Kordonowy v. Apfel, 2000 DSD 8

JEANETTE KORDONOWY,
Plaintiff,
v.
KENNETH S. APFEL,
Commissioner of Social Security,
Defendant.
[2000 DSD 8]

United States District Court
District of South Dakota—Western Division
CIV. 99-5035

MEMORANDUM OPINION AND ORDER

Nancy Manning, Rapid City, SD
Attorney for Plaintiff

Diana Ryan, U. S. Attorney’s Office, Rapid City, SD
Attorney for Defendant

Dated Feb 4, 2000

[¶1] In an opinion dated December 18, 1997, John L. Lawritson, an Administrative Law Judge ("ALJ"), denied Jeanette L. Kordonowy ("Kordonowy") benefits under Title II of the Social Security Act ("the Act") and supplemental security income under Title XVI of the Act, 42 USC §§ 401-433; 1381-1383c. Kordonowy’s request for Appeals Council review was denied. On June 2, 1999, Kordonowy filed a complaint with this Court. Pursuant to this Court’s briefing schedule, Kordonowy has filed a motion for summary judgment urging that the ALJ’s decision be reversed and that benefits be awarded. The Commissioner of Social Security ("Commissioner") has filed a cross-motion for summary judgment requesting that the decision of the ALJ be affirmed. This Court has jurisdiction to proceed pursuant to 42 USC §405(g).

[¶2] Kordonowy was born on October 19, 1956, and is currently 43 years of age. AR 89. She has a high school education and has worked in the past as an electronics assembler, touch-up screener, reflow operator, restaurant worker, and cashier. AR 110, 120.

[¶3] Kordonowy suffers from back and ankle pain, carpal tunnel syndrome, hypertension, obesity, and depression. AR 162, 165, 185, 263, 299-300. Her alleged onset date is November 20, 1994. AR 40. At the administrative hearing, Kordonowy testified that she fractured her right ankle in 1988, requiring the temporary insertion of a steel plate and screws. AR 55-56. Though the plate and screws were removed successfully, her ankle still swells and causes her discomfort. AR 55, 58. Kordonowy also testified to suffering severe back pain as a result of a fall in 1994. AR 165. An MRI taken after the fall revealed a mild to moderate central disc bulge. AR 162. She has stated that she still suffers back pain "all the time," and that the pain is made worse by movement, sitting wrong ways, or bending. AR 57-58. For pain relief she takes nonprescription medication such as Tylenol, and lies down frequently. AR 59. She also uses moist heat with a heating pad. AR 59.

[¶4] Kordonowy further testified to suffering significant pain and numbness in both wrists due to her carpal tunnel syndrome. AR 60. She has problems typing and writing and says she is unable to safely grasp any items heavier than a piece of paper or pencil. AR 61.

[¶5] She also claims to suffer from a host of other physical problems, including headaches, dizziness, shortness of breath, an inability to sleep, hypertension, obesity, and incontinence. AR 63, 66-67. She stated that she can sit for no more than twenty minutes and stand for no more than five to ten minutes without pain. AR 63. She also stated that she can walk no more than 250 feet at a time without a rest, and can only ride in a car for up to five minutes without needing to change positions. AR 63-64. She can lift no more than twelve pounds, cannot push or pull, or reach over her head. AR 65.

[¶6] As for her mental health, Kordonowy testified to suffering from depression resulting in an inability to concentrate or remember important details. AR 68.

[¶7] In assessing the sequential process{fn1} which is required when determining if an individual is disabled pursuant to the Social Security Act, the ALJ first concluded that Kordonowy had not performed any substantial gainful activity ("SGA") since November 20, 1994. AR 18. Next, the ALJ found that Kordonowy’s back, wrist, and ankle impairments, obesity, and depression were severe impairments while her complaints of headaches, dizziness, sensitivity to light, shortness of breath, and incontinence were not severe impairments under the Act. AR 18. In addition, the ALJ found that Kordonowy’s hypertension, though clearly present, also was not a severe impairment as it could be controlled by medication. AR 18-19. At the next step, the ALJ concluded that Kordonowy’s severe impairments (independently or in combination) did not meet or equal any of the impairments listed in Appendix 1 to Subpart P of Part 404, 20 CFR §§ 404.1501 et seq. ("Listed Impairments"). AR 18-19.

[¶8] Upon deciding that Kordonowy could no longer perform her past relevant work, the ALJ set forth to determine Kordonowy’s residual functional capacity ("RFC"). AR 24. Here, the ALJ found that Kordonowy’s statements concerning her impairments and their impact on her ability to work were not entirely credible in light of the discrepancies between her assertions and the medical evidence. AR 26. Accordingly, the ALJ determined that Kordonowy retained the RFC to perform the exertional demands of light work, though he acknowledged that this capacity was diminished by "significant non- exertional limitations which make it impossible for her to engage in more than occasional handling and fingering, climbing, balancing, stooping, crouching and crawling, and work in concentrated exposure to cold or vibrations." AR 24.

[¶9] In view of the above mentioned non-exertional impairments, the ALJ called upon the testimony of a vocational expert before finally determining that Kordonowy could, nonetheless, perform a significant number of jobs in the national economy and therefore could not be considered disabled under the Act.{fn2} AR 25.

[¶10] The decision of the ALJ must be upheld if it is supported by substantial evidence in the record as a whole. See 42 USC § 405(g); Metz v. Shalala, 49 F3d 374, 376 (8th Cir. 1995) (citing Sullins v. Shalala, 25 F3d 601, 603 (8th Cir. 1994), cert. denied, 573 US 1076, 115 SCt 722, 130 LEd2d 627 (1995)); Smith v. Shalala, 987 F2d 1371, 1373 (8th Cir. 1993). Substantial evidence is less than a preponderance, but enough evidence that a reasonable mind might find it adequate to support the conclusion. See Fines v. Apfel, 149 F3d 893 (8th Cir. 1998) (citing Oberst v. Shalala, 2 F3d 249, 250 (8th Cir. 1993)); see also Shannon v. Chater, 54 F3d 484, 486 (8th Cir. 1995) (citing Richardson v. Perales, 402 US 389, 401, 91 S.Ct. 1420, 1427, 28 L.Ed.2d 842 (1971)); Onstead v. Sullivan, 962 F2d 803 (8th Cir. 1992) (quoting Whitehouse v. Sullivan, 949 F2d 1005, 1007 (8th Cir. 1991)).

[¶11] This Court’s review extends beyond a limited search for the existence of evidence supporting the Commissioner’s decision to include giving consideration to evidence in the record which fairly detracts from the decision. See Brockman v. Sullivan, 987 F2d 1344, 1346 (8th Cir. 1993); Locher v. Sullivan, 968 F2d 725, 727 (8th Cir. 1992); Turley v. Sullivan, 939 F2d 524, 528 (8th Cir. 1991). However, this Court may not reweigh the evidence or try the issues de novo. See Murphy v. Sullivan, 953 F2d 383, 384 (8th Cir. 1992). Furthermore, the Court may not reverse the Commissioner’s decision "merely because substantial evidence would have supported an opposite decision." Woolf v. Shalala, 3 F3d 1210, 1213 (8th Cir. 1993); Smith v. Shalala, 987 F2d at 1374 (citing Locher, 986 F2d at 727 (quoting Baker v. Heckler, 730 F2d 1147, 1150 (8th Cir. 1984))). As long as the ALJ’s decision is supported by substantial evidence, this Court cannot reverse the decision of the ALJ even if the Court would have decided it differently. See Smith v. Shalala, 987 F2d at 1374.

[¶12] The Court must also review the Commissioner’s decision to determine if an error of law has been committed. See Smith v. Sullivan, 982 F2d 308, 311 (8th Cir. 1992); Nettles v. Schweiker, 714 F2d 833, 836 (8th Cir. 1983). The Commissioner’s conclusions of law are only persuasive, not binding, on the reviewing court. Smith v. Sullivan, 982 F2d at 311; Satterfield v. Mathews, 483 FSupp 20, 22 (E.D. Ark. 1979), aff’d per curiam, 615 F2d 1288, 1289 (8th Cir. 1980).

[¶13] For Kordonowy to be eligible for an award of benefits, she must be under a disability. See 42 USC §423(d)(1)(A)-(D). A disability is defined as an:

[i]nability 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.

Id. at § 423(d)(1). In this case, the ALJ concluded that Kordonowy was not disabled because she maintained the ability to engage in light work. Kordonowy contends that the decision of the ALJ is erroneous for the following reasons: (1) the ALJ erred in finding that her complaints of headaches, dizziness, sensitivity to light, shortness of breath, incontinence, and hypertension were not severe impairments under the Act; (2) failed to make a determination as to medical equivalence with regard to her bilateral carpal tunnel and obesity; (3) failed to consider her reflex sympathetic dystrophy; (4) failed to develop the record with regard to her depression; (5) failed to consider her symptoms at step three of the sequential evaluation; (6) failed to properly assess her credibility; (7) failed to give controlling weight to the opinion of the treating physician; (8) failed to make the RFC findings consistent with 20 CFR § 404.1545; and (9) failed to give the vocational expert an accurate hypothetical. These contentions shall be addressed seriatim.

[¶14] Step Two of the Sequential Evaluation

[¶15] Kordonowy disputes the ALJ’s finding that her headaches, dizziness, sensitivity to light, shortness of breath, incontinence, and hypertension are not severe impairments. An impairment is deemed severe when it can be said to significantly limit one’s physical ability to do basic work activities. See 20 CFR § 404.1520(c).

[¶16] Though this Court has reviewed the available medical evidence in great detail, it has found little evidence, beyond Kordonowy’s own testimony, to support the above mentioned complaints. In August 1995, Kordonowy visited Rapid City Community Health ("RCCH") and was seen by Dr. Kurt A. Stone. Though her chief complaint was back pain, Kordonowy also complained of suffering from obesity, hair loss, and a change in skin — she did not present any complaints of headaches, dizziness, sensitivity to light, shortness of breath, or incontinence. AR 178. Kordonowy does appear to have suffered headaches as a result of her hypertension medication; however, the medication was quickly changed to eliminate the problem. In addition, Kordonowy complained of suffering from sinus headaches in conjunction with a soar throat during an April 3, 1996 visit to RCCH. AR 210. She also complained of shortness of breath and was given a nebulizer treatment. Test results conducted on this same visit, however, showed "[g]ood lung function, both before and after neb treatment." AR 211. Beyond these few instances, this Court has found little else to support Kordonowy’s complaints of headaches, dizziness, sensitivity to light, shortness of breath, or incontinence.

[¶17] The ALJ’s determination that Kordonowy’s hypertension can be controlled with medication is also well supported by substantial evidence on the record as a whole. AR 170. Because a review of the record supports the finding that these ailments, whether considered separately or in combination, do not significantly limit Kordonowy’s ability to work, they cannot be considered "severe" under the Act.{fn3}

[¶18] Carpal Tunnel and Obesity Impairments

[¶19] Kordonowy suffers from carpal tunnel syndrome and has undergone bilateral carpal tunnel release surgeries. Because carpal tunnel syndrome is not a listed impairment, the ALJ considered the listed impairment which he concluded most closely reflected her status post bilateral carpal tunnel release. See 20 CFR § 404.1564(a). Kordonowy argues that the ALJ should have evaluated her carpal tunnel syndrome under the listing for neurological impairments in Listing 11.00, rather than under the listing for soft tissue injuries of an upper extremity found in Listing 1.13. Because Kordonowy’s impairment is not medically equivalent to either of these listings, the decision of the ALJ shall be affirmed. Listing 1.13 provides:

Soft tissue injuries of an upper or lower extremity requiring a series of staged surgical procedures within 12 months after onset for salvage and/or restoration of major function of the extremity, and such major function was not restored or expected to be restored within 12 months after onset.

20 CFR Part 404, Subpt. P., App. 1 § 1.13. Listing 1.13 is directed at the loss of the use of one extremity, not in itself disabling under the regulations, where restoration of function will require repeated staged surgical procedures over a lengthy period, thus making an individual who would otherwise be capable of substantial gainful employment unavailable for work because of these repeated surgical procedures. The ALJ found that Kordonowy’s bilateral carpal tunnel release surgery was not the "repeated staged surgical procedures" contemplated by Listing 1.13. This finding is supported by substantial evidence in the record as a whole.

[¶20] The record reveals that Kordonowy began suffering from carpal tunnel syndrome in 1982. AR 43, 349. Shortly after being diagnosed, Kordonowy underwent carpal tunnel release surgery on both wrists. AR 309, 314. Medical progress notes do not reveal any complications with either procedure, nor is there any evidence that she was required to undergo further carpal tunnel release surgeries. AR 309-341. In addition, the record indicates that Kordonowy was able to return to work following these surgeries. AR 349.

[¶21] Kordonowy argues that, while the ALJ incorrectly evaluated her carpal tunnel syndrome under Listing 1.13, there is sufficient evidence in the record to satisfy the criteria for neurological disorders. See 20 CFR Part 404, Subpt. P., App. 1 §§ 11.00(C), 11.04(B), 11.14. This Court disagrees.

[¶22] Disability under Listing 11.14 requires a finding of peripheral neuropathy{fn4} "[w]ith disorganization of motor function as described in 11.04(B), in spite of prescribed treatment." 20 CFR Part. 404, Subpt. P., App. 1 §11.14. Paragraph 11.04(B) describes significant and persistent disorganization as that which "result[s] in sustained disturbance of gross and dexterous movements." Id. The regulations also indicate that the assessment of the impairment depends upon "the degree of interference with locomotion and/or interference with the use of fingers, hands, and arms." 20 CFR Part 404, Subpt. P., App. 1 § 11.00(C).

[¶23] Though Kordonowy testified to ever increasing problems with her ability to grip and feel as a result of her bilateral carpal tunnel syndrome, her subjective complaints are simply unsupported by the medical evidence. "For a claimant to qualify for benefits by showing that [her] unlisted impairment, or combination of impairments, is ‘equivalent’ to a listed impairment, [s]he must present medical findings equal in severity to all the criteria for the one most similar listed impairment." Marciniak v. Shalala, 49 F3d 1350, 1353 (8th Cir. 1995) (quoting Sullivan v. Zebley, 493 US 521, 531, 110 SCt 885, 891, 107 LEd2d 967 (1990)); see also 20 CFR § 404.1526 ("Medical equivalence must be based on medical findings"). Here, the medical evidence reveals that Kordonowy underwent carpal tunnel release surgery in 1983 and 1984. No complications were reported, and she returned to work promptly. In addition, following her application for social security benefits, Kordonowy was referred to Dr. Steven K. Hata for a neurological evaluation. AR 349. Dr. Hata’s evaluation reveals that Kordonowy’s hand grip remains "fair" though somewhat diminished. AR 351. Her finger abduction is of normal strength and her finger extension is also normal. AR 351. These medical findings are simply insufficient to establish Kordonowy’s medical equivalence to the Listings for neurological impairments found in Listing 11.00(C).

[¶24] Finally, Kordonowy argues that the ALJ failed to correctly evaluate her obesity. At the administrative hearing, Kordonowy testified that she is 63½ inches tall and weighs 220 pounds. Upon considering her height and weight, the ALJ found that she did not meet or equal the listing for obesity found in the regulations. This finding is supported by substantial evidence on the record as a whole.

[¶25] Kordonowy would be presumed disabled due to obesity if she established the following:

9.09 Obesity: Weight equal to or greater than the values specified in Table ... II for females (100 percent above desired level), and ... [h]istory of pain and limitation of motion in any weight-bearing joint or the lumbosacral spine (on physical examination) associated with findings on medically acceptable imaging techniques of arthritis in the affected joint or lumbosacral spine ... .

20 CFR Part 404, Subpt. P., App. 1 §§ 9.09, 9.09(A). For Kordonowy to meet this listing she is required to weigh a minimum of 254 pounds and suffer a history of pain and limitation in any weight-bearing joint. See 20 CFR Part 404, Subpt. P., App. 1 §§ 9.09, Table II - Women. While the record reflects that Kordonowy has suffered some pain and limitation in her right ankle, it does not establish that she weighs 254 pounds. Accordingly, Kordonowy’s contention that the ALJ erred in finding that she did not establish obesity under the Listings is without merit.

[¶26] Reflex Sympathetic Dystrophy

[¶27] Kordonowy argues that the ALJ failed to fully discuss the ramifications of the reflex sympathetic dystrophy ("RSD"){fn5} which she suffers secondarily to her ankle fracture. AR 176, 178. While the ALJ’s opinion does not specifically mention her RSD, this fact does not warrant reversal. The ALJ does not have to discuss every piece of evidence presented in denying disability benefits, rather he need only develop the record fully and fairly. See Weber v. Apfel, 164 F3d 431, 432 (8th Cir. 1999) (citing Miller v. Shalala, 8 F3d 611, 613 (8th Cir. 1993) (per curiam)). In this case, the ALJ acknowledged Kordonowy’s past ankle fracture and subsequent ankle surgeries as well as her complaints of ankle pain and swelling, but concluded that the impairment did not meet or equal a Listed impairment under the regulations. This finding is supported by substantial evidence in the record as a whole.

[¶28] The medical record reveals that Kordonowy fractured her ankle sometime in 1988. AR 188. The ankle was fixated with surgery that same year, and was reported to be stable and doing well post surgery. AR 158, 263. The hardware was successfully removed by 1990. AR 188. During a 1995 doctors visit, Dr. Kurt A. Stone observed that Kordonowy suffered from some decreased sensation over the dorsum of her foot, but her strength was symmetrical. AR 176. In a 1997 medical evaluation, Dr. Brett D. Lawlor reported that she had normal pain-free range of motion in her ankles and feet. AR 346. While this evidence shows that Kordonowy is afflicted with a painful ankle and foot, the fact that she cannot work without some pain or discomfort will not render her disabled. See Cruse v. Bowen, 867 F2d 1183, 1185 (8th Cir. 1989). Accordingly, the finding of the ALJ is supported by substantial evidence.

[¶29] Symptoms of Depression

[¶30] While the ALJ found that Kordonowy’s depression was a severe impairment under the Act, he concluded that it did not meet or equal the Listing for depression found at 12.04(A). Kordonowy argues that this finding was in error.

[¶31] At the administrative hearing, Kordonowy testified that she often feels depressed and has problems with her memory and ability to concentrate. AR 68. In 1996, Dr. John J. Lassegard diagnosed Kordonowy with depression. AR 206-08. Though Amitriptyline{fn6} was prescribed to help control her bouts with depression, she discontinued use of the medication after only a short while. AR 344, 347. In regard to her refusal to take her Amitriptyline prescription, Dr. Brett D. Lawlor made the following notation in her medical records:

She did get her prescription filled for amitriptyline and this helped her sleep quite well. Unfortunately, she said that she has no money to get a refill on the prescription. The prescription costs $7 but she said this would not be possible. I did recommend that she discontinue smoking. She smokes a pack and a half a day and two days of not smoking would save her enough money to purchase her medication.

AR 344. In order to receive benefits, a claimant must follow the treatment prescribed by her physician if this treatment can restore her ability to work. See 20 CFR § 404.1530 (1998); see also Whitehurse v. Apfel, 158 F3d 987, 988 (8th Cir. 1998); Thomas v. Sullivan, 928 F2d 255, 259-60 (8th Cir. 1991). Such a failure to follow prescribed treatment may only be excused for good reason. See 20 CFR § 404.1530 (enumerating acceptable reasons for refusing to follow prescribed treatment). In this case, the ALJ found that Kordonowy’s refusal to take her Amitriptyline was based solely on her desire to spend her limited resources on cigarettes rather than on her medication for depression. In addition, it is noteworthy that in a recent evaluation conducted by Dr. Lassegard, Kordonowy denied suffering any symptoms of depression at that time. AR 364. In view of this contradiction and because such noncompliance with prescribed treatment is a legitimate basis for a denial of benefits, substantial evidence supports the ALJ’s finding.

[¶32] Step Three of the Sequential Evaluation

[¶33] Kordonowy argues that the ALJ failed to address "[a]ny of the claimant’s symptoms when evaluating whether an impairment met a Listing." Plaintiff’s Memorandum and Points of Authorities at 8. This broad contention is belied by the written decision of the ALJ in which he thoroughly chronicles each of Kordonowy’s numerous symptoms as well as their possible application to the Listing of Impairments found in 20 CFR Part 404, Subpt. P., App. 1. AR 18-27.

[¶34] The Credibility Assessment

[¶35] In assessing Kordonowy’s credibility, the ALJ found her statements concerning the impact of her impairments on her ability to work to be lacking in credibility. For reversal, Kordonowy argues that the ALJ failed to properly evaluate the credibility of her testimony. In analyzing Kordonowy’s subjective complaints, an ALJ must examine: (1) the claimant’s daily activities; (2) the duration, frequency, and intensity of the pain; (3) dosage, effectiveness, and side effects of medication; (4) precipitating and aggravating factors; and (5) functional restrictions. See Polaski v. Heckler, 739 F2d 1320 (8th Cir. 1984). Although an ALJ may not discount a claimant’s subjective complaints based solely on grounds that no objective medical evidence supports its existence, he may discount such complaints if there are inconsistencies on the record as a whole. See Hutton v. Apfel, 175 F3d 651, 654 (8th Cir. 1999); Brockman v. Sullivan, 987 F2d 1344, 1346 (8th Cir. 1993).

[¶36] In this case, the ALJ’s opinion demonstrates that he duly considered each of Kordonowy’s subjective complaints of disabling symptoms under the Polaski standard, but found that they were not entirely credible in light of the discrepancies between her assertions and the information contained in the documentary reports, the reports of treating and examining physicians, and the findings regarding her lack of cooperation in adhering to prescribed treatment. Though it is noteworthy that the ALJ did, at least in part, credit her testimony in finding that her ability to participate in a full range of light work was diminished by significant non-exertional limitations which made it impossible for her to engage in more than occasional handling and fingering, climbing, balancing, stooping, crouching and crawling, and work in concentrated exposure to cold or vibrations. In arriving at these findings, the ALJ observed that Kordonowy participated in such daily activities as washing dishes, vacuuming, and personal grooming — though with some difficulty. He further noted that Kordonowy testified to only taking Tylenol for pain relief, despite ranking her pain at 10 out of 10 on the pain scale. AR 345. As for functional limitations, the ALJ examined Kordonowy’s statements that she is fatigued and could stand for no more than five to ten minutes, walk no more than 250 feet at a time, and lift no more than ten to twelve pounds with frequent breaks. Upon examination, this Court concludes that the ALJ’s credibility findings are supported by substantial evidence on the record as a whole.

[¶37] As the Court has already observed, the ALJ properly discounted Kordonowy’s complaints of disabling carpal tunnel symptoms and post fracture ankle problems. While she testified at the administrative hearing of an inability to grasp small objects for even short periods of time, and to a complete lack of feeling in her fingertips, these assertions are inconsistent with the documentary medical evidence as well as the reports of treating and examining physicians. See Carpal Tunnel and Obesity Discussion, supra. Kordonowy also testified that her ankle becomes swollen and painful by the end of the day. While the ALJ acknowledged this problem to be a severe impairment, he discounted her statements regarding the extreme impact of this impairment on her ability to work. This determination is also supported by substantial evidence in the record as a whole. See Reflex Sympathetic Dystrophy Discussion, supra.

[¶38] Finally, the ALJ discounted Kordonowy’s complaints of disabling back pain. The record reveals that Kordonowy injured her back in 1994. An MRI conducted shortly after the fall showed a mild to moderate disk bulge at the L-5, S-1, without any impingement on the nerve root. AR 165. After conservative treatment failed to relieve Kordonowy’s back problems, she underwent a successful microdiscectomy. AR 185-189. Within four months of the surgery, however, Kordonowy reported pain equal to or greater than the pain she suffered prior to surgery. In response to these complaints of extreme pain, doctors conducted a third MRI which revealed only mild degenerative disc space narrowing, minimal osteophyte spur formation, and no evidence of root impingement. AR 198, 342. In view of this evidence as well as the evidence discussed above, the ALJ found that Kordonowy’s complaints of disabling back pain were not entirely credible:

The undersigned finds that the claimant’s testimony is not entirely credible given that she has not sought treatment for many of her complaints, has minimal findings on examination, has been restricted to light exertion work by Dr. Lawlor and requires only the use of over-the-counter medications for her pain.

AR 23. Because this finding, as well as the other findings discussed above are supported by substantial evidence on the record as a whole, the decision of the ALJ was not in error.

[¶39] Controlling Weight of Treating Physician

[¶40] Kordonowy argues that the ALJ failed to give controlling weight to the opinion of her treating physician, Dr. Teuber. Dr. Teuber opined that Kordonowy was unable to work "due to low back and left leg discomfort." AR 360. In rejecting Dr. Teuber’s opinion, the ALJ pointed to the more recent opinion of Dr. Lawlor, which restricted Kordonowy’s activities in the following manner: (1) lifting no more than twenty pounds on occasion and ten pounds frequently; (2) standing no more than one hour at a time and six hours out of an eight hour day; (3) sitting no more than fifty minutes at a time and six hours out of an eight hour day; (4) occasional climbing, balancing, stooping, crouching, kneeling and crawling; (5) pushing and pulling no more than forty pounds; and (6) no work with moving machinery and vibrations. AR 22.

[¶41] This Court is required to give a treating physician’s opinion great weight, but "such an opinion is not conclusive in determining disability status ... ." Pena v. Chater, 76 F3d 906, 908 (8th Cir. 1996). In this case, the ALJ found that Dr. Teuber’s opinions were not dispositive because he failed to make concurrent medical findings in support of his opinion and failed to offer specific restrictions regarding Kordonowy’s activities. Because this is a legitimate ground for discounting the opinion of a treating physician, the decision of the ALJ was not in error. See Pena, 76 F3d at 908 (opinion of treating physician must be supported by medically acceptable clinical or diagnostic data); see also Rogers v. Chater, 118 F3d 600, 602 (8th Cir. 1997) (opinion of treating physician may be discounted if other assessments are supported by better or more thorough medical evidence) (citing Ward v. Heckler, 786 F2d 844, 846 (8th Cir. 1986)).

[¶42] The RFC Findings

[¶43] Kordonowy argues that the ALJ failed to consider her non-severe symptoms of shortness of breath, pain, dizziness, fatigue and swelling in her ankles in making a determination as to her residual functional capacity. This argument is without merit.

[¶44] Prior to engaging in an RFC analysis, the ALJ acknowledged his burden to "consider limitations and restrictions imposed by all of the claimant’s impairments, even those that are not ‘severe.’" AR 24 (emphasis added). Upon compliance with this requirement, the ALJ went on to conclude that Kordonowy’s "[n]on-severe impairments do not contribute any additional limitations and restrictions over and above those imposed by the claimant’s severe impairments." Id. Nevertheless, the ALJ still found that Kordonowy’s ability to engage in a full range of light work "[i]s diminished by significant non-exertional limitations which make it impossible for her to engage in more than occasional handling and fingering, climbing, balancing, stooping, crouching and crawling, and work in concentrated exposure to cold or vibrations." AR 24. In view of the ALJ’s written decision and final conclusions, this Court is satisfied that he effectively considered all of Kordonowy’s limitations and restrictions in arriving at a decision regarding her RFC.

[¶45] The Vocational Expert

[¶46] Because the ALJ found that Kordonowy could not perform her past relevant work, the burden shifted to the Commissioner to prove that a significant number of jobs existed in the regional economy that Kordonowy was capable of performing. To meet this burden, the ALJ called as a witness a vocational expert, asking the expert to consider a hypothetical individual of Kordonowy’s age, education, and past work experience "[w]ho could perform exertionally at a light level ... [but] could only occasionally climb, balance, stoop, kneel, crouch, and crawl, could also only occasionally handle and finger, and would need work that is not done in concentrated cold and does not involve vibration." AR 76-77. The vocational expert responded that such an individual could perform the work of a parking lot signaler, parking lot attendant, call out operator, and surveillance system monitor.{fn7}

[¶47] Kordonowy argues that the ALJ’s erred in failing to precisely set forth all of her impairments in the hypothetical he posited to the vocational expert. Specifically, she contends that the ALJ should have included her complaints of depression as well as the her specific diagnoses of RSD in her ankle. A hypothetical question is proper when it presents the vocational expert with a set of limitations that are accepted by the ALJ. See Davis v. Shalala, 31 F3d 753, 755 (8th Cir. 1994) (quoting Roberts v. Heckler, 783 F2d 110, 112 (8th Cir. 1985)); see also Hutton v. Apfel, 175 F3d 651, 656 (8th Cir. 1999). While the hypothetical need not be absolutely precise, it must adequately described the claimant’s limitations. See Harwood v. Apfel, 186 F3d 1039, 1044 (8th Cir. 1999). In this case, the hypothetical question presented to the vocational expert reflected only those limitations supported by the record as a whole and accepted by the ALJ. In discounting Kordonowy’s depression, the ALJ observed that she had refused to follow her prescribed program of treatment. See discussion, supra. In regard to Kordonowy’s diagnosis of RSD, the ALJ acknowledged her complaints of incapacitating ankle and foot pain, but concluded that the problem was not disabling. After examining the hypothetical posed to the vocational expert on this matter, this Court finds that the question adequately reflected any symptoms induced by her ankle impairments. Therefore, because the ALJ discounted Kordonowy’s allegations of disabling depression and RSD, he did not have a duty to posit these symptoms in his hypothetical. Accordingly, the ALJ did not commit reversible error on this issue.

[¶48] Based upon the foregoing discussion, it this Court concludes that the ALJ’s decision denying benefits is supported by substantial evidence in the record as a whole. Therefore, it is hereby

[¶49] ORDERED that plaintiff’s motion for summary judgment (Docket #18) is denied.

[¶50] IT IS FURTHER ORDERED that defendant’s motion for summary judgment (Docket #21) is granted. The decision of the Commissioner is affirmed.

Footnotes