S. Guilliams
Appellant

Document Text:

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 04-1113

___________

Mark S. Guilliams, *

*

Appellant, *

* Appeal from the United States

v. * District Court for the 

* Western District of Missouri. 

Jo Anne B. Barnhart, Commissioner, * 

Social Security Administration, *

*

Appellee. * 

___________

Submitted: September 17, 2004

Filed: January 4, 2005

___________

Before COLLOTON, HEANEY, and HANSEN, Circuit Judges.

___________

COLLOTON, Circuit Judge.

Mark Guilliams applied for disability insurance benefits and supplemental

security benefits under Titles II and XVI of the Social Security Act. The

Commissioner of the Social Security Administration denied his application. An

administrative law judge (“ALJ”) determined that although Guilliams’s bilateral

carpal tunnel syndrome and other impairments were, in combination, medically

severe, Guilliams had the residual functional capacity (“RFC”) to perform jobs that

exist in substantial numbers in the national and regional economy. The Social

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The Honorable Howard F. Sachs, United States District Judge for the Western

District of Missouri.

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Security Appeals Council denied review, and the district court1

 affirmed the decision

of the Commissioner. We affirm.

I.

We review de novo the district court’s judgment upholding the denial of social

security benefits. Harris v. Barnhart, 356 F.3d 926, 928 (8th Cir. 2004). In

reviewing the district court’s decision, we consider whether the ALJ’s determination

is supported by substantial evidence on the record as a whole. Id. Substantial

evidence is less than a preponderance, but enough that a reasonable mind would find

it adequate to support the ALJ’s determination. Sultan v. Barnhart, 368 F.3d 857,

862 (8th Cir. 2004). We consider evidence that supports the ALJ’s decision as well

as evidence that detracts from it, but even if inconsistent conclusions may be drawn

from the evidence, the agency’s decision will be upheld if it is supported by

substantial evidence on the record as a whole. Chamberlain v. Shalala, 47 F.3d 1489,

1493 (8th Cir. 1995). We do not re-weigh the evidence presented to the ALJ,

Baldwin v. Barnhart, 349 F.3d 544, 555 (8th Cir. 2003), and we defer to the ALJ’s

determinations regarding the credibility of testimony, so long as they are supported

by good reasons and substantial evidence. Gregg v. Barnhart, 354 F.3d 710, 714 (8th

Cir. 2003).

II.

The Commissioner follows a familiar five-step process to determine whether

a claimant is disabled. See generally 20 C.F.R. §§ 404.1520, 416.920; Bowen v.

Yuckert, 482 U.S. 137, 140-42 (1987). At step four, the ALJ determines the

claimant’s RFC, which is defined as what a claimant “can still do despite [his or her]

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limitations.” 20 C.F.R. §§ 404.1545(a), 416.945(a). In determining a claimant’s

RFC, the ALJ must evaluate his or her credibility and take into account all relevant

evidence. See Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001); 20 C.F.R.

§§ 404.1545, 416.945. 

Guilliams argues that the ALJ incorrectly determined that his RFC included the

ability to do some types of “light work” as defined in the Social Security regulations.

See 20 C.F.R. §§ 404.1567(b); 416.967(b). He alleges that, in reaching this

conclusion, the ALJ improperly discredited his complaints of pain and disregarded

the evidence provided by one of his examining physicians. We conclude that the

ALJ’s determination that Guilliams’s complaints of pain were exaggerated was

supported by substantial evidence, and that he gave sufficient weight to the evidence

of Guilliams’s examining physicians.

A claimant’s subjective complaints may be discounted if there are

inconsistencies in the record as a whole. 20 C.F.R. §§ 404.1529, 416.929; McKinney

v. Apfel, 228 F.3d 860, 864 (8th Cir. 2000); Polaski v. Heckler, 739 F.2d 1320, 1322

(8th Cir. 1984). In evaluating subjective complaints, however, the ALJ must consider

objective medical evidence, as well as any evidence relating to the so-called Polaski

factors, namely: (i) a claimant’s daily activities; (ii) the duration, frequency, and

intensity of the claimant’s pain; (iii) precipitating and aggravating factors; (iv)

dosage, effectiveness, and side effects of medication; and (v) functional restrictions.

Polaski, 739 F.2d at 1322. In rejecting a claimant’s complaints of pain as not

credible, we expect an ALJ to “detail the reasons for discrediting the testimony and

set forth the inconsistencies found.” Lewis v. Barnhart, 353 F.3d 642, 647 (8th Cir.

2003).

We believe that substantial evidence supports the ALJ’s decision to discount

Guilliams’s claims of disabling pain. Guilliams complained of numbness and tingling

in his hands, (R. at 204), occasional pain in his heels, (R. at 317), and chronic pain

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in his wrists, arms, back, and legs. (R. at 204, 306). Guilliams alleged in particular

that he suffered from severe back pain that radiated into both legs. (R. at 306). The

ALJ concluded, however, that Guilliams’s complaints of pain were inconsistent with

substantial medical evidence and other evidence.

During several examinations by a treating physician, Kam-Fai Pang, M.D.,

Guilliams appeared to be in no significant distress. (R. at 293, 306, 317). One such

examination revealed that Guilliams had normal curvature of the spine and lacked any

paraspinal muscle spasms or tender points. (R. at 306). A subsequent MRI

confirmed that Guilliams’s lumbar spine had a largely normal alignment. (R. at 224).

Dr. Pang believed, in fact, that his examination of Guilliams was suggestive of

symptom magnification. (R. at 307). 

An earlier examination by Allen J. Parmet, M.D., a state consulting physician,

also was inconsistent with Guilliams’s complaints of disabling pain. Dr. Parmet

recorded “some discrepancies in the physical examination that call the degree of

restriction into question.” (R. at 206). Specifically, Guilliams’s “grip strength

diminishment and restricted range of motion, particularly [in] the right [hand],” was

“in contrast with the maintenance of muscle mass and recent use of his hands.” (Id.).

In addition to the objective medical evidence, an analysis of the Polaski factors

reveals inconsistencies between Guilliams’s allegations of pain and the evidence in

the record. Significant daily activities may be inconsistent with claims of disabling

pain, see Haley v. Massanari, 258 F.3d 742, 748 (8th Cir. 2001), and Guilliams

testified that he performed household chores such as cooking, laundry, and

vacuuming. (R. at 33, 136). An examining physician, moreover, noted that

Guilliams’s hands were calloused and greasy at the time of his examination (more

than six weeks after the alleged onset of his disability), indicating significant daily

activities. (R. at 206). 

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Other Polaski factors suggest additional inconsistencies. Evidence of effective

medication resulting in relief, for example, may diminish the credibility of a

claimant’s complaints. See Rose v. Apfel, 181 F.3d 943, 944 (8th Cir. 1999).

Guilliams admitted at his hearing that recent medication had relieved his pain. (R.

at 41). A failure to follow a recommended course of treatment also weighs against

a claimant’s credibility. Gowell v. Apfel, 242 F.3d 793, 797 (8th Cir. 2001).

Guilliams did not take advantage of Dr. Pang’s offer to refer him to a podiatrist in

response to Guilliams’s complaints of heel pain. (R. at 317). Finally, Guilliams’s

allegations regarding functional restrictions were not consistent with the record

evidence. Guilliams alleged debilitating back pain, but, as noted above, he performed

numerous household chores. Although Guilliams brought a cane to his examination

by Dr. Pang, the doctor noted that the cane was not necessary for Guilliams’s

ambulation. (R. at 317). The inconsistencies between Guilliams’s allegations and the

record evidence provide sufficient support for the ALJ’s decision to discredit

Guilliams’s complaints of pain.

The ALJ did not, as Guilliams alleges, simply substitute his opinion for

medical evidence in determining Guilliams’s RFC. RFC is a medical question, and

an ALJ’s finding must be supported by some medical evidence. Masterson v.

Barnhart, 363 F.3d 731, 738 (8th Cir. 2004). The ALJ, however, still “bears the

primary responsibility for assessing a claimant’s residual functional capacity based

on all relevant evidence.” Roberts v. Apfel, 222 F.3d 466, 469 (8th Cir. 2000). The

ALJ here relied on evidence in the record that suggested Guilliams was capable of

considerable physical activity despite his carpal tunnel and other impairments. When

Guilliams was released from the hospital following a surgery to repair a hernia in July

2000, for example, John Webb, M.D., the surgeon who had performed the operation,

specified that Guilliams was “not limited from work.” (R. at 233). Guilliams’s

examining physicians consistently noted an absence of muscle atrophy and muscle

spasms, (R. at 306), only slight loss of range of motion, (R. at 209, 313), and largely

unimpaired reflexes (R. at 206). Dr. Parmet, an occupational specialist, (R. at 206),

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concluded from his examination that Guilliams was capable of performing light work.

(Id.). This and other evidence provides substantial support for the ALJ’s

determination of Guillaims’s RFC.

Guilliams contends that the ALJ failed to give sufficient weight to the evidence

of Harry G. Miller, M.D., an orthopedic surgeon, who opined that Guilliams had

“physical limitations” and was “physically disabled f[rom] gainful labor-type

employment.” (R. at 315). Guilliams argues that, as the diagnosis of a specialist, Dr.

Miller’s evidence is entitled to more weight than the ALJ accorded it. It is true that

opinions of specialists on issues within their areas of expertise are “generally”

entitled to more weight than the opinions of non-specialists. See 20 C.F.R.

§§ 404.1527(d)(5), 416.927(d)(5). Physician opinions that are internally inconsistent,

however, are entitled to less deference than they would receive in the absence of

inconsistencies. See Johnson v. Chater, 87 F.3d 1015, 1018 (8th Cir. 1996). Dr.

Miller’s report contained several inconsistencies. While stating that Guilliams was

“totally disabled,” the report also finds that he “would be an excellent candidate for

vocational rehabilitation evaluation.” (R. at 315). The report also noted that

Guilliams’s “[m]usculature is of good quality in his upper extremities,” (R. at 313),

yet recommended “total limitations in lifting and carrying.” (R. at 315). We agree

with the district court that the inconsistencies in Dr. Miller’s report justify the ALJ’s

determination that the report’s conclusion was outweighed by the other record

evidence. 

III.

Guilliams also argues that the ALJ’s step-five determination that he could

perform work that exists in significant numbers within the regional and national

economies is unsupported by substantial evidence. The issue at step five is “whether

the claimant is able to perform other work in the national economy in view of [his or]

her age, education, and work experience.” Harris, 356 F.3d at 929. The ALJ relied

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on testimony from a vocational expert in answering this question in the affirmative.

(R. at 44-48). The Commissioner may rely on a vocational expert’s response to a

properly formulated hypothetical question to show that jobs that a person with the

claimant’s RFC can perform exist in significant numbers. See 20 C.F.R.

§§ 404.1566(e), 416.966(e); Long v. Chater, 108 F.3d 185, 188 (8th Cir.1997). 

Guilliams alleges that the vocational expert’s testimony does not constitute

substantial evidence because it was elicited by an improper hypothetical question.

A hypothetical question is properly formulated if it sets forth impairments “supported

by substantial evidence in the record and accepted as true by the ALJ.” Davis v.

Apfel, 239 F.3d 962, 966 (8th Cir. 2001). Guilliams argues that the hypothetical

question was erroneous because it did not contain any reference to his allegations of

pain. Discredited complaints of pain, however, are properly excluded from a

hypothetical question so long as the ALJ had reason to discredit them. See Tucker v.

Barnhart, 363 F.3d 781, 784 (8th Cir. 2004). Here, as discussed above, there was

substantial evidence to support the ALJ’s determination that Guilliams’s complaints

of pain were not credible. Therefore, they were properly excluded from the

hypothetical question on which the ALJ relied.

Guilliams also challenges the ALJ’s hypothetical question to the vocational

expert on the ground that it improperly assumed the category of work that Guilliams

could perform. An ALJ may not merely “pose[] a generalized hypothetical question

to [a] vocational expert which assume[s]” a claimant has the physical capacity to

perform a given category of work. McGhee v. Harris, 683 F.2d 256, 259 (8th Cir.

1982). Guilliams complains that in this case, the ALJ began his question with an

improper assumption, to wit: “If I were to find that Mr. Guilliams was restricted to

light work . . . .” (R. at 45). 

Hypothetical questions that assume a claimant is capable of performing a

category of work are problematic because they often result in a failure to create a

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record showing that “the vocational expert considered the particular individual

disabilities of the claimant in evaluating [his] ability to perform alternative

employment.” McGhee, 683 F.3d at 259. At Guilliams’s hearing, however, this was

not the result of the ALJ’s hypothetical question. The ALJ’s hypothetical continued

on from its initial assumption to specify in great detail Guilliams’s impairments, as

follows:

If I were to find that Mr. Guilliams was restricted to light work, and that

he was limited as far as lifting is concerned -- occasionally could lift up

to 20 pounds, although frequently would be able to lift 10 pounds[, that

he] could be on his feet the better part of the day standing or walking .

. . [b]ut has problems with his hands stemming from carpal tunnel of a

mild . . . to moderate [nature] that would affect him . . . are there jobs

that could be done by [Guilliams]? 

(R. at 45). The hypothetical’s initial assumption thus was not fatal to its propriety in

this case because it otherwise “precisely set out the claimant’s particular physical and

mental impairments.” Simonson v. Schweiker, 699 F.2d 426, 430 (8th Cir. 1983)

(internal quotation and citation omitted). Because the vocational expert was

presented with a proper hypothetical, her testimony that there were significant

numbers of jobs that Guilliams could perform despite his limitations constitutes

substantial evidence supporting the ALJ’s determination that Guilliams was not

disabled. See Tucker, 363 F.3d at 784.

The judgment of the district court is affirmed. 

 ______________________________

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