Johns v. Social Security Administration, No. 3:2019cv00354 - Document 13 (E.D. Ark. 2020)
Court Description: MEMORANDUM OPINION AND ORDER: Johns' complaint is dismissed, all requested relief is denied, and judgment will be entered for the Commissioner. Signed by Magistrate Judge Patricia S. Harris on 8/18/2020. (jak)
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Johns v. Social Security Administration Doc. 13 IN THE UNITED STATES DISTRICT COURT EASTERN DISTRICT OF ARKANSAS NORTHERN DIVISION WILLIAM JOHNS PLAINTIFF v. NO. 3:19-cv-00354 PSH ANDREW SAUL, Commissioner of the Social Security Administration DEFENDANT MEMORANDUM OPINION AND ORDER In t his case, plaint iff William Johns (“ Johns” ) maint ains t hat t he findings of an Administ rat ive Law Judge (“ ALJ” ) are not support ed by subst ant ial evidence on t he record as a whole. 1 Johns so maint ains because t he record does not cont ain an opinion from a t reat ing or examining physician comment ing on Johns’ specific work-relat ed limit at ions, leaving t he ALJ t o draw his own inferences about Johns’ work-relat ed limit at ions. The quest ion for t he Court is whet her t he ALJ’ s findings are support ed by “ subst ant ial evidence on t he record as a whole and not based on any legal error.” See Sloan v. Saul, 933 F.3d 946, 949 (8t h Cir. 2019). “ Subst ant ial evidence is less t han a preponderance, but enough t hat a reasonable mind would accept it as adequat e t o support t he [ALJ’ s] conclusion.” See Id. “ Legal error may be an error of procedure, t he use of erroneous legal st andards, or an incorrect applicat ion of t he law.” See Lucus v. Saul, 960 F.3d 1066, 1068 (8t h Cir. June 3, 2020) [quot ing Collins v. Ast rue, 648 F.3d 869, 871 (8t h Cir. 2011) (cit at ions omit t ed)]. 1 Dockets.Justia.com Johns was fort y-t wo years old on August 1, 2015, i.e., t he day he allegedly became disabled. He alleged in his applicat ions for disabilit y insurance benefit s and supplement al securit y income payment s t hat he is disabled as a result of impairment s t hat include heart problems. The record reflect s t hat Johns has a hist ory of heart problems dat ing back t o at least 2008. That year, he suffered a myocardial infarct ion which required t he placement of t wo st ent s. See Transcript at 467-507. 2 On August 11, 2015, Johns present ed t o t he Whit e Count y Medical Cent er complaining of chest pain. See Transcript at 567-582. His social hist ory was compiled, and it reflect s t hat he was smoking a pack of cigaret t es a day and had been doing so for t went y-seven years. The result s of an echocardiogram showed mild concent ric left vent ricular hypert rophy. His est imat ed left vent ricle ej ect ion fract ion was bet ween fift y and sixt y. 3 The result s of a cardiac cat het erizat ion revealed a blocked st ent , and t he Johns represent s t hat he suffered a second myocardial infarct ion in 2011 which required t he placement of t wo st ent s. See Docket Ent ry 11 at CM/ ECF 4. The medical 2 evidence he cit es, t hough, is from his 2008 myocardial infarct ion. See Transcript at 467507. His t est imony was t hat he suffered a “ heart at t ack” in 2008 which required t he placement of t wo st ent s but did not have “ more done” unt il 2015. See Transcript at 39. The ALJ found, and t he Court agrees, t hat t he “ ej ect ion fract ion ... is t he percent age of t he blood empt ied from t he vent ricle during syst ole; t he left vent ricular ej ect ion averages 60% t o 70% in healt hy heart s but can be markedly reduced if part of t he heart muscle dies (e.g., aft er myocardial infarct ion) or in cardiomyopat hy or valvular heart disease.” See Transcript at 16, n.1. 3 2 st ent was replaced. Johns was diagnosed wit h impairment s t hat included unst able angina, coronary art ery disease, and ant erosept al infarct . He was also diagnosed wit h hypert ension, which was deemed t o be st able. He was cont inued on medicat ions t hat included nit roglycerin and carvedilol, was placed on Brilint a and aspirin, and inst ruct ed t o t ransit ion t o Plavix aft er t hirt y days. He was also inst ruct ed t o t ake lisinopril inst ead of verapamil and at orvast at in inst ead of pravast at in. On Sept ember 18, 2015, Johns was seen for a follow-up examinat ion by Dr. Kat herine Durham, M.D., (“ Durham” ). See Transcript at 562-564. The progress not e reflect s t hat his hist ory of present illness was recorded t o be as follows: This is a 42-year-old man here t oday for a follow-up. He says t hat he cont inues t o have chest pain and he says t hat t his is usually relieved wit h one nit ro and rest . He says he overall does not feel well and has fat igue. He also has dyspnea wit h exert ion. He said, in t he past when he had st ent s t o t he [left ant erior descending art ery], he felt a lot bet t er, but at t his t ime he is not . He does admit t hat he feels some bet t er t han when in t he hospit al, but has not regained his full capacit y t o daily act ivit ies. He is very concerned about t his. He is t aking his medicat ions as prescribed and denies missing any doses of Brilint a and is now t ransit ion[ing] t o Plavix aft er t he first 30 days. He cont inues t o smoke, but say t hat he is t rying t o cut back. He is concerned because he feels agit at ed. 3 See Transcript at 562. Durham’ s diagnoses included coronary art ery disease and ongoing exert ional angina. She ordered a myocardial perfusion st udy, t he result s of which revealed a fixed defect in t he sept al wall of his heart consist ent wit h a previous myocardial infarct ion, no evidence of ischemia, and a left vent ricular ej ect ion fract ion of sixt y-one percent . See Transcript at 565-566. Johns saw Durham again on December 15, 2015. See Transcript at 629-631. The progress not e reflect s t hat Johns had no pain wit h exert ion but had pain about t wice a week in a pat t ern t hat had not changed since his last evaluat ion. He cont inued t o smoke cigaret t es and was not exercising regularly. He had normal muscle st rengt h and t one and no gross mot or deficit s. His hypert ension was well-cont rolled. Durham cont inued Johns on medicat ion. Johns did not see Durham again unt il April 18, 2016. See Transcript at 632-634. At t he present at ion, Johns report ed t hat he cont inued t o have int ermit t ent chest pain made worse wit h st ress, cont inued t o t ire easily, and occasionally had dyspnea on exert ion. His hypert ension was cont rolled, but he cont inued t o smoke cigaret t es on a regular basis. Durham cont inued Johns on medicat ion t hat included nit roglycerin, carvedilol, and losart an. She also counseled him t o st op smoking cigaret t es. 4 On June 20, 2016, Johns was admit t ed t o St . Bernards Medical Cent er for chest pain consist ent wit h acut e coronary syndrome and unst able angina. See Transcript at 664-672. A heart cat het erizat ion revealed single vessel coronary art ery disease of t he left ant erior descending art ery wit h significant fract ional flow reserve. Test ing also revealed a left vent ricular ej ect ion fract ion of bet ween sixt y and sixt y-five percent . Dr. Ziad Awar, M.D., (“ Awar” ) performed what he charact erized as a successful percut aneous coronary int ervent ion wit h a drug-elut ing st ent and a percut aneous t ransluminal coronary angioplast y t o t he mid segment of t he left ant erior descending art ery. Johns was discharged on June 22, 2016. The discharge not e reflect s t hat he was inst ruct ed t o avoid heavy lift ing for t wo t o t hree days but should begin regular exercise on a limit ed basis. He could ret urn t o work in approximat ely t en days. The not e addit ionally reflect s t hat he was st rongly encouraged t o st op smoking cigaret t es as it is a leading cause of heart disease. Johns was t hereaft er seen by Sara Wilcox, an Advanced Pract ice Regist ered Nurse (“ APRN” ), for complaint s t hat included a hemat oma, lack of sleep, and depression. See Transcript at 689-691 (07/ 14/ 2016), 688-689 (08/ 29/ 2016). The progress not es reflect s t hat Johns was feeling t ired and depressed, but he cont inued t o work full-t ime and be an everyday smoker. 5 Johns saw Awar’ s assist ant on August 15, 2016. See Transcript at 675678. Johns report ed cont inued chest pain made worse wit h exert ion. He also report ed dizziness when st anding t oo fast , no energy, sleeplessness, dayt ime fat igue, and headaches. His hypert ension was well cont rolled. His medicat ion was adj ust ed, and Provachol and CoQ10 were also prescribed. On Sept ember 1, 2016, Wilcox complet ed a Medical Source St at ement on Johns’ behalf. See Transcript at 637-639. She opined t hat he can lift and carry a maximum of t went y pounds occasionally and t en pounds frequent ly. He can st and and walk for a maximum of about t wo hours but can only do so for t en minut es at a t ime. He can sit wit hout limit at ion but can only do so for one hour at a t ime. Addit ionally, he must elevat e his feet , requires frequent and longer t han normal breaks, and must have t he opport unit y t o shift at will from st anding/ walking or sit t ing. Wilcox est imat ed t hat Johns must miss work more t han t hree days a mont h. When asked t o provide t he obj ect ive medical evidence t o support her opinions, she represent ed t he following: “ Pat ient is posit ive for dyspnea on exert ion and has dizziness. Does have chronic st able angina which result s in not being able t o work for long periods at a t ime.” See Transcript at 638. She represent ed t hat t he t ime period covered by her opinions is from “ Sept ember [of] 2015 t o current .” See Transcript at 638. 6 Johns t hereaft er saw Wilcox and ot her professionals at ARCare on mult iple occasions. See Transcript at 684-685 (09/ 29/ 2016), 681-683 (12/ 19/ 2016), 680-681 (04/ 07/ 2017), 863 (08/ 23/ 2017), 861-863 (09/ 26/ 2017), 861 (11/ 01/ 2017), 858-861 (11/ 07/ 2017), 858 (03/ 02/ 2018), 856-858 (03/ 07/ 2018), 856 (03/ 08/ 2018), 856 (04/ 13/ 2018), 854-856 (06/ 11/ 2018), 853-854 (06/ 21/ 2018). The progress not es reflect t hat Johns cont inued t o complain of chest and neck pain. He cont inued t o smoke cigaret t es, t hough. He was cont inued on medicat ion and encouraged t o exercise. Johns also cont inued t o see Awar. See Transcript at 763-768 (08/ 22/ 2017), 744-762 (09/ 19/ 2017-09/ 20/ 2017), 735-743 (10/ 06/ 2017), 725-734 (12/ 05/ 2017), 715-724 (01/ 04/ 2018). At t he present at ions, Johns consist ent ly complained of pain and t ight ening in his chest and short ness of breat h. He report ed t hat t he pain grew worse wit h exert ion but improved wit h nit roglycerin and rest . His hypert ension was adequat ely cont rolled, but he cont inued t o smoke cigaret t es. His left vent ricular ej ect ion fract ion was t ypically bet ween fift y-five and sixt y-five percent . During t he period, Johns underwent a heart cat het erizat ion and received what appears t o have been mult iple st ent replacement s. He was cont inued on medicat ion and encouraged t o exercise. 7 Johns was seen at t he Whit e Count y Medical Cent er and/ or Searcy Medical Cent er in 2017 and 2018 for complaint s t hat included back and knee pain. See Transcript at 701-713 (06/ 07/ 2017), 695-697 (06/ 08/ 2017), 835-838 (08/ 03/ 2017), 830-834 (05/ 24/ 2018). The progress not es reflect t hat he had a limit ed range of mot ion in his cervical spine and had pain wit h rot at ion and ext ension. He was diagnosed wit h int ervert ebral cervical disc disorder wit h radiculopat hy. Medicat ion and inj ect ions were prescribed. The progress not es also reflect t hat Johns had mild edema in his right knee, an ant algic gait , and appreciable effusion. X-rays revealed degenerat ive changes t o his pat ellofemoral j oint and chondrocalcinosis of t he medial and lat eral compart ment s. Ost eoart hrit is and art hralgia were among t he diagnoses. His knee was aspirat ed on at least t wo occasions, he received inj ect ions, and a knee brace was prescribed. On December 11, 2017, Johns was seen by Dr. Joshua Morrison, M.D., (“ Morrison” ) for complaint s t hat included chest pain, short ness of breat h, and fat igue. See Transcript at 793-796. The progress not e reflect s t hat a prior CT scan had been abnormal, showing a cyst ic-appearing st ruct ure in t he left hilar region of Johns’ chest . A pulmonary funct ion t est revealed moderat e rest rict ions. Morrison diagnosed, int er alia, lung disease and recommended medicat ion and addit ional t est ing. 8 Johns was seen at t he Whit e Count y Medical Cent er Cardiology Clinic by Dr. Bradley Hughes, M.D., (“ Hughes” ) on at least t wo occasions in 2018. See Transcript at 810-812 (03/ 05/ 2018), 816-818 (04/ 04/ 2018). At t he first present at ion, t he result s of an elect rocardiogram revealed no evidence of ischemia. Johns was cont inued on medicat ion and a st ress t est was scheduled. At t he second present at ion, his hist ory of present illness was recorded t o be as follows: Mr. Johns is a 45-year-old gent leman wit h chronic angina as well as known coronary art ery disease st at us post mult iple [percut aneous coronary int ervent ion or coronary angioplast y]. He st at es he has eit her six or seven st ent s. He smokes a pack per day and has done so for approximat ely 30 years. He st at es t hat he underwent a cardiac cat het erizat ion in January of t his year by his cardiologist in Jonesboro, and he was t old at t hat t ime t hat he did not need any more st ent s and t hat one of his art eries was t oo small t o have any addit ional st ent s placed. He underwent a Cardiolit e st ress t est since he was last seen here due t o some complaint s of chest discomfort and t hat st udy showed mild-t o-moderat e dist al ant erior and ant eroapical reversible defect . He ret urns t o clinic for follow-up of t hat t est t oday. He st at es he does cont inue t o have some occasional chest discomfort . When he has t he chest discomfort , he j ust has t o sit down and rest and wait for it t o resolve. He does remain compliant wit h his medicat ion list as list ed. See Transcript at 816. Hughes increased Johns’ use of isosorbide, which he was t hen t aking along wit h aspirin, at orvast at in, Cart ia, carvedilol, Effient , Nit rost at , pant oprazole, and Ranexa. 9 On May 9, 2018, Johns was seen for a cardiac evaluat ion by Dr. Daniel Sherbert , M.D., (“ Sherbert ” ). See Transcript at 847-849. At t he present at ion, Johns complained of chest pain on exert ion, fat igue, dyspnea, and leg discomfort wit h walking. Upon physical examinat ion, he had a regular heart rat e and rhyt hm. An elect rocardiogram was performed, and t he result s were abnormal. Sherbert diagnosed coronary art ery disease, smoker, and chest pain; cont inued Johns on his medicat ion; and prescribed a nicot ine pat ch t o aid in smoking cessat ion. Johns appears t o have seen Sherbert on t wo subsequent occasions. See Transcript at 844-846 (06/ 13/ 2018), 865-867 (11/ 21/ 2018). Johns report ed chest spasms, short ness of breat h wit h exert ion, and dizziness but had a regular heart rat e and rhyt hm. The result s of an elect rocardiogram were again abnormal. Johns report ed t hat he had st opped t aking at orvast at in due t o cramping in his arms. Sherbert cont inued Johns on medicat ion t hat included isosorbide and Ranexa, alt hough simvast at in was added t o his medicat ion list . Johns’ medical records were reviewed by st at e agency medical expert s. See Transcript at 80-92, 93-105, 107-123. The medical expert s were of t he opinion t hat Johns is capable of performing unskilled, light work. 10 Johns complet ed a series of document s in connect ion wit h his applicat ions. See Transcript at 332-339, 340-341, 358-359, 360-367. In t he document s, he represent ed, int er alia, t hat he can at t end t o his own personal care, perform light house work, shop, manage money, drive an aut omobile, occasionally hunt and fish, and spend t ime wit h ot hers. He est imat ed t hat he can st and/ walk for t en t o t went y minut es before he experiences pain and can sit for one hour before experiencing pain. The record cont ains more t han one summary of Johns’ earnings hist ory. See Transcript at 277-293. Taken t oget her, t hey reflect t hat he has had minimal earnings during his adult life. Johns t est ified during t he administ rat ive hearing. See Transcript at 54-72. He is approximat ely five feet , eight inches t all and weighs 210 pounds. He has a fourt een-year-old son and helps care for him. Johns lives by himself in a t railer owned by his fat her. His fat her pays t he ut ilit ies, cooks Johns’ meals, buys him cigaret t es, permit s him use of an aut omobile, and pays his fuel cost s. Johns’ impairment s cause, int er alia, chest pains, short ness of breat h, and fat igue. He experiences pain in his neck, shoulder, and ankle. He cont inues t o smoke cigaret t es but has cut back t o half a pack a day. He can lift no more t han fort y pounds at a t ime and can sit for about t hirt y t o fort y-five minut es before having t o elevat e his legs. 11 The ALJ found at st ep t wo of t he sequent ial evaluat ion process t hat Johns has severe impairment s in t he form of ost eoart hrit is, coronary art ery disease, hypert ension, obesit y, depression, anxiet y, and chronic obst ruct ive pulmonary disorder. The ALJ assessed Johns’ residual funct ional capacit y and found t hat he is capable of performing sedent ary work wit h some addit ional limit at ions. 4 As a part of so finding, t he ALJ discount ed Wilcox’ s medical opinions cont ained in t he Medical Source St at ement because she is not an accept able medical source, her opinions lack an obj ect ive basis, and t hey are inconsist ent wit h t he record. The ALJ also discount ed t he medical opinions of t he st at e agency medical expert s, finding t hat Johns has great er limit at ions t han t hey opined. The ALJ found at st ep four t hat Johns has no past relevant work. At st ep five, t he ALJ found t hat a hypot het ical individual wit h Johns’ limit at ions could work as a document preparer or surveillance monit or. Given t hose findings, t he ALJ concluded t hat Johns was not under a disabilit y as defined by Social Securit y Act . As t o t he addit ional limit at ions, t he ALJ found t hat Johns can only occasionally climb, st oop, crouch, kneel, and crawl and must avoid any exposure t o t emperat ure ext remes, chemicals, dust , fumes, humidit y, unprot ect ed height s, work on ladders and scaffolds, and commercial driving. The ALJ also found t hat Johns is able t o perform “ simple unskilled or semi-skilled act ivit y; underst and, follow, and remember concret e inst ruct ions; and has no cont act rest rict ions wit h supervisors, co-workers, or t he public.” See Transcript at 14. 4 12 Johns maint ains t hat t he ALJ’ s findings are not support ed by subst ant ial evidence on t he record as a whole. Johns so maint ains because t he record does not cont ain an opinion from a t reat ing or examining physician comment ing on Johns’ specific work-relat ed limit at ions, leaving t he ALJ t o draw his own inferences about Johns’ work-relat ed limit at ions. Johns not es t hat “ [t ]his especially is problemat ic here, where Johns suffers from a complicat ed heart condit ion requiring mult iple st ent s, t hus requiring t he ALJ t o read, int erpret , and draw medical conclusions from Johns’ voluminous and complex medical t reat ment records from several cardiac specialist s.” See Docket Ent ry 11 at CM/ ECF 15-16. The ALJ is required t o assess t he claimant ’ s residual funct ional capacit y, which is a det erminat ion of t he most a person can do despit e his limit at ions. See Brown v. Barnhart , 390 F.3d 535 (8t h Cir. 2004). The assessment is made using all of t he relevant evidence in t he record, but t he assessment must be support ed by some medical evidence. See Wildman v. Ast rue, 596 F.3d 959 (8t h Cir. 2010). There is no requirement , t hough, t he assessment be support ed by a specific medical opinion. See Hensley v. Colvin, 829 F.3d 926 (8t h Cir. 2016). In t he absence of opinion evidence, t he medical records of t he most relevant t reat ing physicians can provide affirmat ive medical evidence support ing t he ALJ’ s assessment . See Id. 13 The Court is sat isfied t hat t he ALJ adequat ely developed t he record, and t here is sufficient informat ion for him t o have made an informed decision. It is t rue t hat t here is no opinion from a t reat ing or examining physician comment ing on Johns’ specific work-relat ed limit at ions. Such an opinion was not required in t his inst ance, t hough, as t he ALJ could and did assess Johns’ residual funct ional capacit y on t he basis of t he evidence in t he record. The Court so finds for t he following reasons. First , t he ALJ’ s assessment of Johns’ residual funct ional capacit y is not inconsist ent wit h t he evidence relevant t o his ment al impairment s, and opinion evidence as t o t he work-relat ed limit at ions caused by t he impairment s was not necessary. Alt hough Johns was diagnosed wit h depression and anxiet y and prescribed medicat ion, depression screenings were eit her negat ive, see Transcript at 681, 686, or revealed only mild t o moderat e sympt oms, see Transcript at 689. 5 He was advised of t reat ment opt ions but does not appear t o have t aken advant age of t hem. The record also reflect s t hat he can do such t hings as shop, manage his money, spend t ime wit h ot hers, and help care for his child. The findings appear t o have been made by Wilcox and anot her APRN. Alt hough an APRN is not an accept able medical source for purposes of t he Social Securit y Act , an APRN can provide informat ion t o help underst and a claimant ’ s impairment s. See Sloan v. Ast rue, 499 F.3d 883 (8t h Cir. 2007). 5 14 Second, t he ALJ’ s assessment of Johns’ residual funct ional capacit y is not inconsist ent wit h t he evidence relevant t o his neck and back pain, and opinion evidence as t o t he work-relat ed limit at ions caused by t he impairment s was not necessary. MRI t est ing of Johns’ cervical spine in January of 2016 showed minimal disc desiccat ion at t he C5-C6 level but no significant disc bulge, disc prot rusion, canal st enosis, or foraminal narrowing. See Transcript at 613. The subsequent physical examinat ions of his cervical spine were largely unremarkable, save t he observat ions of a Physician’ s Assist ant (“ PA” ) in August of 2017. At t hat present at ion, t he PA observed t hat Johns had “ minimal t enderness on palpat ion,” a limit ed range of mot ion, and pain wit h rot at ion and ext ension in his cervical spine. See Transcript at 837. The PA prescribed medicat ion and considered referring Johns for an epidural inj ect ion. It is not clear how long Johns used t he medicat ion, and it does not appear t hat he ever received t he inj ect ion. In any event , Johns was t hereaft er seen by several medical professionals, and none of t hem made findings consist ent wit h t he observat ions made by t he PA. For inst ance, Johns was seen by Morrison in December of 2017, and a physical examinat ion was largely unremarkable. See Transcript at 793796. Moreover, t he record reflect s t hat Johns can do such t hings as perform light house work, occasionally hunt and fish, and help care for his child. 15 Third, t he ALJ’ s assessment of Johns’ residual funct ional capacit y is not inconsist ent wit h t he evidence relevant t o his knee pain, and opinion evidence as t o t he work-relat ed limit at ions caused by t he impairment was not necessary. X-rays of Johns’ knee in June of 2017 revealed degenerat ive changes t o his pat ellofemoral j oint and chondrocalcinosis of t he medial and lat eral compart ment s. See Transcript at 697. His knee was aspirat ed on at least t wo occasions, he received inj ect ions, and a knee brace was prescribed. Alt hough repeat ed physical examinat ions reflect t hat Johns had normal muscle st rengt h and t one in his lower ext remit ies, his knee pain undoubt edly impact ed his abilit y t o st and and walk. The ALJ appears t o have t aken t he limit at ions caused by t he impairment int o account as he found t hat Johns was limit ed t o a reduced range of sedent ary work. Fourt h, t he ALJ’ s assessment of Johns’ residual funct ional capacit y is not inconsist ent wit h t he evidence relevant t o his ankle pain, and opinion evidence as t o t he work-relat ed limit at ions caused by t he impairment was not necessary. Johns t est ified t hat he underwent surgery in t he early 1990s aft er t earing t he ligament s in his right ankle. See Transcript at 59-60. There is lit t le evidence t hat t ouches on t he severit y of t he inj ury. In any event , t he ALJ’ s finding t hat Johns is limit ed t o a reduced range of sedent ary work undoubt edly account s for t he limit at ions caused by t he impairment . 16 Fift h, t he ALJ’ s assessment of Johns’ residual funct ional capacit y is not inconsist ent wit h t he evidence relevant t o his hypert ension, and opinion evidence as t o t he work-relat ed limit at ions caused by t he impairment was not necessary. Alt hough Johns has hypert ension, it was rout inely st able or ot herwise adequat ely cont rolled wit h medicat ion. See Transcript at 576, 631, 634, 677, 792. There is not hing t o suggest t hat t he impairment causes him any meaningful work-relat ed limit at ions. Sixt h, t he ALJ’ s assessment of Johns’ residual funct ional capacit y is not inconsist ent wit h t he evidence relevant t o his obesit y, and opinion evidence as t o t he work-relat ed limit at ions caused by t he impairment was not necessary. Alt hough his Body Mass Index is approximat ely t hirt y-t wo, or wit hin t he obese range, t here is not hing t o suggest t hat his weight causes him any meaningful work-relat ed limit at ions. Last , t he principal issue in t his case is t he ext ent t o which Johns’ heart problems impact his work-relat ed abilit ies. He has suffered at least one myocardial infarct ion and has repeat edly sought medical at t ent ion for his heart problems. He has undergone several heart cat het erizat ions; has had a number of st ent placement s; has consist ent ly complained of chest pain, short ness of breat h, and fat igue; and has been prescribed medicat ion. The ALJ’ s assessment t hat Johns can nevert heless perform a 17 reduced range of sedent ary work is not inconsist ent , t hough, wit h t he evidence relevant t o his heart problems as t he assessment appears t o t ake int o account t he limit at ions caused by t he impairment . Opinion evidence as t o t he work-relat ed limit at ions caused by t he impairment , while helpful, was not required because t he medical records of his t reat ing physicians are capable of more t han one accept able charact erizat ion and provide affirmat ive evidence support ing t he assessment . For inst ance, t he medical records from Johns’ August of 2015 present at ion t o t he Whit e Count y Medical Cent er reflect t hat he was smoking one pack of cigaret t es a day and had been doing so for t went yseven years. The result s of an echocardiogram revealed t hat alt hough he had concent ric left vent ricular hypert rophy, it was charact erized as mild. It is t rue t hat a st ent was replaced and medicat ion prescribed, but it is t elling t hat his left vent ricular ej ect ion fract ion was est imat ed t o be bet ween fift y-fift y and sixt y, or wit hin t he normal range, and no workrelat ed limit at ions were imposed. Durham’ s progress not es reflect t hat Johns had normal muscle st rengt h and t one and no gross mot or deficit s. Johns cont inued t o smoke cigaret t es and had made no at t empt t o exercise on a regular basis. The result s of a myocardial perfusion st udy revealed a fixed defect in t he sept al 18 wall of his heart consist ent wit h a previous myocardial infarct ion, but t here was no evidence of ischemia. His left vent ricular ej ect ion fract ion was found t o be wit hin t he normal range. She cont inued him on medicat ion but imposed no work-relat ed limit at ions. The medical records from Johns’ June of 2016 present at ion t o t he St . Bernards Medical Cent er reflect t hat he had single vessel coronary art ery disease of t he left ant erior descending art ery wit h significant fract ional flow reserve. Awar performed a successful percut aneous coronary int ervent ion. When Johns was discharged, Awar inst ruct ed Johns t o avoid heavy lift ing for t wo t o t hree days, but Johns could ot herwise begin regular exercise on a limit ed basis and could ret urn t o work in approximat ely t en days. Awar’ s recommendat ions are inconsist ent wit h Johns’ allegat ion of disabling sympt oms. Awar also encouraged Johns t o st op smoking cigaret t es, a recommendat ion Johns did not fully embrace. Awar’ s subsequent progress not es reflect t hat Johns received mult iple st ent placement s and/ or replacement s and cont inued t o complain of chest pain and short ness of breat h. Johns’ left vent ricular ej ect ion fract ion, t hough, was wit hin t he normal range. He was also encouraged t o exercise and st op smoking cigaret t es. Those recommendat ions are not consist ent wit h his allegat ion of disabling sympt oms. 19 Johns saw Wilcox on mult iple occasions for complaint s t hat included chest pain. In Sept ember of 2016, Wilcox complet ed a Medical Source St at ement in which she opined as t o Johns’ work-relat ed limit at ions. The ALJ discount ed Wilcox’ s opinions because Wilcox is not an accept able medical source, her opinions lack an obj ect ive basis, and t hey are inconsist ent wit h t he record. The ALJ could properly do so as his reasons are good reasons and are support ed by subst ant ial evidence on t he record as a whole. Morrison’ s progress not e from December of 2017 reflect s t hat Johns cont inued t o complain of chest pain, short ness of breat h, and fat igue, and had a prior abnormal CT scan. A pulmonary funct ion t est , t hough, revealed only moderat e rest rict ions. Morrison cont inued Johns on medicat ion but imposed no work-relat ed limit at ions. The progress not es compiled by Hughes and Sherbert are equally unremarkable. The not es reflect t hat t he result s of elect rocardiograms revealed no evidence of ischemia but were ot herwise deemed t o be abnormal. Johns cont inued t o smoke cigaret t es and apparent ly made no effort t o exercise. Alt hough Hughes and Sherbert prescribed medicat ion, t hey did not place limit at ions on Johns’ abilit y t o perform work-relat ed act ivit ies. 20 The ALJ’ s const ruct ion of t he medical records of Johns’ t reat ing physicians is also not inconsist ent wit h t he non-medical evidence in t he record. Johns can at t end t o his own personal care, perform light house work, shop, manage money, drive an aut omobile, occasionally hunt and fish, spend t ime wit h ot hers, and help care for his child. It is for t he foregoing reasons t hat t he ALJ could properly assess Johns’ residual funct ional capacit y wit hout t he benefit of an opinion from a t reat ing or examining physician comment ing on Johns’ specific workrelat ed limit at ions. Subst ant ial evidence on t he record as a whole support s t he assessment , and t he fact t hat t here is some medical evidence support ing Johns’ posit ion concerning t he severit y of his sympt oms does not mean t he ALJ’ s decision is not support ed by subst ant ial evidence on t he record as a whole. See Adamczyk v. Saul, --- Fed.Appx. ---, 2020 WL 3957172 (8t h Cir. 2020). Johns’ complaint is dismissed, all request ed relief is denied, and j udgment will be ent ered for t he Commissioner. IT IS SO ORDERED t his 18t h day of August , 2020. __________________________________ UNITED STATES MAGISTRATE JUDGE 21
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