by the following factors: (1) length of treatment relationship and frequency of examination; (2) nature and extent of the treatment relationship; (3) supportability with relevant evidence, such as medical signs and laboratory findings; (4) consistency with the record as a whole; (5) area of specialization of the treating physician. See 20 C.F.R. § 416.927(d)(2)-(5).
Here, the ALJ followed the five-step evaluation procedure articulated by the Court of Appeals. Feliciano does not contest the ALJ's findings that he had a severe impairment, that he did not have an impairment or combination of impairments listed in, or medically equal to one listed in 20 C.F.R. Part 404, subpt. P, Regulations No. 4, or that he did not have the residual capacity to perform his past work. Feliciano disputes the ALJ's conclusion that he had the residual functional capacity to perform the physical exertion requirements of light work. He argues that the ALJ's determination was not supported by the medical evidence of record, arguing specifically that the ALJ failed to accord sufficient weight to the records of his treating physicians, Drs. Pinon and Guha.
The ALJ did not accord the reports of Feliciano's treating physicians controlling weight. He specifically found that Dr. Pinon's report does not "provide clinical findings corresponding to the restrictions referred to therein," and Dr. Guha's opinion "is not adequately supported by clinical or laboratory findings . . . ."
Feliciano argues that the opinions of his treating physicians were entitled to controlling weight. He argues that Drs. Pinon and Guha's findings of paraspinal muscle spasm, pain on straight leg raising at 60 degrees, pain on prolonged positioning and restricted range of motion well-support their diagnoses of chronic lower back pain. Neither physician, however, included objective clinical or laboratory findings in connection with Feliciano's complaint of chronic lower back pain. Rather, they diagnosed, by history, chronic back pain, muscle strain and spasm intermittent since 1987. Neither physician found any motor loss, muscle weakness, sensory or reflex loss, and a neurological examination and x-rays of Feliciano's lumbosacral spine in 1991 and 1993 were normal. Accordingly, the opinions of Drs. Pinon and Guha are not entitled to controlling weight.
Feliciano argues next that the opinions of his treating physicians must nevertheless be accorded greater weight than that of the consulting physician, Dr. Mancheno. The ALJ declined to credit the opinions of Drs. Guha and Pinon. We review the ALJ's decision with the five factors of 34 C.F.R. § 416.927(d)(2)-(5) in mind.
With regard to the length of the treatment relationship, frequency of examination, and nature and extent of the treatment relationship, the ALJ specifically found that Feliciano had seen various physicians at North Central, and only occasionally was treated by the same physician. Indeed, Feliciano testified that "there is a team of doctors that see me four or five times when I have gone. Sometimes I go and another doctor sees me, other times -- there are different doctors." Although he testified that he had seen "the Indian doctor," an apparent reference to Dr. Guha, four or five times, Dr. Guha's report does not state how many times he saw Feliciano. In response to the question "Nature, frequency and length of contact," Dr. Guha wrote "56 [sic] y.o. male seen in Rehab. clinic at North Central Bronx Hosp. since 10/28/91 with h/o low back pain x 4 yrs. at that time." In addition, Feliciano's attorney conceded that Dr. Pinon treats Feliciano primarily for his diabetes and high blood pressure, and only more generally for his chronic lower back pain.
With regard to supportability, as discussed above, the opinions of Drs. Pinon and Guha are not well-supported with relevant evidence. Neither includes objective medical signs or laboratory findings supporting Feliciano's claims of chronic lower back pain.
With regard to consistency, the ALJ found that the opinions of Drs. Pinon and Guha as to Feliciano's functional limitations were not consistent with the record as a whole. He noted that the opinions were not consistent with objective medical evidence in the record, including records from North Central. Indeed, a neurological examination and x-rays from 1991 and 1993 of Feliciano's lumbosacral spine were normal. He noted that Dr. Guha's opinion was not internally consistent. Dr. Guha reported that Feliciano experienced pain upon pushing and pulling with his right and left hands, could stand continuously for 2-3 hours, could lift and carry only 5 pounds, and could walk only 3-4 blocks. In a different report dated the same day, Dr. Guha reported that Feliciano could stand only 1-2 hours, but could lift and carry 10 pounds. Finally, the ALJ found that the opinions of Drs. Pinon and Guha were not consistent with each other or with Feliciano's testimony regarding his daily activities. Dr. Pinon opined, by history, that Feliciano could stand or sit for only 30 minutes, could walk only 2 blocks and could lift 20 pounds.
Feliciano testified, however, that he cooks sometimes, that he has no problem feeding himself or dressing himself, except to put on his shoes, that he spends most of the day reading or watching television, but sometimes goes to church, watches children in the neighborhood park, grocery shops (although he has the bags delivered), stands outside his building or plays dominoes with his friends. Feliciano further testified that he could lift and carry up to 15 pounds. He also testified that he takes only non-prescription drugs -- Motrin and Ibuprofen -- for the pain.
Finally, there is no evidence as to the area(s) of specialization of either Dr. Pinon or Dr. Guha.
Because none of the five factors weigh in favor of according the opinions of Drs. Pinon and Guha particular weight, the ALJ was not required to credit the opinions of Drs. Pinon and Guha as treating physicians. In addition, this Court finds that based upon Feliciano's own testimony regarding his daily activities and medication, medical reports from North Central and Dr. Mancheno's opinion, the ALJ's finding that Feliciano was not entitled to SSI benefits because he retains the capacity to perform light work is supported by substantial evidence.
In conclusion, plaintiff's motion for judgment on the pleadings reversing the administrative decision of the Commissioner is denied. Defendant's motion for judgment on the pleadings affirming the Commissioner's decision is granted. The Clerk of the Court is directed to enter judgment in favor of the defendant and to close the case.
Dated: White Plains, N.Y.
June 10, 1996
Barrington D. Parker, Jr.