USCA1 Opinion
[NOT FOR PUBLICATION]
UNITED STATES COURT OF APPEALS
FOR THE FIRST CIRCUIT
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No. 94-1891
MARIA GUILBE SANTIAGO,
Plaintiff, Appellant,
v.
SECRETARY OF HEALTH AND HUMAN SERVICES,
Defendant, Appellee.
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APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
[Hon. Carmen Consuelo Cerezo, U.S. District Judge]
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Before
Torruella, Chief Judge,
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Boudin and Stahl, Circuit Judges.
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Juan A. Hernandez Rivera and Juan R. Requena Davila on brief for
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appellant.
Guillermo Gil, United States Attorney, Maria Hortensia Rios,
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Assistant United States Attorney, and Robert J. Triba, Assistant
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Regional Counsel, Department of Health and Human Services, on brief
for appellee.
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January 25, 1995
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Per Curiam. Plaintiff-appellant Maria Guilbe-Santiago
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appeals from a district court judgment affirming the decision
of the Secretary of Health and Human Services denying her
application for disability insurance benefits. For the
following reasons, we affirm.
BACKGROUND
Appellant was born on July 1, 1950 and is a high school
graduate.1 Between September 1982 and February 1991,
appellant worked as a school cook. Prior to that, she worked
for several years as a flame adjuster at a factory which
produced disposable lighters. On February 7, 1990, appellant
injured her neck and left shoulder when lifting a heavy
cooking pot at work. On June 10, 1991, she filed an
application for benefits alleging disability since February
19, 1991 due to frequent pain in her left arm. She
complained that the pain, which is "very severe," prevents
her from lifting her arm. She also complained of headaches
and a nervous condition. The Social Security Administration
denied appellant's application initially and on
reconsideration.
Appellant obtained a hearing before an Administrative
Law Judge (ALJ) on November 4, 1992. She testified that she
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1. We base this birth date on appellant's testimony at the
administrative hearing, but note that on her application for
disability benefits, appellant gave her date of birth as
November 6, 1950.
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has pain in her neck, swollen cervical muscles, and strong
headaches. She also testified that she experiences numbness
and cramps in her hands, and that they shake. Pain
medication prescribed by the State Insurance Fund (Fund), she
stated, alleviated her pain but made her sleepy. A series of
injections given by a private physician, one to two weeks
before the hearing, reduced inflammation and provided a few
hours of relief. With respect to her physical limitations,
appellant testified that she cannot lift her arm, "cannot
move [her] neck too much," and cannot pull, push or lift
things with her hands. However, appellant can sit and walk
without limitation. Appellant also testified that she sought
mental health treatment because she felt pressure in her
chest, could not sleep at night, and became very upset. She
stated that medication has alleviated her nervous symptoms.
A vocational expert (VE) also testified. He identified
appellant's past cooking job as semi-skilled, medium work,
and her factory job as unskilled, sedentary work. The ALJ
posed a hypothetical to the VE which assumed that appellant
has a limited range of motion in her neck or cervical
region.2 The hypothetical also assumed occasional postural
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2. Specifically, the hypothetical assumed that in the
cervical region, lateral flexion is limited to thirty-five
[out of a possible forty degrees], flexion and extension are
limited to twenty-five [out of a possible thirty degrees],
and rotation to both the right and left is limited to forty
[out of a possible forty-five degrees].
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limitations, an inability to lift more than twenty pounds
[occasionally] and ten pounds frequently, and an inability to
do skilled work. The VE concluded that appellant could do
her past work as a flame adjuster, although he noted that
this type of work is no longer available in Puerto Rico. He
also identified several other light, unskilled jobs which
appellant could perform in the local economy.
The ALJ rejected appellant's allegations of disabling
pain, and found that she has occasional mild, cervical
discomfort that does not preclude normal sitting and
ambulation. He also found that she has a mild anxiety
disorder. The ALJ concluded that appellant has the residual
functional capacity to perform light, unskilled work. He
further concluded that she is not disabled because she can
perform her former job as a flame adjuster. The Appeals
Council denied review. An appeal was taken to the district
court, which concluded that the Secretary's decision is
supported by substantial evidence. This appeal followed.
THE MEDICAL EVIDENCE
According to the record, appellant was referred to the
Fund on February 9, 1990. She was diagnosed as suffering
from cervical and left shoulder sprain and was treated with
physical therapy. By July 12, 1990, appellant had improved
quite a bit, and physical therapy was discontinued. I n
February 1991, appellant was seen at the Fund for pain in her
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left shoulder, upper extremity, and hand. An EMG was
positive for C6 radiculopathy and borderline bilateral carpal
tunnel syndrome.3 A CT Scan revealed slight narrowing of
the left neural foramina at C6-C7 secondary to mild annular
bulge and bony proliferative changes. During the next
several months, muscle spasms were noted, as well as
inflammation in the left supraclavicular area and restricted
motion in the left shoulder and neck. The diagnoses, which
varied somewhat, included cervical myofascial pain syndrome,
cervicodorsal myositis secondary to C6 radiculopathy, and
cervical and left shoulder sprain.4 Appellant was treated
with physical therapy, oral pain medications, trigger point
injections, and nerve blocks. Although appellant continued
to complain of pain, the record reveals that on April 17,
1991, she was considered to have good potential for recovery.
An x-ray of the left shoulder performed on April 26, 1991 was
normal. On June 19, 1991, a physiatrist noted that there was
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3. Radiculopathy is disease of the nerve roots. Dorland's
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Illustrated Medical Dictionary (Dorland's) 1626 (28th ed.
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1994). Carpal tunnel syndrome is a complex of symptoms
resulting from compression of the median nerve in the carpal
tunnel, with pain and burning or tingling paresthesias in the
fingers and hand, sometimes extending to the elbow. Id. at
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1626.
4. Myofascial Pain Syndrome (or fibromyalgia) is pain in the
fibrous tissues, muscles, tendons, ligaments, and other white
connective tissues. The Merck Manual 1369 (16th ed. 1992).
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Myositis is inflammation of a voluntary muscle. Dorland's at
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1095. A sprain is a joint injury in which some of the fibers
of a supporting ligament are ruptured but the continuity of
the ligament remains intact. Id. at 1566.
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continued improvement and that appellant reported a twenty
percent decrease in pain. In June and July 1991, appellant
was also evaluated for an emotional condition and was
diagnosed as suffering from generalized anxiety disorder.
She was discharged from the Fund on August 29, 1991 with five
percent disability.
Appellant began treatment at the Ponce Mental Health
Center in October 1991. Her symptoms included irritability,
fearfulness, difficulty sleeping, headaches, sensitivity to
noise, depression, suicidal ideation, and a tendency to be
isolated. Appellant was diagnosed as suffering from
adjustment disorder and treated with medication. By November
6, 1991, she reported feeling better. Thereafter, she was
seen on roughly a monthly basis. Although at some of her
appointments, she reported feeling "so-so," the record
reveals that appellant was coherent and oriented. Her memory
and intelligence were preserved and her judgment was intact.
On May 8, 1992, the last recorded interview, appellant was
calm, stable, and with adequate affect. She reported that
she felt better and was sleeping well.
Dr. Winston Ortiz, a consulting neurologist, examined
appellant on two occasions. On August 19, 1991, his
examination of appellant's motor system, reflexes, and
sensory system was negative. Appellant had a normal gait and
was able to bend, stoop, kneel and squat. There were no
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muscle spasms. Although appellant had some limitation of
motion in the cervical region, she had full range of motion
in all other areas. A cervical x-ray revealed minimal to
moderate anterior spurring from the C3 level to the C6 level,
but no other bone or joint pathology. Dr. Ortiz diagnosed
cervical strain with no neurological deficits. An
examination by Dr. Ortiz on June 15, 1992 did not reveal any
deterioration in appellant's physical condition.
On September 5, 1991, Dr. Carmen Bird, a non-examining
medical consultant, reviewed the medical evidence of record
and completed a residual functional capacity assessment. She
found occasional postural limitations, but no manipulative,
visual, communicative, or environmental limitations. In
addition, she found that appellant has an unlimited capacity
to push or pull, as well as the capacity to lift twenty
pounds occasionally and ten pounds frequently, to stand or
sit about six hours out of an eight hour day, and to sit
about six hours out of an eight hour day.
On June 2, 1992, appellant was seen by Dr. Maria de Los
A. Siberon, a private physician. She diagnosed appellant as
suffering from cervical strain and prescribed pain
medication. Appellant was also seen by Dr. Ismael Jusino
McDougall on one occasion in 1992 in connection with shoulder
and neck pain. However, the brief entry regarding this visit
is largely illegible.
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DISCUSSION
Appellant argues that the ALJ did not properly evaluate
her allegations of disabling pain. In particular, she
contends that he disregarded her subjective complaints of
pain, and improperly considered only the objective medical
evidence. We disagree. The record includes ample evidence
bearing on her subjective complaints, including information
about her work history, daily activities, intensity and
duration of pain, medications and other treatment, and
functional restrictions. The ALJ's decision makes it plain
that, in conformance with the regulations and case law, he
considered this information. See 20 C.F.R. 404.1529
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(1991); Avery v. Secretary of Health & Human Servs., 797 F.2d
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19, 28-29 (1st Cir. 1986). The ALJ found, inter alia, that
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appellant worked for approximately one year after her injury;
that her pain is localized; that she engages in sedentary and
light daily activities; that she has only mild limitation of
motion in the neck and full range of motion in the back,
extremities, and joints; and that she has normal gait without
any neurological deficits. He did not reject appellant's
pain allegations entirely but determined that she was capable
of light work. We are persuaded that this determination is
supported by substantial evidence.
Appellant also contends that the hypothetical posed to
the VE was flawed and did not accurately reflect her pain,
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mental impairment, and restrictions in the use of her arm and
hands. We reject appellant's contention that the
hypothetical was inadequate. The hypothetical conveyed in
precise terms each of appellant's limitations as found by the
ALJ. See Arocho v. Secretary of Health & Human Services, 670
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F.2d 374, 375 (1st Cir. 1982). Moreover, the ALJ's findings
regarding these limitations are supported by substantial
evidence. Id. We have already upheld the ALJ's
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determination regarding appellant's pain. The evidence of
appellant's mental impairment reveals a mild, anxiety
disorder that has responded well to medication. Such
evidence amply supports the ALJ's conclusion that appellant
can perform unskilled work. Finally, there is no functional
assessment in the record which supports appellant's
allegation of restricted hand and arm use, and the assessment
by the Secretary's consulting physician is to the contrary.
Under the circumstances, the ALJ could conclude that there
was no limitation in appellant's ability to push, pull or
lift.
Appellant's remaining claims are that the ALJ
disregarded evidence from treating sources, relied on
isolated statements that ran contrary to the weight of the
evidence, failed to consider the combined effect of her
impairments, and substituted his own opinion for the medical
evidence which tended to show a disability. We have reviewed
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the medical record and the ALJ's decision and find no such
errors. The ALJ was not required to recite every piece of
evidence which favored appellant. See Stein v. Sullivan, 966
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F.2d 317, 319 (7th Cir. 1992) (noting that the level of
articulation required is not precise). His decision reveals
that he considered the record as a whole, and that he
considered the combined impact of appellant's impairments.
See 20 C.F.R. 404.1520, 404.1523. Appellant's claim that
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the ALJ "substituted" his own opinion for the medical
evidence is without basis.
Affirmed.
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