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IN THE UNITED STATES DISTRICT COURT FOR THE

NORTHERN DISTRICT OF FLORIDA

PENSACOLA DIVISION

CYNTHIA A. WILLIAMS,

Plaintiff 

v. Case No. 3:10cv151/WS/CJK

MICHAEL J. ASTRUE,

Commissioner of Social Security,

Defendant.

REPORT AND RECOMMENDATION

This matter is before the court upon plaintiff’s application for supplemental

security income benefits, pursuant to Title XVI of the Social Security Act (Act), 42

U.S.C. §§ 1381 et seq. Section 1383(c)(3) of the Act provides for judicial review of

a “final determination” of the Commissioner of the Social Security Administration

(Commissioner) under Title XVI. 

On November 30, 2006, plaintiff, Cynthia Williams, filed an application for

supplemental security income, alleging disability beginning May 20, 1985 (doc. 7). 

The claimwas denied initially on February 8, 2007, and upon reconsideration on May

9, 2007. Plaintiff thereafter filed a written request for hearing pursuant to 20 C.F.R.

§ 416.1429. Following a hearing, the administrative law judge (ALJ) determined on

January 29, 2009, that plaintiff was not disabled under the Social Security Act at any

time through the date of the decision (doc. 7, pp. 13-23). On April 1, 2010, the

Appeals Council of the Social Security Administration denied plaintiff’s request for

review, rendering final the decision of the Commissioner (doc. 7, pp. 1-4). 

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Plaintiff, born May 1958, alleged disability due to back injury and a history of

major surgery at L4-5, back pain, left leg pain, and neck pain. Plaintiff claimed that

the injury and attendant maladies caused severe pain, and that activities such as

cleaning, making the bed, and family interaction were too strenuous (doc. 7-4). 

Plaintiff reported past work experience as a nursing assistant, which ended after she

injured her back in 1985 (docs. 7-1, 7-4). In 2005, plaintiff received a lump-sum

worker’s compensation settlement (doc. 7-1). 

After evaluating the record evidence, the ALJ found that plaintiff had severe

impairments consisting of central disc herniation and degeneration of L4-5, with

degenerative changes, degenerative arthritis, and hypertension (doc. 7). Despite the

aforesaid impairments, the ALJ concluded that plaintiff did not have an impairment

or combination of impairments to meet or medically equal the criteria for an

impairment enumerated in 20 C.F.R. Part 404, Subpart P, Appendix 1 (doc. 7). The

ALJ then determined that plaintiff has the residual functional capacity to perform a

full range of light work (doc. 7). Though the plaintiff had no past relevant work to

which she could be expected to return, the ALJ found that plaintiff’s residual

functional capacity would allow the performance of work existing in significant

numbers in the national economy. Having considered all the evidence, the ALJ

determined that claimant has not been under a disability within the meaning of the

Social Security Act since the date the application for supplemental security income

benefits was filed (doc. 7). 

Plaintiff now challengesthe factual findings ofthe Commissioner and has filed

a complaint for reversal of the Commissioner’s denial of disability benefits. In

support of this challenge, plaintiff argues generally that the decision of the

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Commissioner is not supported by substantial evidence, because plaintiff is unable

to performany work on a regular and continuing basis (doc. 9). In particular, plaintiff

contends that the ALJ erred by failing to give great weight to the disability opinions

of plaintiff’s treating physician, Dr. Louis B. Fowler, who opined that plaintiff is

restricted from sitting, standing, and/or walking for at least two hours at a time and

for six hours total in an eight-hour workday (docs. 7, 9). Plaintiff assertsthat the ALJ

failed to state with particularity the reasons for rejecting Dr. Fowler’s opinion, in

contravention of prevailing case law (doc. 9). Citing various records and objective

medical tests, plaintiff submits that the evidence is fully supportive of Dr. Fowler’s

disability assessment. She argues that because Dr. Fowler’s medical assessments are

supported by medical evidence, the doctor’s disability opinion must be accepted as

true as a matter of law.

In her disability report, plaintiff stated that a back injury at L4-L5, major

surgery to replace L4-L5, open back surgery, and neck/left leg injuries limit her

ability to work. Plaintiff reported that these conditions cause “severe pain,” making

daily activities like cleaning and cooking “too strenuous.” Further, plaintiff asserted

that she had been unable to work since May 1985 and reported a medical regimen of

14 medications, all prescribed by Dr. Fowler. Despite the volume of medication,

plaintiff reported no adverse side effects, with the exception of headaches caused by

the Nexium she had been taking. Plaintiff reported thatshe had fusion surgery on her

lower back in 1988, but had not had a pain injection in more than a year. Plaintiff did

not report surgery or injections on any other part of the body (doc. 7-4).

Following the initial denial of her claim in February 2007, plaintiff completed

a report in which she averred that the same 13 medications previously reported as

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causing no side effects now caused headaches, stomach aches, fatigue, and nausea

(doc. 7-4). Also, a report of contact dated March 2007 indicates that plaintiff had a

telephone conversation with a state disability determination service employee, during

which plaintiff discussed symptom relief she received from the medications, but

mentioned no adverse side effects (doc. 7-5). Office visit notes from Dr. Fowler for

April and August 2007 and March 2008, as well as an April 2007 narrative report from

consultative physician Dr. Richard W. Lucey, contain no mention of adverse side

effects caused by the prescribed medication regimen (docs. 7-18, 7-19). 

During a telephone interview in March 2007, plaintiff reported that she had

experienced no changes in her condition and had seen no new medical sources (doc.

7-5). During an interview with Dr. Lucey, plaintiff reported chronic pain in her lower

back. The doctor reported a treatment history consisting of analgesics, muscle

relaxants, and anti-inflammatory agents. Plaintiff made no mention of adverse side

effects caused by the prescribed medications or changes in her medication regimen

(doc. 7-18). In December 2006, Dr. Fowler commented that plaintiff ambulated

“moderately well,” with only a slight limp and no need for an assistive device. Dr.

Fowler opined in April 2007 that plaintiff was not restricted from bending or

performing fine/gross manipulations.

In assessing plaintiff’s residual functional capacity, Dr. Fowler concluded that

plaintiff has several functional impairments: (1) the ability to tolerate walking between

one and two hours in an eight-hour workday; (2) the ability to tolerate standing less

than one hour in an eight-hour workday; and (3) the ability to tolerate sitting between

one and two hours in an eight-hour workday (doc. 7-18). Having carefully considered

the entire record, the ALJ, conversely, determined that plaintiff has the residual

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functional capacity to perform the full range of light work as defined in 20 C.F.R. §

416.967(b). The ALJ found, inter alia, that plaintiff can sit and walk at least two

hours at a time and up to six hours total during an eight-hour workday. 

Pursuant to 20 C.F.R. § 404.1520(a)-(g), the ALJ analyzed the instant disability

claim in five steps:

1. If the claimant is performing substantial gainful activity, she is not disabled.

2. If the claimant is not performing substantial gainful activity, her impairments

must be severe before she can be found disabled.

3. If the claimant is not performing substantial gainful activity and she has

severe impairments that have lasted or are expected to last for a continuous period of

at least twelve months, and if her impairments meet or medically equal the criteria of

any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1, the claimant is

presumed disabled without further inquiry.

4. If the claimant’s impairments do not prevent her from doing her past relevant

work, she is not disabled.

5. Even if the claimant’s impairments prevent her from performing her past

relevant work, if other work existsin significant numbersin the national economy that

accommodates her residual functional capacity and vocational factors, she is not

disabled. 

“The role of the federal court in reviewing a benefits determination is a narrow

one.” Baker on Behalf of Baker v. Sullivan, 880 F.2d 319, 321 (11th Cir. 1989). The

undersigned “may not decide the facts anew, reweigh evidence, or substitute [his]

judgment for that of the Secretary.” Id. Rather, the undersigned reviews “the

Secretary’s findings to determine whether they are supported by substantial evidence

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in the record as a whole.” McRoberts v. Bowen, 841 F.2d 1077, 1080 (11th Cir.

1988). “The findings of the Commissioner of Social Security as to any fact, if

supported by substantial evidence, shall be conclusive . . . .” 42 U.S.C. § 405(g).

Based on the evidence presented, the undersigned concludes that the decision

of the Commissioner issupported by substantial evidence and that the ALJ did not err

in discounting the disability opinions of plaintiff’s treating physician, Dr. Fowler. 

With regard to the testimony of a treating physician, our controlling law provides, “In

evaluating . . . medical evidence, the ‘[Secretary] must accord ‘substantial’ or

‘considerable’ weight to the opinion of a claimant’s treating physician unless ‘good

cause’ is shown to the contrary.’” Schnorr v. Bowen, 816 F.2d 578, 582 (11th Cir.

1987) (quoting Broughton v. Heckler, 776 F.2d 960, 961-62 (11th Cir. 1985));see also

MacGregor v. Bowen, 786 F.2d 1050, 1053 (11th Cir. 1986) (“The Secretary must

specify what weight is given to a treating physician’s opinion and any reason for

giving it no weight, and failure to do so is reversible error.”). The ALJ followed this

directive.

“[T]he opinion of a treating physician may be rejected when it is so brief and

conclusory that it lacks persuasive weight or where it is unsubstantiated by . . . clinical

or laboratory findings.” Bloodsworth v. Heckler, 703 F.2d 1233, 1240 (11th Cir.

1983). “Further, the Secretary may reject the opinion of any physician when the

evidence supports a contrary conclusion.” Id. A treating physician’s opinion may also

be discounted if inconsistent with her own evaluations and reports, see Jones v. Dep’t

of Health and Human Servs., 941 F.2d 1529, 1533 (11th Cir. 1991), or if derived from

the self-reporting of a claimant with poor credibility. See 20 C.F.R. § 404.1527(d)(6)

(mandating the consideration of other factors before deciding how much weight to

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accord a medical opinion); Long v. Shalala, 902 F. Supp. 1544, 1547 (M.D. Fla. 1995)

(“Because the Administrative Law Judge determined that the Petitioner was not

credible, he deduced that the opinions of her treating physicians were not credible.”).

Here, Dr. Fowler’s disability opinion was not substantiated by clinical or

laboratory findings. See Bloodsworth, 703 F.2d at 1240. As the ALJ observed, the

evidence contains no record of any hospitalizations for physical health conditions

since the date of plaintiff’s application. Additionally, the record suggests that

plaintiff’s impairments have been alleviated and controlled by the regular use of

prescription and over-the-counter medications. See Dawkins v. Bowen, 848 F.2d 1211,

1213 (11th Cir. 1988) (“A medical condition that can reasonably be remedied either

by surgery, treatment, or medication is not disabling.” (quoting Lovelace v. Bowen,

813 F.2d 55, 59 (5th Cir.1987) (footnote omitted))). Significantly, plaintiff’s most

recent office visits with Dr. Fowler reveal that her back pain and hypertension are

“stable” and did not otherwise disclose any change in physical condition (doc. 7-19). 

In total, the record discloses just three office visits with Dr. Fowler over a span of two

years (2007-2008), no radiological or diagnostic testing, and no inpatient or

emergency department hospital visits.

The remaining evidence, moreover, supports a conclusion contrary to the one

offered by Dr. Fowler. See Bloodsworth, 703 F.2d at 1240. Dr. Lucey examined

plaintiff in April 2007 and reported that plaintiff’s neck had full range of motion, that

plaintiff’s upper extremities revealed normalstrength and range of motion in all major

joints, and that plaintiff had full range of motion in the knees and all other joints in the

lower extremities. Dr. Lucey noted that plaintiff’s posture was erect and that she 

walked with a normal gait, demonstrating the ability to heel and toe and tandem walk, 

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without evidence of weakness or loss of coordination. The absence of recent medical

treatment also tends to support the residual functional capacity as established by the

ALJ. Perhaps most importantly, the functional limitations as set forth by Dr. Fowler

support plaintiff’s residual functional capacity. Though Dr. Fowlerstated that plaintiff

was not able to squat or climb stairs or ladders, the jobs identified by the vocational

expert do not require such activity. 

Finally, plaintiff’s credibility, orlack thereof, drawsinto question the reliability

of Dr. Fowler’s reports and assessments. See Long, 902 F. Supp. at 1547. The

helpfulness of plaintiff’s medical complaints, asthe ALJ noted, is compromised by her

lack of recent medical treatment, her record of low earnings prior to her injury, and her

lack of effort to rejoin the workforce. Having settled her worker’s compensation claim

in June 2005, albeit without future medical benefits, plaintiff did not visit with Dr.

Fowler for more than one year (doc. 7-3). Plaintiff thereafter presented for checkups

or medication refills on only two occasions in 2007, and just a single time in 2008

(doc. 7-19). The treatment plaintiff sought and received, moreover, was relatively

conservative in nature, consisting primarily of analgesics and muscle relaxants (doc.

7-18). An objective reviewer might easily conclude, asthe ALJ did, that the frequency

and intensity of medical intervention was not consistent with that required by an

individual suffering from total disability. See Wolfe v. Chater, 86 F.3d 1072, 1078

(11th Cir. 1996) (holding that allegations of disabling pain may be discounted in light

of conservative medical treatment).

Inconsistencies in plaintiff’s initial allegations and those made following the

initial denial of this claim further diminish her credibility. Most notably, plaintiff

initially complained of no side effects from the numerous medications prescribed for

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her impairments, save for headaches brought on by Nexium (doc. 7-4). Nor did

plaintiff raise the issue of side effects when she was examined by Dr. Lucey (doc. 7-

18). At a hearing in December 2008, however, plaintiff testified that the prescription

medications caused her to sleep two or three hours twice per day. Plaintiff also

alleged in a report completed following the initial denial of her claim that the same 13

medications previously reported as causing no side effects now caused headaches,

stomachaches, and nausea, in addition to fatigue (doc. 7-4). 

In consideration of the foregoing, the undersigned findssubstantial support for 

the conclusion of the ALJ that the allegations made by plaintiff relative to

symptomology, functional limitations, and restrictions on activities of daily living are

not credible and lack corroboration or substantiation in the medical evidence

presented. See Marbury v. Sullivan, 957 F.2d 837, 839 (11th Cir. 1992) (“After

considering a claimant’s complaints of pain, the ALJ may reject themas not creditable,

and that determination will be reviewed for substantial evidence.”). “The ALJ must

clearly articulate the reasons for giving less weight to the opinion of a treating

physician, and the failure to do so is reversible error.” Lewis v. Callahan, 125 F.3d

1436, 1440 (11th Cir. 1997). Here, the ALJ did so articulate the reasons for

discrediting the opinion of plaintiff’s treating physician, and those reasons are

supported by substantial record evidence. See Bloodsworth, 703 F.2d at 1239. 

Accordingly, it is respectfully RECOMMENDED:

The application for supplemental security income benefits be DENIED. 

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At Pensacola, Florida, this 9th day of May, 2011.

/s/Charles J. Kahn, Jr.

CHARLES J. KAHN, JR.

UNITEDSTATES MAGISTRATEJUDGE

Case No: 3:10cv151/WS/CJK

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