Greg Peterson v. SSA

Greg Peterson v. SSA                   CV-08-189-SM 06/12/09
               UNITED STATES DISTRICT COURT FOR THE
                     DISTRICT OF NEW HAMPSHIRE


Greg Peterson


     v.                                    Civil No. 08-CV-189-SM
                                           Opinion No. 

Michael J. Astrue, Commissioner
Social Security Administration



                     REPORT AND RECOMMENDATION

     Before the court is plaintiff Greg Peterson's motion to

reverse the decision of the Commissioner to deny his application

for Social Security Disability ("SSD") benefits    (document no. 7).

The Commissioner moves to affirm the denial    (document no. 9),

contending it is supported by substantial evidence.     Plaintiff's

application was filed on November 9, 2006 and denied, both

initially and on reconsideration, then reviewed by both an

Administrative Law Judge ("ALJ") and the Appeals Council, which

affirmed the denial on April 2, 2008.    After that final denial,

plaintiff commenced this action seeking further review.     See 

(g)   (Supp. 2008).   The matter was referred to me for

a recommendation of disposition.     See 

(b)(1)(B).

For the reasons set forth below, I recommend the Commissioner's

motion to affirm (document no. 9) be granted.
                                  Discussion

        A.   Background

        Pursuant to this court's local rules, see United States

District Court for the District of New Hampshire Rule 9.1(d), the

parties filed a Joint Statement of Facts       (document no. 10)   ("JS")

which is part of the record and which I have reviewed.         Those

facts were taken from the Certified Record ("CR") , which is also

part of the file currently before the court.        Only those facts

relevant to the disposition of this matter are discussed below,

as needed.

        B.   Standard of Review

        An individual seeking social security benefits has a right

to judicial review of a decision denying the application.          See 

(g).      The court is empowered to affirm, modify,

reverse or remand the decision of the Commissioner, based upon

the pleadings and transcript of the record.        See 

   The factual

findings of the Commissioner shall be conclusive, however, so

long as they are supported by "substantial evidence" in the

record.      See Ortiz v. Sec'v of HHS, 

 (1st Cir.

1991)    (quoting 

(g)).     "Substantial evidence" is

"'more than a mere scintilla.        It means such relevant evidence as


                                      2
a reasonable mind might accept as adequate to support a

conclusion.'"        Richardson v. Perales, 

 (1971)

(quoting Consol. Edison Co. v. NLRB, 

 (1938));

see also Currier v. Sec'v of HHS, 

 (1st Cir.

1980).        The Commissioner is responsible for resolving issues of

credibility and drawing inferences from the evidence in the

record.        See Rodriquez v. Sec'v of HHS, 

    (1st

Cir. 1981)       (reviewing court must defer to the judgment of the

Commissioner).        The Court does not need to agree with the

Commissioner's decision but only to determine whether it is

supported by substantial evidence.        See 

   Finally, the court

must uphold a final decision denying benefits unless the decision

is based on a legal or factual error.        See Manso-Pizarro v. Sec'v

of HHS, 

 (1st Cir. 1996)       (citing Sullivan v.

Hudson, 

 (1989)).

        C.     Claimant's Arguments

        Plaintiff bases his claim for benefits on his chronic back

pain.        He alleges his disability onset date was October 31, 2006,

although he first had surgery for his back problems in August




                                      3
2002.1   Plaintiff is a 54 year old man with a GED who worked for

years as a heating, ventilation and air-conditioning ("HVAC")

mechanic, but stopped that work in October 2006 because of his

back problems.   He claims he cannot work because the pain limits

his ability to bend and prevents him from lifting anything.

       Plaintiff contends the ALJ erred at step 5 in the disability

determination process when he concluded plaintiff had the

residual functional capacity ("RFC") to perform a full range of

light work.    See 

(g)2.   Plaintiff argues the

ALJ's denial reflects the following errors:    (1) not appropriately

weighing the opinion of a nurse practitioner who was treating

him,   (2) not finding plaintiff's complaints of pain credible,   (3)

assessing an RFC that is not supported by substantial evidence,

and (4) improperly concluding there are a significant number of



     1The record shows that plaintiff has degenerative disc
disease of the lumbar spine and had disc fusion surgery at L5-S1,
but it did not succeed in alleviating his pain.   See CR at 15-16,
152-60.

     2The parties do not dispute that plaintiff has not engaged
in substantial gainful activity since his alleged onset date and
that he has severe physical impairments that prevent him from
performing his prior work but that do not equal or exceed one of
the impairments listed in the regulations.   See 

(a) - (d) (listing five step sequential analysis). The
dispute focuses on what RFC plaintiff retained to perform what,
if any, other work.  See 

 §§ 404.1520(e)- (g).

                                  4
other jobs in the national economy plaintiff could perform

despite his limitations.    The first three arguments all challenge

the ALJ's assessment of plaintiff's RFC and will be addressed

together below, followed by an analysis of his final argument

about the ALJ's conclusion at step 5.

           1.              Plaintiff's RFC

     Plaintiff contends the ALJ's assessment of his RFC is not

supported by substantial evidence because he failed to give

proper weight to both his nurse practitioner's     ("NP") opinion and

his own reports of pain which, had they been weighed properly,

would have resulted in a determination that he was unable to

perform a full range of light work on a sustained basis.      In

particular, plaintiff asserts that the ALJ did not follow Social

Security Ruling ("SSR") 06-03p, which sets forth the SSA's policy

for "Considering Opinions and Other Evidence from Sources Who Are

Not 'Acceptable Medical Sources' in Disability Claims."      See

www.ssa.gov/OP_Home/rulings    (Aug. 9, 2006).   He also asserts the

ALJ did not evaluate his complaints of pain consistent with the

requirements of Avery v. Sec'v of HHS, 

 (1st Cir.

1986).   The record indicates that the ALJ in fact considered

plaintiff's symptoms and the extent to which they were consistent



                                  5
with the objective medical evidence and opinion evidence, in

accordance with the governing regulations and rulings.       After

carefully reviewing the record, I am not persuaded by plaintiff's

arguments and find the ALJ's assessment of plaintiff's RFC is

supported by substantial evidence,

            a.   SSR 06-03p

     The regulations require plaintiff to establish his alleged

disabling impairment with evidence from "acceptable medical

sources,"    see 

(a)    (listing acceptable

medical sources that can establish medically determinable

impairments), and allow him to use evidence from "other sources"

to show the impairment's severity and its impact on his ability

to work.    See 

 § 404.1513(d)    (listing other medical and non­

medical sources of evidence) .      To carry his burden of proof,

plaintiff relied on the opinion of Victoria Blight, a nurse

practitioner who was his primary treatment provider from April

2005 through August 2007 but who is not an "acceptable medical

source" for purposes of establishing his impairment.       See id.

To overcome this evidentiary hurdle, plaintiff invoked SSR 06-

03p, which recognizes that the treatment notes and opinions of

non-physician medical care providers, such as nurse


                                     6
practitioners, "are important and should be evaluated on key

issues such as impairment severity and functional effects, along

with other relevant evidence in the file."    SSR 06-03p.   These

opinions provide context in which to weigh the opinions of

"acceptable medical sources," to assess what is contradicted and

what is supported by all the evidence in the record.    See id.3

     SSR 06-03p provides that the weight to be given "other

sources" of evidence varies depending on the facts of a case,

including, among other factors, the source of the opinion, the

source's qualifications, and the issue(s) that the opinion is

about.   See id.   The same factors that determine how much weight

should be given an "acceptable medical source" opinion apply to

evaluate the weight to be given an "other source" opinion, like



     3SSR 06-03p provides in relevant part:   "The term 'medical
sources' refers to both 'acceptable medical sources' and other
health care providers who are not 'acceptable medical sources.'
See 20 C.F.R. 404.1502 & 416.902.. . . The distinction between
'acceptable medical sources' and other health care providers who
are not 'acceptable medical sources' is necessary for three
reasons.   First, we need evidence from 'acceptable medical
sources' to establish the existence of a medically determinable
impairment.   See 20 C.F.R. 404.1513(a) & 416.913(a). Second,
only 'acceptable medical sources' can give us medical opinions.
See 20 C.F.R. 404.1527(a)(2) & 416.927(a)(2). Third, only
'acceptable medical sources' can be considered treating sources,
as defined in 20 C.F.R. 404.1502 & 416.902, whose medical
opinions may be entitled to controlling weight.    See 20 C.F.R.
404.1527(d) and 416.927(d)."

                                  7
the opinion of NP Blight at issue here:

               - length and frequency of treatment;
               - consistency with other evidence;
               - relevant evidence to support the opinion;
               - how well the opinion is explained;
               - whether the source has a specialty or
                    area of expertise related to the
                    claimant's impairment; and
               - any other factors that tend to support
                    or refute the opinion.

In some circumstances, the "other" medical source's opinion may

be given more weight if the provider has seen the claimant more

frequently than the "acceptable" medical source, has provided

better supporting evidence, and has better explained the opinion.

See id.   Finally, SSR 06-03p provides that the adjudicator should

explain the weight given to the opinion of these "other sources"

in assessing disability, to ensure that the decision reveals the

adjudicator's reasoning.

     The record demonstrates that, contrary to plaintiff's

assertion in support of his motion to reverse, the ALJ followed

the policy guidelines of SSR 06-03p in evaluating the weight to

be given NP Blight's opinion.   The ALJ described NP Blight's

opinion as follows:

          ARNP Blight did add additional limitations
          in a Medical Source Statement completed [in
          September 2007], but this source is not an
          acceptable medical source. Moreover, her
          assertion that the claimant was unable
          to sit for more than 30 minutes as well
          as her description of the claimant's
          limitations with regard to stand[ing] and
          walking are not supported by any findings
          by a treating or examining physician.
          The undersigned affords little weight to
          the opinion of ARNP Blight and significant
          weight to the opinion of Dr. Claussen in
          forming the conclusions set forth above.

CR at 20; see also CR at 17 (summarizing NP Blight's findings).

This explanation shows that the ALJ did consider NP Blight's

opinion, in light of the entire record, to determine what insight

it provided about the severity of plaintiff's alleged disability

and its impact on his ability to function.    The ALJ found that

her opinion was not supported by "any findings of a treating or

examining physician"   (emphasis added).

     The ALJ's conclusion that NP Blight's opinion is not

consistent with any treating or examining physician is supported

by the record.   Although Dr. Claussen agreed with NP Blight with

respect to the limited weight plaintiff could carry, see CR at

363, Dr. Claussen gave no opinion about the limitation on sitting

and standing or on operating foot and hand controls and, instead,

simply opined that plaintiff could not perform his prior work as

an HVAC technician because of the physical demands of the job.

See id.   That point is undisputed.   Drs. Hockman and O'Connell

                                 9
both treated plaintiff for the pain caused by his back problems4,

and, like Dr. Claussen, concluded he could not continue to work

as he had in the past but gave no opinion about other limits on

his functionality that would support NP Blight's assessment in

September 2007.   See CR at 203-07, 216, 363.    In February 2007,

Dr. Hockman noted that plaintiff was "ready to retire," but

advised him that he needed an RFC "in order to be able to tell

exactly what he was capable of doing and not."    CR at 304.   As

treating physicians, these doctors' opinions were weighed most

heavily.   See 

(d)(2).5

     Similarly, Drs. Dion and Masewic both evaluated plaintiff as

part of his application for disability benefits and found he




     4In fact NP Blight referred plaintiff to these doctors for
their specialized care.  See CR at 134, 216 & 203.

     5Plaintiff argues a long-term disability claim form filled
out in January 2007 jointly by NP Blight and Dr. Claussen is
evidence that supports NP Blight's September 2007 RFC assessment.
That claim form states that plaintiff was permanently disabled
from continuing his former work and also states that he was not a
candidate for rehabilitation.  See CR at 342. Plaintiff argues
that means he could not be rehabilitated to another occupation;
however, the form does not make that connection either directly
or even indirectly, but rather gives rise to the inference that
he was not a candidate for rehabilitation to his former work.   In
fact, the doctors wrote that it was "unknown" whether plaintiff
was or would continue to be unable to work at another occupation.
See 

                                10
could not return to his former work, but either provided no

opinion on his functionality or assessed it much greater than NP

Blight had.     See CR at 117-24, 372-75.   These opinions, as non­

treating physicians, provide further evidence in support of the

ALJ's conclusion.     See Gordils v. Sec' of Health & Human Svcs,

 (1st Cir. 1990)      (combining the opinions of

consulting doctors to find substantial evidence).       Finally, the

notes from these treating and examining physicians all indicate

that, despite plaintiff's persistent and significant back pain,

he remained neurologically intact, with a steady gait and normal

motor and sensory function.     See CR at 205 (Dr. O'Connell), 216

(Dr. Hockman)    363 (Dr. Claussen), 373 (Dr. Dion) & 376 (Dr. Hu).6

This objective medical evidence simply does not support NP

Blight's opinion about plaintiff's limited ability to sit, stand,

or use his hands and feet, see CR at 366-67, and the ALJ followed




     6Between plaintiff's August 2002 back surgery and his
October 31, 2006 alleged onset date, plaintiff was seen by at
least three different doctors, at the Veteran's Administration
and the Pain Management Center, all of whom determined that he
had no sensory abnormalities in the lower extremities, no motor
deficits and intact reflexes.   See JS at 4-6. While this
evidence predates plaintiff's alleged onset date, the consistency
of the diagnosis substantiates the ALJ's determination that NP
Blight's opinion should not be accorded much weight because it
was not supported by other evidence in the record.

                                  11
SSR 06-03p when he chose to discount her opinion accordingly.

     The record further supports the ALJ's decision not to weigh

NP Blight's opinion heavily because it did not meet several of

the criteria outlined in SSR 06-03p that justify giving the

opinion greater weight.   Specifically, NP Blight was not a

specialist and did not have an area of expertise in back pain,

but instead is a nurse practitioner in a family medicine general

practice group, and her treatment notes and referral letters

reflect her general primary care.     See CR at 245-348   (treating

plaintiff for a variety of medical problems, including colon

polyps, gallstones, cataracts, pain management, alcohol abuse and

cardiac care).   Her opinion of September 2007 is neither well

explained nor well supported by other relevant evidence.       She

simply filled out a form "Medical Source Statement of Ability to

do Work-Related Activities   (Physical)."   CR at 365.    There are no

notes, x-rays, laboratory results or test results that

substantiate her findings.   Since NP Blight's opinion was not

consistent with other opinions in the record, nor was it well

explained or supported with other objective medical evidence, the

ALJ appropriately discounted her opinion.     His assessment of the

evidence must control when, as is the case here, there is nothing



                                 12
in the record that demonstrates a legal or factual error.      See

Manso-Pizarro, 

.

            b.   Credibility Assessment

        Plaintiff next challenges the ALJ's finding that his

complaints of pain were not credible.     He argues the ALJ ignored

certain evidence and failed to consider other evidence, and erred

when he evaluated plaintiff's complaints according to the factors

set forth in Avery v. Sec'v of HHS, 

 (1st Cir. 1986),

and in the regulations, citing 

(c)(3) and SSR

96-7p.    Although the record contains multiple notes regarding

plaintiff's pain associated with his lower back, the Commissioner

is responsible for resolving issues of credibility, and deference

is accorded those determinations unless they are not supported by

substantial evidence.     See Rodriguez, 

; see also

Ortiz v. Sec'v of HHS, 

 (1st Cir. 1989)

(deferring to the ALJ's assessment of subjective complaints of

pain); Frustaqlia v. Sec'v of HHS, 

 (1st Cir.

1987)    (deferring to the ALJ who heard the testimony and observed

the claimant).    My review of the record leads to the conclusion

that the ALJ's findings are supported by substantial evidence.

        The evidence shows that because plaintiff's impairment did


                                  13
not meet or equal the listing criteria for a spine disorder

disability, his RFC needed to be assessed to determine the

effects of his impairment and any additional limitations imposed

by pain on his capacity to perform either his former work or

other work.   See Avery, 797 F.2d at 28.    Plaintiff asserts that

his subjective feeling of pain is greater than the objective

medical findings of his limitations.   In such circumstances,

several factors need to be considered to assess the pain and its

allegedly disabling severity.   See id.    The ALJ is required to

consider the claimant's work history and obtain information

about:   the nature, location, onset, duration, frequency,

radiation and intensity of any pain; precipitating and

aggravating factors, such as movement, activity and environmental

conditions; type, dosage, effectiveness and adverse side-effects

of any pain medication; treatment, other than medication,    for the

pain; functional restrictions; and the claimant's daily

activities.   See id. at 29; see also Mandziei v. Chater, 

 (D.N.H. 1996); 20 C.F.R. §§ §404.1529(c )(3).

"In evaluating a claimant's subjective complaints of pain, the

adjudicator must give full consideration to all of the available

evidence, medical and other, that reflects on the impairment and



                                14
any attendant limitations of function."   Avery, 797 F.2d at 29.

     The ALJ's decision demonstrates that he followed the Avery

guidelines and the regulations in evaluating plaintiff's alleged

disabling pain.   The ALJ considered all of plaintiff's symptoms

and the extent to which they were consistent with the objective

medical evidence, other evidence, and the opinion evidence, based

on the requirements of 

 & 404.1527 and SSRs

96-2p, 96-4p, 96-5p, 96-6p, 96-7p and 06-3p.   See CR at 18.   He

specifically noted that "whenever statements about the intensity,

persistence, or functionally limiting effects of pain or other

symptoms are not substantiated by objective medical evidence, the

[ALJ] must make a finding on the credibility of the statements

based on a consideration of the entire case record."   CR at 18.

To that end, the ALJ evaluated plaintiff's prior work record, his

activities of daily life ("ADL"), the location, duration,

frequency and intensity of his pain, factors that precipitate or

aggravate the symptoms, what medications plaintiff was taking to

alleviate the pain, what treatment other than medication

plaintiff had received to reduce the pain, any non-treatment

measures plaintiff had pursued to relieve his pain, and finally

any other factors concerning his functional limitations and



                                15
restrictions due his pain and other symptoms.    See CR at 19.

     The ALJ concluded that plaintiff's "statements about the

intensity, persistence and limiting effects of the symptoms

[were] not entirely credible."   

   As the ALJ explained:

          (i) he has been consistently found to have
          normal motor and sensory function as well
          as a steady gait; (ii) he did not follow Dr.
          Hockman's February 2007 recommendation to
          obtain an RFC assessment to determine what
          other work he could do; (iii) he reported
          to Dr. Claussen that he could lift as much
          as 40 pounds, though she determined he should
          not lift more than 20 pounds; (iv) his credibility
          was undermined by his continued abuse of alcohol
          and his statements to Dr. Robinson that he was
          looking for ways to obtain [SSDI] benefits, to
          Dr. Hockman that he was ready to retire, and to
          Dr. Gustavson that he had been advised he would
          end up in a wheelchair, although no evidence in
          the record supported that statement; and (v) his
          credibility was further undermined by the
          discrepancies between his reported ADL, his
          testimony and his statements to Dr. Claussen.

See CR at 19-20.   Because plaintiff did not suffer from any

neurologically identifiable problems, the alleged severity of his

pain was questionable.   See 20 C.F.R. Appendix 1, Listing 1.04;

see also CR at 17-18.7   The ALJ noted that plaintiff had declined



     7The ALJ found that the medical evidence established that
plaintiff has a severe impairment resulting from his low back
pain status following his lumbar surgery in August 2002 which
affected his ability to perform basic work functions such as
lifting and carrying, but that the impairment did not satisfy the

                                 16
to follow the various doctors' recommendations, such as obtaining

an RFC assessment and controlling his alcohol abuse, which was

consistently identified throughout the record as being a major

impediment to the effectiveness of prescription pain medication.

Finally, the ALJ was not convinced by the alleged severity of

plaintiff's pain when he continued to engage in many ADLs with no

assistance and yet evinced minimal desire to help himself, by

either pursuing vocational education or managing his alcohol

intake.   All of these findings are supported by the record.

     None of plaintiff's arguments demonstrates that critical

evidence was overlooked or not considered by the ALJ.    Though

plaintiff points to his long record of working as proof of his

good work ethic, it was undisputed he could not return to his

former work and yet the record contains no evidence that he had

done anything to find other work.    See e.g. CR at 125-38

(plaintiff's 2007 SSI Disability self-report in which he asks the

SSA to find him another job and admits to not having participated

in any job programs), 216 (Dr. Hockman's August 2006 advice that



criteria for a spine disorder set forth in Appendix 1,   Listing
1.04, because plaintiff was consistently noted to have   normal
sensory and reflex function, was fully weight bearing,   and MRI
testing in October 2007 showed no significant stenosis   and no
evidence of disc herniation. See CR at 17-18.

                                17
plaintiff "become active about his pain" and "change the way he

does his job" to see if that helps), 291-92, 301 & 342           (NP Blight

and Dr. Claussen's opinions in October 2006 and January 2007 that

plaintiff could not continue his HVAC work but it was "unknown"

whether he could do other jobs), 304           (Dr. Hockman's February 2007

recommendation that plaintiff get an RFC to determine what he was

capable of doing after quitting his HVAC work which plaintiff did

not do), 359 (plaintiff's July 2007 letter seeking long term

disability coverage because he could not return to his former

work).     This record suggests plaintiff was not very committed to

pursuing a new career that accommodated his physical limitations.

The ALJ reasonably could have perceived that this attitude, more

than his alleged pain, impeded his efforts to find other work.

     Plaintiff next argues his ADLs bolster his credibility that

his pain level precludes him from engaging in substantial gainful

activity.     Plaintiff, however, has not identified any activities

or limitations that the ALJ misunderstood or overlooked.            To the

contrary, the ALJ listed many of the same limited activities that

plaintiff reported in December 2006 and testified to at the

hearing.    C f . CR at 19 & 101-08.        By plaintiff's own admission,

though his back problems precluded him from doing strenuous



                                       18
physical labor, they did not prevent him from caring for himself

independently, doing light housework and simple cooking, walking

and driving a car alone, shopping, socializing, and managing his

financial affairs.   See 

    Also, though plaintiff was limited

in his ability to do a variety of physical movements that would

have been required to continue performing strenuous manual labor,

like bending, squatting and lifting, he described himself as able

to   always follow both oral and written instructions, constantly

pay attention, and handle both stress and changes in routine

fine.   See CR at 106-07.   While plaintiff's back problems and

associated pain required him to change jobs, this evidence of his

ADLs does not support his claim that his pain was so intense and

severe that he could not engage in other work.8      C f . Allred v.

Heckler, 

    (8th Cir. 1984)   (objective medical




     8Plaintiff argues he is not required to show total
incapacity to be determined unable to engage in substantial
gainful activity. While this proposition correctly states the
law, the cases cited in support of his argument for reversal are
not persuasive because the facts are distinguishable.   See
Hatfield v. Apfel, No. CIV. A. 94-1295-JTM, 

, *7
(D.Kan. Mar. 3, 1998) (erroneous assessment of pain where ADLs
did not indicate how much plaintiff could sit or stand during the
day, which activities were required in her past relevant work);
see also Baumqarten v. Chater, 

 (8th Cir. 1996)
(reversing ALJ because inconsistencies relied on to discount
plaintiff's credibility were not supported by the record).

                                  19
evidence and consistent medical opinions found plaintiff "totally

disabled from any physical activities") .    The ALJ's finding that

plaintiff's complaints were not entirely credible based on his

ADLs is substantiated by the record.

     Plaintiff also asserts the ALJ failed to fully consider the

location, duration, frequency and intensity of his pain and its

precipitating and aggravating factors, as Avery requires.       He

contends the ALJ only superficially reviewed the record of his

pain symptoms because he had been consistently found to have

normal motor and sensory functioning and a steady gait.       In fact,

the ALJ discussed plaintiff's entire history of back problems,

beginning with the original injury sustained while serving in the

military through Dr. Dion's October 2007 pain consultation, and

specifically recognized the limitations his back pain caused.

See CR at 16-17.    The undisputed record demonstrates that

plaintiff suffered a severe impairment to his lower back which

has caused persistent pain for many years.     The ALJ recognized

this established pattern, and it is well-supported by the entire

medical record.    The record is replete, however, with notes that

plaintiff's alcohol abuse has prevented him from effectively

treating his pain with prescription medication.     See e.g. CR at



                                 20
152 (Dr. Ahn in August 2002), 178 (Dr. Sievers in November 2003),

264   (Dr. O'Connell in December 2005), 247, 250, 280 (NP Blight on

several occasions), 272   (Dr. Campbell in February 2006), 219 (Dr.

Gustavson in February 2007), 307 (Dr. Mattin in February 2007) &

372   (Dr. Dion in October 2007).    As nearly every medical care

provider who evaluated or treated plaintiff told him he needed to

reduce his alcohol intake to better manage his pain, the ALJ

reasonably could have concluded that plaintiff was sabotaging the

efforts at pain management with his alcohol abuse and was free to

discount his reported pain accordingly.        See 

(requiring claimant to follow prescribed treatment and finding no

disability if not followed "without a good reason").

      Plaintiff next challenges the ALJ's credibility analysis by

contending he neglected to account for the ineffectiveness of the

numerous treatments plaintiff had pursued, including medication,

physical therapy, prescription drug and botox injections, and

several non-medical treatments such as heating pads, stretching,

massages and avoiding pain triggers.        Plaintiff correctly argues

the record demonstrates how little success these various methods

provided in alleviating his pain.        See CR at 291 & 373 (summaries

of his treatment history).    Yet the record also demonstrates that



                                    21
after he stopped working as an HVAC technician, his pain

lessened.     See CR at 301.   In October 2007, Dr. Dion opined that

pain management treatment should decrease plaintiff's overall

disability, and he identified the first goal of treatment as

being to "improve overall functionality and quality of life with

use of medications, physical therapy, lifestyle modifications

with decreased alcohol intake and smoking cessation."      CR at 375.

The ALJ is required to weigh the evidence, and nothing in the

record undermines the conclusion that because plaintiff's pain

symptoms had reduced after he stopped working as an HVAC

technician, they could continue to improve so long as he avoided

similar manual labor that aggravated his condition, stopped

abusing alcohol, and followed the treatment directives of his

medical care providers.

     While the record contains evidence which shows plaintiff in

fact endured back pain, it also substantiates the ALJ's finding

that plaintiff was not entirely credible in his reports about the

severity of that pain.     In making factual findings, the ALJ must

weigh the evidence and evaluate credibility, to which the court

must defer unless those decisions are not supported by the

record.     See Frustaqlia, 820 F.2d at 195; see also 

1529(c)    (explaining how symptoms of pain are evaluated).       Since I

must defer to the credibility determinations drawn by the ALJ as

long as they are not inconsistent with the weight of the

evidence, plaintiff's reported pain must be accepted as not

entirely credible, and the ALJ's decision to that effect is

conclusive.      See Ortiz, 

.

            c.   RFC Determination

     The ALJ found that although plaintiff was unable to perform

any past relevant work, see 

, he retained the RFC

to perform a full range of light work.         See CR at 20.   Plaintiff

contends he is unable to perform the full range of light work on

a sustained basis, as evidenced by NP Blight's assessment and his

symptoms of pain.     As discussed supra, the ALJ's decision to

discount both NP Blight's assessment and his symptoms of pain is

supported by the record and, therefore, controls.         Since the

record supports the ALJ's decisions about NP Blight's opinion and

plaintiff's credibility, the ALJ's RFC assessment readily

follows.

     Plaintiff argues this RFC is not supported by substantial

evidence in light of the factors set forth in SSR 96-8p.          SSR 96-

8p interprets the SSA's policy on how to determine a claimant's


                                     23
RFC initially, and provides in relevant part:

          Ordinarily, RFC is an assessment of an
          individual's ability to do sustained work-related physical and mental activities in
          a work setting on a regular and continuing
          basis. A "regular and continuing basis"
          means 8 hours a day, for 5 days a week, or
          an equivalent work schedule.. . .

          The RFC assessment must first identify the
          individual's functional limitations or
          restrictions and assess his other work-related abilities on a function-by-function
          basis, including the functions in paragraphs
           (b), (c), and (d) of 

 and
          416.945.   Only after that may RFC be expressed
          in terms of the extertional levels of work,
          sedentary, light, medium, heavy and very heavy.. . .

          Ordinarily, RFC is the individual's maximum
          remaining ability to do sustained work activities
          in an ordinary work setting on a regular and
          continuing basis, and the RFC assessment must
          include a discussion of the individual's
          abilities on that basis.

          The Act requires that an individual's inability
          to work must result from the individual's physical
          or mental impairment(s). Therefore, in assessing
          RFC, the adjudicator must consider only limitations
          and restrictions attributable to medically determinable
          impairments.  It is incorrect to find that an
          individual has limitations or restrictions beyond
          those caused by his or her medical impairment(s)
          including any related symptoms, such as pain, due
          to factors such as age or height, or whether the
          individual had ever engaged in certain activities
          in his or her past relevant work (e.g. lifting heavy
          weights). Age and body habitus . . . are not factors
          in assessing RFC initial claims.


                               24
SSR 96-8p, 

    (S.S.A. July 2, 1996)   (emphasis in

original).   The ruling sets forth the exertional and non-

exertional factors to be considered, that include both physical

and mental capabilities.     See 

     Once again the    record supports the ALJ's findings.     As

discussed at length     above, the ALJ reviewed the evidence

concerning plaintiff's medical history, including laboratory

findings and other objective medical evidence, the effects of

treatment, the various medical source statements, plaintiff's

ADLs, his reports of pain and his attempts to work.       See CR at

18-20; see also SSR      96-8p (listing evidence to be considered in

assessing RFC)9; 

(a)   (setting forth howRFC

is determined).     The ALJ specifically addressed plaintiff's

medically determinable mental impairment of alcohol abuse,

discussed the relevant functional areas, and concluded it was

only a nonsevere impairment.     See CR at 17-18.    That decision is

directly supported by the opinions of Drs. Gustavson and Martin.

See CR at 217-39.     He then proceeded through the analysis of




     9Other evidence that could be considered but was not part of
the record here includes lay evidence, recorded observations,
need for a structured living environment, and work evaluations.
See SSR 96-8p.

                                   25
plaintiff's medically determinable severe physical impairment,

and also addressed how his back problem affected his functioning.

See id. at 19-20.   While the ALJ did not explicitly address each

functional limitation on his physical and mental abilities listed

in the regulations, see 

(b)   & (c) and SSR 96-

8p, the record contained RFC assessments done by plaintiff. Dr.

Masewic and Dr. Martin which support the ALJ's conclusion that

plaintiff retained the ability to perform light duty work.10

Only NP Blight opined that plaintiff had greater limitations on

his ability to sit, stand, reach and pull, yet her assessment of

plaintiff's most significant restriction -- that he was limited

to lifting and carrying only 10 pounds frequently and 20 pounds

occasionally and never greater than that -- is actually

consistent with the findings of the other medical evaluators.



     10The regulations require the ALJ to assess a claimant's
physical function by looking at the ability to sit, stand, walk,
lift, carry, push, pull or other manipulative or postural
functions, like reaching, handling, stooping or crouching, and
mental function by considering the ability to understand,
remember and carry out instructions, and to respond appropriately
to supervision, co-workers and work pressures in a work setting.
See 

(b) & (c). The record contains evidence
of plaintiff's ability to perform these various functions.    See
CR at 101-09 (plaintiff's self-report), 117-24 (Dr. Masewic's
physical RFC assessment), 217-21 (Dr. Gustavson's mental
disability evaluation), 222-38 (Dr. Martin's mental RFC
assessment) and 365-70 (NP Blight's RFC assessment).

                                26
     Accordingly, the ALJ did not err when he found, based on the

evidence before him, that plaintiff retained the RFC to do light

duty work.   Light duty work is defined as involving lifting no

more than 20 pounds at a time, with frequent lifting or carrying

only 10 pounds, and includes sedentary work unless there are

other limiting factors such as loss of fine dexterity or

inability to sit for long periods of time.   See 

(b).   The evidence consistently showed that although

plaintiff could not continue to do any type of heavy manual

labor, he remains cognitively sharp, able to conduct himself

appropriately in a work-like environment, with some exertional

limitations, only minimal postural limitations, and no

manipulative, visual or communicative limitations.   See CR at

118-21, 219, 238.   Plaintiff has not identified anything in the

record that undermines the ALJ's conclusion or otherwise suggests

that plaintiff could not sustain a light duty job for a regular

work week.   There is substantial evidence in the record that

plaintiff retained the RFC to perform the full range of light

work.

     2.   Step 5 Analysis

     With substantial evidence supporting the ALJ's findings



                                27
about plaintiff's RFC, the step 5 analysis is straight forward.

See 

(g)   (considering RFC together with claimant's

age, education and work experience to determine if an adjustment

to other work may be made).     In order to support a finding that

plaintiff is not disabled at step 5, the SSA was "responsible for

providing evidence that demonstrates that other work exists in

significant numbers in the national economy that plaintiff can

do, given [his RFC] and vocational factors."     

 § 404.1560(c) .

The ALJ properly combined plaintiff's RFC to perform the full

range of light duty work with the vocational factors of his

"closely approaching advanced age," his high school education and

ability to communicate in English to assess whether plaintiff was

disabled.    See CR at 20-21.   When, as is the case here, plaintiff

is not engaged in substantial gainful activity and had a severe

medically determinable impairment that prevented him from doing

his past relevant work, the regulations direct the ALJ to

Appendix 2, which provides rules to determine disability based on

functional and vocational patternsof jobs in the national

economy.    See 

    (explaining how Appendix 2 is

used to determine whether jobs are     available given a particular

functional and vocational profile).



                                  28
     The rules in Appendix 2 dictate the result here.        See 

("if the findings of fact made about all factors are the same         as

the rule, we use that rule to decide whether a person is

disabled").   Table 2 sets forth the rules that govern      when a

claimant has an RFC,   like plaintiff, limited to light     work as a

result of a severe medically determinable impairment.        See 20

C.F.R. P t . 404, Subpt. P, A p p . 2, Table No. 2.   Plaintiff was

"closely approaching advanced age" at the alleged onset date of

his disability, see 

(d), with a GED and the

ability to speak in English, see 

 § 404.1564(b)(4) & (5).

Those factors placed plaintiff within Rules 202.13-15 of Appendix

2, which rules vary depending on whether a claimant's previous

work experience render the claimant unskilled or skilled and, if

skilled, whether those skills are transferrable.       Under each rule

a claimant is considered not disabled, regardless of his skill

level.   See 20 C.F.R. P t . 404, Subpt. P, App. 2, Table No. 2,

Rules 202.13, 202.14 & 202.15.

     The ALJ correctly concluded that "transferability of job

skills [was] not material to the determination of disability

because applying the Medical-Vocational Rules directly supports a

finding of 'not disabled,' whether or not the claimant has



                                   29
transferable job skills."    CR at 20; see also id.     Because the

ALJ also found that plaintiff was only able to perform light duty

work, the skills he acquired as an HVAC technician presumably

would not have been transferrable and also, therefore, would not

have been relevant to a determination of what jobs existed in the

national economy given his functional and vocational profile.

See 

    ("if you cannot use your skills [from

your work experience] in other skilled or semi-skilled work, we

will consider your work background the same as unskilled").

Under these circumstances, where plaintiff did not have

transferrable skills, the ALJ properly applied Rule 202.14, which

applies to claimants with non-transferrable skills and requires a

determination of "not disabled."       See CR at 21 (citing Medical-

Vocational Rule 202.14).

     Plaintiff argues the ALJ's decision is not supported by

substantial evidence because he did not have the RFC to perform

the full range of light work and, therefore, the ALJ erroneously

relied on Rule 202.14 to find he was not disabled.       As discussed

at length above, the ALJ's assessment of plaintiff's RFC is

supported by substantial evidence and, as a result, that finding

must be accepted.   See Rodriquez, 

     (requiring the



                                  30
court only to determine whether the ALJ's decision is supported

by substantial evidence, not to agree with it).     Given

plaintiff's RFC and his other vocational factors. Rule 202.14

governs, and the ALJ's decision that plaintiff is not disabled

must be upheld.   See Ortiz, 

 (ALJ's factual

findings are conclusive if supported by substantial evidence);

see also Manso-Pizarro, 

 (upholding ALJ's denial of

benefits absent legal or factual error).

                            Conclusion

     For the reasons set forth above, I recommend that

plaintiff's Motion to Reverse   (document no. 7) be denied and

defendant's Motion to Affirm (document no. 9) be granted.

     Any objections to this report and recommendation must be

filed within ten (10) days of receipt of this notice.       Failure to

file objections within the specified time waives the right to

appeal the district court's order.    See Unauthorized Practice of

Law Comm, v. Gordon, 

    (1st Cir. 1992);

United States v. Valencia-Copete, 

 (1st Cir. 1986).




                                 mhn R. Muirhead          V
                                 rib-ed States Magistrate Judge

                                 31
Date:     June 12, 2009

cc:     Raymond J. Kelly, Esq.
        T. David Plourde, Esq.




                                 32