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Heino v. Astrue

August 27, 2009


Appeal from the United States District Court for the Northern District of Iowa.

The opinion of the court was delivered by: Smith, Circuit Judge.

Submitted: May 12, 2009

Before RILEY, SMITH, and COLLOTON, Circuit Judges.

Rena L. Heino appeals from the district court's*fn1 affirmance of the administrative law judge's (ALJ) denial of Heino's applications for disability insurance benefits (DIB) and social security income (SSI). Heino raises a number of arguments, each of which we address below. After careful review, we affirm the district court.

I. Background

Rena L. Heino, age 26, applied for DIB and SSI on December 5, 2003. She alleged a disability onset date of March 31, 2002, stating that she could not work because of migraine headaches, obesity, fibromyalgia with severe pain, a torn rotator cuff in her left shoulder, asthma, osteoarthritis in the hips and knees, and knee problems due to her weight and injuries sustained in a motor vehicle accident. When she applied for DIB and SSI, Heino was 5'1" tall and weighed 230 pounds, down from a high of 325 pounds. Her past surgeries included a gastric bypass and knee replacement. She reported that her migraine headaches occurred several times a week and previously required hospitalization for several days. The Social Security Administration (SSA) denied Heino's benefit claims, and Heino filed a request for a hearing before an ALJ.

Following a hearing, the ALJ found that Heino had a history of obesity for which she underwent gastric bypass surgery in 1999. According to the ALJ, Heino lost much weight after the surgery as intended but unfortunately gained it back due to stress at home. The ALJ also noted that Heino suffered from subacromial bursitis and had a dislocated left shoulder from a car wreck in December 1998. Heino had been treated with an acromioplasty in March 1999. In May 2003, she had normal strength in the shoulder, but a few weeks later she had decreased strength and range of motion but no complaint of pain. A magnetic resonance imaging gave no indication of a tear or impingement. In July 2003, Heino received an injection of xylocaine and Depo Medrol for pain with apparently good results.

Heino also injured her left knee in the December 1998 car wreck and reinjured the knee during a subsequent fall. Because the knee showed substantial cartilage degeneration, Heino underwent a full knee replacement in July 2003. Heino recovered well and, by December 2003, was walking "two miles three to four times daily." In March 2006, she had to undergo a surgical knee treatment under anesthesia due to increasing pain.

Additionally, Heino has bronchial asthma that is controlled with inhalers. She also has complained of headaches, including migraines. According to the ALJ's assessment of the medical record, Heino's migraine headaches are infrequent. The medical evidence indicated that Heino has degenerative disc disease in the cervical and lumbar spine. But examining physicians have deemed her muscle strength in her arms and legs, motor strength, and reflexes normal. Heino also has emotional impairments. She has a history of situational depression that was exacerbated by the birth of twins, for whom she is the sole caregiver. She also has a history of post-traumatic stress disorder.

The ALJ noted that Heino's impairments are severe, limiting her to the performance of low stress work, and that she has only "fair ability to handle complex work." But the ALJ nonetheless concluded that "she is only mildly restricted in her activities of daily living" and has "mild difficulties maintaining concentration, persistence and pace."

The ALJ characterized Heino's description of her limitations as follows:

[Heino testified that] she could lift less than 10 pounds and that she could not carry a gallon of milk, which weighs about eight pounds. She indicated that she could walk one or two blocks but that she could not negotiate stairs. She stated that she used a walker and that when shopping would need to sit and rest at least once. She indicated that she could stand for only a couple of minutes and that her knees were not stable. It was her testimony that she could sit for a maximum of 30 minutes and that because of her weight she could not sit comfortably in a chair. She reported that she could bend, stoop and squat to some degree but not when her back went out. She indicated further that she could reach with her left arm, did not have a good enough grip to allow her to open jars and experienced stiffness and soreness in her fingers when typing on a computer. She alleged problems with pushing, pulling and reaching as well.

In her description of her mental capabilities, the claimant testified that she had poor short term memory resulting in difficulty remembering the various tasks that she needed to do. She alleged that her pain caused difficulty with her concentration and that she could not stay focused and complete tasks. She denied any difficulty relating to the people with whom she had contact at work but admitted that she did have arguments with her husband, apparently regarding her children. She has entertained thoughts of harming herself and at times has taken too much medication, allegedly because of her pain. She spoke as well of post traumatic stress disorder related to abuse as a child and to an abandonment disorder as an infant, with anxiety attacks multiple times each week.

Dr. Gary J. Cromer, a medical consultant with the Disability Determination Services of Iowa, found that Heino "could meet the exertional demands of light work." Dr. Cromer found that she "could climb, balance, stoop, kneel and crouch occasionally." He concluded that Heino "could reach only occasionally with her left arm and that she had no other problems with manipulation." He also opined that Heino "did not have any visual, communicative or environment limitations."

Dr. Claro T. Palma treated Heino for pain and completed a residual functional capacity (RFC) assessment on October 21, 2005. Dr. Palma opined that Heino "could walk less than one block at a time" and "could sit for 30 minutes at a time and for a total of about two hours in an eight-hour workday and could stand for 15 minutes at a time and stand/walk for a total of less than two hours in an eight-hour workday." He opined that she "would have to walk about for five minutes every 30 minutes and would need to be allowed to shift positions at will from sitting, standing or walking." He stated that "at times she would need to take unscheduled breaks during the day." He also concluded that "she could lift less than 10 pounds and then only occasionally." "[S]he was significantly limited in repetitive reaching, handling and fingering, could stoop for 10% of an eight-hour day but could not crouch at all."

The ALJ discounted Dr. Palma's conclusion of significant limitations, noting that Dr. Palma's own treatment records did not support his opinions. The ALJ observed that the treatment records indicated that as of January 31, 2005, the claimant had normal motion in all joints except for the left hip and both knees and only mild pain. In addition, she did not have any difficulty with normal daily activities except for getting into and out of an automobile, running errands and shopping, which caused problems but which she could still do.

Dr. Raja M. Junaid, a psychiatrist, assessed Heino's RFC. The ALJ characterized Dr. Junaid's conclusions as follows:

[Heino] would probably be absent from work more than three times a month because of her impairments or treatment and overall, that she had only fair ability to function. More specifically, he felt that she had fair ability to remember work-like procedures, maintain attention for two hours at a time, maintain regular attendance, be punctual, work without special supervision, work in proximity to others without being unduly distracted, accept instructions, respond appropriately to criticism, get along with co-workers, respond appropriately to work changes, deal with normal work stress and be aware of normal hazards and take appropriate precautions. Dr. Junaid indicated further that the claimant had fair ability to do semi-skilled or skilled work if she took her medication. He noted as well that she had fair ability to interact with the general public, adhere to basic standards of neatness and cleanliness and travel in ...

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