Sandy A. Johnston appeals from a final order entered in the District Court 1 for the Western. District of Missouri affirming the decision of the Social Security Administration denying her claim for supplemental security income (SSI) benefits under Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq. Johnston v. Apfel, No. 97-1083-CV-W-66BA-SSA (W.D.Mo. Mar. 11, 1999) (district court order). For reversal, Johnston argues that the ALJ erred .in (1) using the wrong standard at step two. of the sequential analysis to evaluate the severity of her impairments and in finding that she did.not suffer from a severe impairment or combination of impairments, (2) finding her thyroid-related eye disease did not meet Listing 9.02(A), and (3) discounting her credibility in evaluating the severity of her subjective complaints. For the reasons discussed below, we affirm the order of the district court.
The district court had jurisdiction to review the final decision of the Social Security Administration under 42 U.S.C. § 1383(c)(3) (judicial review of final decision of Social Security Administration under Title XVI). We have appellate jurisdiction under 28 U.S.C. § 1291.
Johnston applied for SSI benefits in July 1995, claiming that she became disabled in January 1995 due to complications from hyperthyroidism (Grave’s disease) (she was diagnosed with hyperthyroidism in May 1995) and heart problems. Her application was denied initially and on reconsideration. She then requested a hearing before an administrative law judge (ALJ). After the hearing, the ALJ found that Johnston did not suffer from a severe impairment and denied her claim. The Appeals Council affirmed the decision of the ALJ. Johnston then sought judicial review in federal district court. The district court affirmed the decision of the ALJ. This appeal followed.
As noted above, Johnston filed an application for SSI benefits in July 1995, claiming that she became disabled in January 1995 due to complications from hyperthyroidism and heart problems. She complained of the following symptoms and medication side effects — headaches, blurred vision, double vision, chest pain, forgetfulness, mood swings, panic attacks, uncontrollable and unpredictable crying spells, body aches, swelling, weight gain, fatigue, and inability to concentrate. Johnston has been working since 1975; however, as noted by the ALJ, her employment record is sporadic. She has not worked at any one job for more than a few months at a time (her longest period of employment was for 7 months). Most of her jobs lasted only 1 to 4 months. The ALJ found that her work history reflected little or no motivation to work. Her husband supported her during their marriаge; she never earned more than $3,500 in any year and apparently earned as little as $100 per year for most years.
Johnston underwent successful treatment (radio-iodine ablation therapy which deactivated the thyroid gland) for her hyperthyroidism and takes a synthetic thyroid hormone. It took several months to adjust the dosage, but her thyrоid level is now normal. Johnston has eye problems caused by her hyperthyroidism, specifically, active thyroid-related orbitopathy, peri-orbital swelling, exophthalmos (protrusion of the eyeballs), fat herniation in the lids, and chronic exposure keratitis (due to the protrusion of her eyeballs, she cannot completely close her eyelids and her eyes dry out and become irritated). In February 1996 an ophthalmologist found that Johnston’s eye condition had stabilized within the prior 4-6 months and recommended corrective eye surgery, but apparently Johnston was reluctant to undergo surgery and has not had the eye surgery.
Johnston also complained of nervousness аnd anxiety. She was initially diagnosed with probable panic disorder and anxiety disorder and was prescribed medications. According to the ALJ, the medications corrected her symptoms within days, and she reported improvement of energy, sleep, concentration, and anxiety, school was going well, and no panic attacks оr crying spells.
In February 1996 Johnston underwent cardiac tests (x-ray, EKG, echocardio-gram). The test results were normal or unremarkable. She does have occasional sinus brachycardia (slowness of the heart beat or pulse), but it was apparently not related to her hyperthyroidism.
At the administrative hearing, Johnston testified that, after treаtment for her hyperthyroidism, she began to experience panic attacks and have problems concentrating. She testified that the panic attacks are unpredictable and occur several times a day despite her medication. She testified that she has a problem sitting still due to nervousness and that she has unpredictable crying spells several times a month. Her daily activities include a little cooking, very light housework and taking care of her daughter. Her sister helps her by cleaning her house, shopping, and taking her daughter to day care. (The father has been taking care of her son.) She listens to the radio because she cannot focus well enough to watch TV or read. Because she believes her anxiety and panic attacks are aggravated by crowds, Johnston spends much of her time at home. She rarely drives because of her vision problems. She handles her own money. She testified that her biggest problems were fatigue and her eyes.
Johnston requested review by the Appeals Council. The Appeals Council denied review. Johnston then sought judicial review in federal district court. The parties filed motions for summary judgment. The district court granted summary judgment in favor of the government. The district court found that substantial evidence on the record as a whole supported the finding of the ALJ that Johnston’s physical and mental impairments did not have more than a minimal, if any, effect on her ability to work and therefore she did not have a severe impairment or combination оf impairments. See district court order, slip op. at 7-9. The district court noted that it took Johnston’s treating physician several months to adjust her hormone medication dosage and that her symptoms of racing heart beat, blurred vision, and inability to concentrate could be directly traced to her fluctuating hormone levels. See id. at 7. The district court аlso noted that, although Johnston suffered from thyroid-related orbitopathy, her doctor had prescribed eye drops for her dry eye condition. She did have a slight deficit in ocular motility and imperfect eye coordination that resulted in occasional double vision. However, the district court noted that her visual acuity remained gоod, she had no color vision abnormalities, and she had no optic nerve compromise or visual loss as a result of her thyroid problems, and that, after her hormone medication dosage had been adjusted, her eye disease had stabilized and she was a candidate for corrective eye surgery. See id.
The district court also found that Johnston did not meet Listing 9.02(A) for thyroid disorders with progressive exophthal-mos as measured by exophthalmometry. See id. The district court noted that the medical evidence did not show that she suffered from progressive exophthalmos. See id. The medical evidence instead showed that her thyroid-related orbitopa-thy had stabilized with the adjustment of her hormone medication. See id. at 8. The district court also found that Johnston’s anxiety problems only mildly limited functioning and had been treated successfully with medication. See id.
The district court also found that substantial evidence on the record as a whole supported the finding of the ALJ that Johnston’s subjective complaints were inconsistent with the medical reсord, her daily activities, and her work history.
See id.
The district court noted that, with one exception, Johnston did not complain about any medication side effects to her treating physicians.
See id.
The ALJ noted that no physician, treating or otherwise, expressed any opinion that Johnston was disabled; no treating physician placed any speсific restrictions on her activities; and disability determination, service physicians
Johnston first argues that the AU used the wrong standard at step 2 of the sequential evaluation analysis to evaluаte the severity of her impairments. As noted above, the AU found that Johnston's physical and mental impairments were not severe because there was no evidence that they imposed "any significant limitations" upon her ability to do basic work activities. Johnston argues that the correct standard at step 2 is not "any significant limitation" but insteаd the lesser standard of "no more than a minimal effect" on the ability to work. See, e.g., Nguyen v. Chater,
Johnston next argues that the AU erred in finding that she did not suffer from a severe impairment or combination of impairments. We will uphold the decision of the AU (which was affirmed by the Appeals Council and is the final decision of the Commissioner of the Social Security Administration) if it is supported by substantial evidence on the record as a whole. See, e.g., Williams v. Sullivan,
We hold that the AU's finding is supported by substantial evidence on the record as a whole. The medical record showed that Johnston underwent successful treatment for her thyroid disease and has had normal thyroid levels since taking synthetic thyroid hormone. Some of her symptoms (problems with heart rate, blurred vision and inability to concentrate) were directly related to her fluctuating hormone levels before her doctor adjusted her medication dosage. Johnston's eye problems were related to her thyroid disease and responded to treatment. The medical record showed that she hаs good visual acuity, no color vision abnormalities, no optic nerve compromise, and no visual loss as a result of her thyroid condition. The medical record also showed that Johnston's thyroid-related eye disease was not progressive and had stabilized by February 1996.
The medical record also showed that Johnston's heart prоblems were not severe. Her tests were normal, and the brachycardia (low heart rate) was probably due to anxiety. The medical record also showed that Johnston's panic and anxiety disorders were not severe and were probably due to anxiety about the recommended corrective eye surgery and that her symрtoms had responded to medication. In May 1996 Johnston reported improvement in her symptoms (improved sleep, energy and concentration, felt better about self,
Johnston did not meet the requirements of Listing 9.02(A). Next, Johnston argues that her thyroid-related eye disease met the requirements in Listing 9.02(A) and therefore she has a severe impairment for purposes of the sequential evaluation analysis. (The ALJ stopped at step 2 and therefore did not consider whether she met the requirements of Listing 9.02(A).)
Listing 9.02(A) requires progressive exo-phthalmos (the abnormal protrusion of the eyeball), caused by thyroid disorder, as verified by exophthalmometry measurements. The medical record showed that Johnston’s exophthalmos was not progressively worsening because, although her eye measurements increased between June and August 1995, the measurements decreased in September 1995 and did not change much between October 1995 and February 1996, at whiсh time the ophthalmologist concluded that her eye disease had stabilized with no optic compromise or visual loss.
Johnston next argues that the ALJ improperly discounted her credibility in evaluating the severity of her subjective complaints. For example, she argues that the ALJ improperly discounted her blurred and double vision and exophthalmos. She also argues that the medications prescribed for the vision problems and her panic and anxiety attacks caused dizziness, lightheadedness and agoraphobia. She also argues that her vision problems, heart problems, anxiety and panic attacks, and inability to concentrate significantly restricted her daily activities and that she required the assistance of family members to take care of her household and her children. She also argues that the ALJ erred in finding that her work history showed little • or no motivation to work. She argues that her earnings were low because she depended upon her husband for financial support during the marriage.
We hold that the ALJ properly discounted Johnston’s credibility in evaluating the severity of her subjective complaints.
See Polaski v. Heckler,
Accordingly, we affirm the order of the district court.
Notes
. The Honorable William A. Knox, United States Magistrate Judge for the Western District of Missouri.