F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
AUG 13 2003
FOR THE TENTH CIRCUIT
PATRICK FISHER
Clerk
MARY L. QANTU,
Plaintiff-Appellant,
v. No. 02-1314
(D.C. No. 99-MK-1935 (PAC))
JO ANNE BARNHART, (D. Colo.)
Defendant-Appellee.
ORDER AND JUDGMENT *
Before TACHA, Chief Judge, HARTZ, and O’BRIEN, Circuit Judges.
After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties’ request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
ordered submitted without oral argument.
Claimant Mary Qantu appeals the district court’s affirmance of the decision
by the Commissioner of Social Security denying her applications for disability
*
This order and judgment is not binding precedent, except under the
doctrines of law of the case, res judicata, and collateral estoppel. The court
generally disfavors the citation of orders and judgments; nevertheless, an order
and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3.
benefits and supplemental security income. Because the agency’s decision is
supported by substantial evidence and no legal errors occurred, we affirm.
On January 10, 1995, claimant tripped on a rug at work and fell down a
flight of stairs. Aplt’s App., Vol. I at 121, 132. As a result, she suffered pain in
her neck and back, numbness in her arms, and frequent headaches. See id. at
116-18, 119-120, 122-23. Claimant underwent several months of physical therapy
and chiropractic treatment under the supervision of treating physician Hine, of the
Southern Colorado Clinic. See id. at 114, 116; Vol. II at 280-81, 303-313.
In April 1995 Dr. Hine determined that claimant had reached maximum
medical improvement and released her for work, limited by the requirements that
she not lift more than thirty pounds, carry no more than twenty-five pounds, and
lift no more than twenty pounds over her shoulders. Id. , Vol. I at 146, 148, 158.
In May 1995 Dr. Hine referred claimant to Dr. Herrerra, at the Southern Colorado
Clinic, for her headaches. Id. at 159. Upon initial examination, Dr. Herrerra
agreed that claimant could return to work. Id. at 158. He prescribed medication
and requested a CT scan of the head, which showed no abnormalities. Id. at 156,
158. Claimant continued to see Dr. Herrerra monthly for her headaches, and
started monthly maintenance visits with Dr. Campbell after Dr. Hine left the
clinic. See id. at 157. Dr. Campbell reiterated that claimant could return to work,
subject to lifting restrictions. Id. at 146, 152, 157.
-2-
2
In April 1996 claimant experienced an exacerbation of her symptoms and
returned to the Southern Colorado Clinic for treatment. See id. at 139-140.
Claimant was sent back to physical therapy. See id., Vol. II at 299-302. By the
end of April, claimant reported to her physical therapist that she had no specific
complaints of pain and that she had gone hiking in the mountains. Id. at 292. In
May 1996 treating physician Campbell reiterated that claimant could return to
work limited only by the restrictions described above. Id. at 273-74.
In July 1996 claimant began treatment with Kevin Boehle at the Southern
Colorado Clinic. Id. at 386-387. Examination revealed tissue texture changes
and muscle spasms in claimant’s neck; trigger points along her spine, and
tenderness in the lumbar spine with chronic tissue changes consistent with chronic
muscle spasm and irritation. Id. at 386. Current x-rays showed some chronic
arthritic changes in the neck and lower spine. Id. at 385, 387. Claimant was
referred to Dr. Crawford for trigger-point injections and an EMG to evaluate her
left arm numbness. Id. at 386-87.
Dr. Crawford’s physical examination of claimant’s back showed normal
gait; negative Romberg; normal spine curvature with no thoracic or lumbosacral
tenderness; full lumbar flexion and extension; and twenty-five degrees of lateral
bending without pain. Id. at 282. She had a tender nodule in the left mid-gluteal
muscle, and bilateral tenderness, but no sciatic notch or posterior thigh
-3-
3
tenderness. Id. Her cervical spine was tender, but without spasm or nodules, her
cervical flexion and extension were limited, and right and left rotation caused
pain. Id. Claimant had a scapular myofascial pain nodule and mild right lateral
scapular tenderness. Id. Her shoulders had a full range of motion without pain,
normal strength in her upper extremities except for some weakness of pinch of the
left fifth finger and thumb, and her lower extremities were normal. Id.
Dr. Crawford opined that claimant had bilateral parascapular and left gluteal
myofascial pain syndrome, and that the myofascial pain syndrome was causing her
headaches, but that her subjective symptoms seemed out of proportion to the
physical findings. Id. at 283. The EMG showed left carpal tunnel, recurrent, or
possible residual changed from her original surgery in 1980. Id. at 285.
Dr. Boehle treated claimant through the end of August 1996. Based on his
treatment of claimant, Dr. Boehle concurred with the opinion that claimant could
return to full-time work subject only to the lifting restrictions described above.
Id. at 372-73, 378. He opined that she had reached maximum medical
improvement for all medical conditions stemming from her accident, and that any
other problems she was having were from previous or underlying conditions. Id.
at 367. He also opined that claimant was showing strong tendencies of
drug-seeking and inappropriate behavior with the staff. Id.
-4-
4
In March 1997 claimant presented at the Parkview Episcopal Medical
Center for a headache with nausea and photophobia. Id., Vol I. at 194. She
underwent a CT scan which was negative, and was given medication which
resolved her headache. Id. at 195, 196. In April 1997 she returned for a lumbar
spine x-ray, which showed some evidence of degenerative disc disease with space
narrowing at L4-5 and L5-S1, but no acute abnormality. Id. at 192.
In April 1997 claimant underwent a consultative examination with
Dr. Gaudio. See id. at 160-64. Physical examination revealed that all ranges of
motion were within normal limits; straight leg raising was negative; Phalen’s and
Tinel’s tests were negative; there were no joint effusions or abnormalities; and
claimant had normal muscle tone and strength, with no spasms or loss of
sensation Id. at 162-63. Claimant showed no abnormalities on the mini-mental
status test, and did not appear to have any deficits in concentration. Id. at 163.
Dr. Gaudio found “no evidence of impairment-related physical limitation with
regard to her low back pain or left shoulder blade pain”; “no evidence to support
the diagnosis of carpal tunnel syndrome”; and no evidence to support claimant’s
complaint that she has trouble concentrating. Id. He concluded that based on the
objective evidence, claimant had no physical or postural limitations. Id. at 164.
Claimant also began treatment for depression at the Spanish Peaks Mental
Health Center (SPMHC) in April 1997. Id. at 185-86. Claimant was assessed
-5-
5
with a Global Assessment of Functioning score of 70, id. at 186, which is defined
as “[s]ome mild symptoms (e.g. depressed mood and mild insomnia) OR some
difficulty in social, occupational, or school functioning (e.g. occasional truancy,
or theft within the household), but generally functioning pretty well, has some
meaningful interpersonal relationships.” American Psychiatric Assoc., Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV), (4th ed. 1994), p. 32
(emphasis deleted). Claimant was treated with antidepressants and therapy, first
weekly and then every other week, through February 1998. Aplt’s App., Vol. I at
166-186; 201-215. Treatment notes indicated that her depression stemmed
primarily from domestic issues including a custody battle with her ex-husband and
difficulties with her children. See e.g., id. at 168, 174, 177, 185, 206-212.
In February 1998 claimant underwent a consultative psychological
examination with John Clarke, who administered psychological tests known as the
MMPI and the Zung Self-Rating Depression Scale. Id. at 217. Dr. Clarke
reviewed claimant’s physical and mental health records and interviewed claimant.
Id. Based on his review and the test results, Clarke opined that claimant’s
depression was severe to extreme, and that she was “presently psychologically
disabled.” Id. at 219-20.
Claimant filed for benefits in the spring of 1996, alleging an inability to
work after January 10, 1995, due to a cervical strain, fibromyalgia, depression,
-6-
6
and headaches. Id. at 72. After her applications were denied at the first and
second administrative levels, she participated in a hearing before an
administrative law judge (ALJ) in April 1998. See id., Vol. II at 397-453.
Claimant was represented by counsel at the hearing.
On August 21, 1998, the ALJ issued her decision, finding that although
claimant could not return to her former work as a nurse’s aide, she retained the
ability to perform a significant number of jobs and therefore was not disabled.
See id., Vol. I at 15-23. The ALJ found that claimant retained the physical ability
to do light work that did not require lifting more than thirty pounds, carrying
more than twenty-five pounds, or lifting more than twenty pound above the
shoulders. Id. at 22. She found that claimant was mentally limited to simple
unskilled work involving occasional interactions with the public. Id. The ALJ
also determined that claimant’s mental condition slightly limited her daily
activities, moderately limited her ability to maintain social relationships, seldom
caused deficiencies of concentration, persistence, or pace, and never caused an
episode of deterioration or decompensation in work or a work-like setting. Id. at
25-26. The Appeals Council denied review, making the ALJ’s determination the
final decision of the Commissioner. The district court affirmed, and this appeal
followed.
-7-
7
We review the Commissioner’s decision to determine only whether it is
supported by substantial evidence and whether legal errors occurred. See
Castellano v. Sec’y of Health & Human Servs., 26 F.3d 1027, 1028 (10th Cir.
1994). Substantial evidence is “that which a reasonable mind might accept as
adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401
(1971) (internal quotation marks omitted). We may not reweigh the evidence or
substitute our judgment for that of the agency. Casias v. Sec’y of Health &
Human Servs., 933 F.2d 799, 801 (10th Cir. 1991).
Claimant argues that the ALJ committed legal error by disregarding her
objective medical evidence of carpal tunnel syndrome, left ankle neuropathy, and
back spasms, and her psychological test results. We have held that “[t]he record
must demonstrate that the ALJ considered all of the evidence, but an ALJ is not
required to discuss every piece of evidence.” Clifton v. Chater , 79 F.3d 1007,
1009-10 (10th Cir. 1996). Here, it is clear the ALJ considered the evidence
identified by claimant, but concluded that it did not support a finding of
disability. See Aplt’s App., Vol. I at 17 (finding the medical evidence did not
establish that claimant’s carpal tunnel compromised her residual functional
capacity); at 18 (considering reports by Dr. Boehle, who noted claimant’s spasms
but concluded that she could return to full-time work with certain lifting and
carrying restrictions); at 19 (considering psychological test results but rejecting
-8-
8
the consulting psychologist’s conclusion). Although the ALJ did not specifically
refer to claimant’s ankle neuropathy, there is no evidence that this condition
limited claimant’s abilities.
Claimant next challenges the ALJ’s assessment of her nonexertional
impairments of pain, depression, and reduced grip strength in her left hand. Our
review of the ALJ’s decision reveals that she properly discussed the relevant
evidence, including claimant’s medical records, frequency of medical contacts,
daily activities, pain medication, and motivation, in determining that claimant’s
pain, depression, and weakness were not disabling. See Kepler v. Chater , 68 F.3d
387, 391 (10th Cir. 1995) (discussing factors ALJ should consider).
The ALJ’s primary reason for rejecting claimant’s complaints was that they
were not fully credible. See Aplt’s App., Vol. I at 17-18, 20-21 (rejecting
complaints of disabling pain, weakness, and depression because they conflicted
with record evidence and claimant’s other statements). As required, the ALJ
affirmatively linked her credibility findings to substantial evidence in the record.
See id. at 18 (complaints conflicted with treating physicians’ consistent opinions
that claimant could return to work); at 19 (treating mental health source’s records
assessed claimant’s functional limitations as mild, noted claimant’s half-hearted
attempt to find work, and described claimant’s own reports of improvement); at
20 (describing claimant’s reports to several sources that her conditions had
-9-
9
improved with only occasional problems); and at 20-21 (relying on treating
physician’s opinion that claimant’s symptomology was not consistent with her
clinical presentation, that claimant was showing strong tendencies of drug-
seeking behavior; and that further treatment was not indicated). Because
credibility determinations are within the province of the ALJ, we will not upset
such findings where, as here, they are supported by substantial evidence. Kepler ,
68 F.3d at 391.
Further, it is clear from the ALJ’s decision that she accepted that claimant
suffered some pain, but found that her pain was not disabling. We emphasize that
a claimant’s inability to work pain-free, standing alone, is not a sufficient reason
to find her disabled. Gossett v. Bowen , 862 F.2d 802, 807 (10th Cir. 1988).
Claimant also argues that the ALJ erred in rejecting the opinion of
consulting psychologist Clarke. The ALJ rejected the opinion that claimant was
“psychologically disabled” because Dr. Clarke did not provide any functional
assessment of claimant’s abilities; because the opinion was contrary to the
opinion of claimant’s treating source; and because Dr. Clarke was a consulting
source who only saw claimant one time. Aplt’s App., Vol. I at 19-20. As these
are legitimate bases for rejecting a source’s opinion, we find no error.
-10-
The judgment of the district court is AFFIRMED.
Entered for the Court
Harris L Hartz
Circuit Judge
-11-