Opinion
Civil 1:20-CV-1629
12-20-2021
DONNA BERRY, Plaintiff, v. KILOLO KIJAKAZI, Acting Commissioner of Social Security[1], Defendant.
Brann Judge
REPORT AND RECOMMENDATION
MARTIN C. CARLSON UNITED STATES MAGISTRATE JUDGE
I. Introduction
Donna Berry was a worker in her early 50's at the time of her alleged onset of disability. Berry alleged that she was wholly disabled due to diabetes, obesity, heart and coronary artery disease, as well as degenerative disc disease and other related conditions. However, the medical record in Berry's case, while somewhat mixed, contained numerous test results and treatment notes which recorded normal, unremarkable and non-disabling clinical findings. These findings led a state agency expert to conclude that Berry, although impaired, was not totally disabled. Berry's treating cardiologist submitted a medical opinion which was far more restrictive, but that opinion could not readily be reconciled with the doctor's relatively benign treatment notes. Presented with this conflicting evidence, the Administrative Law Judge (ALJ) found that Berry could perform a limited range of light work, and denied her disability claim.
Berry now challenges the legal sufficiency of the ALJ's decision, arguing that the ALJ erred in evaluating her obesity, assessing the medical opinion evidence, and considering the severity of her symptoms. As we discuss below, with respect to these issues, the administrative record was mixed and equivocal, but contained substantial evidence which supported the ALJ's findings. Mindful of the fact that substantial evidence is a term of art in this legal field which "means only-such relevant evidence as a reasonable mind might accept as adequate to support a conclusion, "" Biestek, 139 S.Ct. at 1154, we find that the ALJ's evaluation of Berry's obesity, treatment of the medical opinion evidence, and assessment of the severity of Berry's symptoms were all supported by substantial evidence. Therefore, for the reasons set forth below, we recommend that the court affirm the decision of the Commissioner denying this claim.
II. Statement of Facts and of the Case
On February 21, 2018, Donna Berry applied for disability benefits under Title II of the Social Security Act, alleging an onset of disability beginning in December of 2017. (Tr. 19). Billings was born in 1966, was 51 years old at the time of the alleged onset of her disability. (Tr. 33). She had a high school education and was previously employed as an inventory specialist. (Tr. 33). In her disability application, Berry alleged that she was totally disabled due to Berry alleged that she was wholly disabled due to diabetes, obesity, heart and coronary artery disease, as well as degenerative disc disease and other related conditions. (Tr. 21).
During the pertinent time period for this disability claim Berry's primary care physician was Dr. Joseph Reinhardt. Dr. Reinhardt's treatment notes reflected approximately a dozen clinical encounters with Berry between January of 2017 and March of 2019. (Tr. 398, 414, 418, 420, 427, 945-946, 951, 953, 964, 966, 971, 977, 981, 983, 986, 990). In the course of this treatment, Dr. Reinhardt identified some cardiac symptoms experienced by Berry. For example, the doctor reported in January of 2017 that Berry had progressive shortness of breath. (Tr. 986). Dr. Reinhardt's treatment notes also indicated that Berry reported experiencing episodes of angina on a number of occasions in 2018. (Tr. 951, 953, 964, 966). Dr. Reinhardt further noted in March of 2018 that Berry had been hospitalized in Florida for suspected atrial fibrillation. (Tr. 971).
While Dr. Reinhardt's treatment records identified these anomalies and abnormalities, the clinical notes often reported in 2017 and 2019 that Berry had no significant abnormalities or problems. (Tr. 425-426, 945-946). Dr. Reinhardt's treatment records also frequently reported instances in which Berry reported no chest pain or palpitations, and denied experiencing coughing, dizziness or blurred vision. (Tr. 414, 418, 420, 977, 981, 983). Thus, many of the doctor's treatment notes contained normal or unremarkable clinical findings. (Tr. 398, 427, 990). Further, these treatment notes and medical records documented that Berry was mildly to moderately obese but did not identify any specific physical limitations stemming from this obesity. (Tr. 27).
Berry also received extensive medical tests between 2017 and 2019. While these tests confirmed Berry's diabetes, obesity, and some mild to moderate cardiac symptoms, these medical records also contained notations that Berry's test results largely fell within normal parameters. For example, February 2017 pulmonary test results indicated no significant abnormalities. (Tr. 425-426). Brain MRI studies in March of 2017 were normal and a June 2017 thyroid ultrasound examination also yielded unremarkable results. (Tr. 422, 992). Likewise, it was reported that CT scans, x-rays and an echocardiogram in December of 2017 were essentially normal. (Tr. 407-408, 410, 412). In September of 2018, Dr. Reinhardt reported that while Berry was experiencing angina a cardiac catheterization found that no stents were indicated. (Tr. 964). Ultrasound testing of Berry's left leg conducted in November of 2018 was normal as was a February 2019 fluoroscope examination. (Tr. 948, 955).
The mixed medical picture presented by Berry's treatment records stood in stark contrast to the highly restrictive March 2019 functional capacity questionnaire completed by Dr. Reinhardt. (Tr. 1004-1008). Notwithstanding the numerous notations of essentially normal or unremarkable clinical findings set forth in Dr. Reinhardt's treatment records, in this questionnaire the doctor described Berry as completely incapacitated. (Id.) According to Dr. Reinhardt, Berry was incapable of performing any work. She could sit, stand or walk for less than 2 hours in a work day, would need frequent unscheduled breaks of uncertain duration, could never lift 10 pounds or twist, stoop, crouch, climb ladders or stairs, and was required to avoid all environmental exposure to heat, cold, dampness, smells, dust and chemicals. (Id.)
A state agency medical expert who reviewed these same clinical records came to a different conclusion. On May 15, 2018, Dr. Virginia Dato, found base upon a review of these treatment records that Berry was capable of performing light work notwithstanding her impairments. (Tr. 67-74).
It is against this factual backdrop marked by conflicting medical opinions and treatment records which recorded some impairments while reflecting numerous normal and unremarkable findings that the ALJ conducted a hearing in this case on May 13, 2019. (Tr. 40-63). The plaintiff and a vocational expert both testified at this hearing. Following this hearing on June 4, 2019, the ALJ issued a decision denying Berry's application for benefits. (Tr. 16-35). In that decision, the ALJ first concluded that the plaintiff met the insured status requirements of the Act through December 31, 2020. (Tr. 21). At Step 2 of the sequential analysis that governs Social Security cases, the ALJ found that Berry's diabetes, obesity, heart and coronary artery disease, as well as degenerative disc disease and other related conditions were all severe impairments. (Tr. 21). At Step 3 the ALJ determined that the plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments. (Tr. 24-27).
Between Steps 3 and 4 the ALJ concluded that Berry retained the residual functional capacity (RFC) to perform light work with some postural mand environmental limitations. (Tr. 27). In reaching this conclusion, the ALJ directly addressed the issues presented in this appeal relating to Berry's obesity, her symptom severity and the persuasiveness of Dr. Reinhardt's highly restrictive medical opinion.
With respect to the evaluation of the severity of Berry's symptoms, the ALJ engaged in an extensive analysis. (Tr. 28-31). According to the ALJ, Berry's self-reported limitations were not entirely congruent with the objective medical evidence. (Tr. 29). The ALJ then detailed Berry's treatment history, carefully documenting the unremarkable medical test results and treatment notations that littered Berry's medical history. (Tr. 29-31). The ALJ also observed that despite Berry's reported symptom severity she stated that she could complete personal care and household tasks which were suggestive of a retained capacity to perform light work. (Tr. 28).
The ALJ also outlined the rationale for finding Dr. Reinhardt's highly restrictive medical opinion too be less persuasive than the views expressed by the state agency physician, explaining that the doctor's extreme opinion was poorly supported internal and by Dr. Reinhardt's own records, which failed to document limitations as severe as those expressed in this medical opinion questionnaire. (Tr. 32). The ALJ also noted that Dr. Reinhardt's opinion "is not consistent with the other objective evidence of record, the majority of which documents no significant reporting of cardiovascular or respiratory symptoms and largely normal findings on physical and mental examination . . . ." (Tr. 33).
Finally, the ALJ's opinion specifically focused upon, and addressed, Berry's obesity, both in its listing analysis and when crafting an RFC for Berry. (Tr. 27, 31). Thus, while the ALJ acknowledged that Berry suffered from mild to moderate obesity, the ALJ also found that neither the medical records nor Berry identified any specific limitations stemming from this obesity, and the medical history showed only very conservative treatment of this condition in the form of diet and exercise recommendations. (Id.)
Having made these findings, the ALJ determined that Berry could not perform her past work, but retained the capacity to perform other jobs that existed in significant numbers in the national economy. (Tr. 33-34). The ALJ held that Berry had not met the demanding showing necessary to sustain her claim for benefits and denied this claim. (Tr. 35).
This appeal followed. (Doc. 1). On appeal, Berry launches a threefold attack upon the sufficiency of the ALJ's analysis of this disability claim, arguing that the ALJ erred in consideration of the medical opinion of a treating source, Dr. Reinhardt, failed to adequately address her obesity, and further erred in evaluating the severity of her symptoms. However, given the highly deferential standard of review which applies here, we are constrained to conclude that substantial evidence supported the ALJ's findings in this case. Therefore, for the reasons set forth below, we recommend that the Commissioner's decision be affirmed.
III. Discussion
A. Substantial Evidence Review - the Role of this Court
When reviewing the Commissioner's final decision denying a claimant's application for benefits, this Court's review is limited to the question of whether the findings of the final decision-maker are supported by substantial evidence in the record. See 42 U.S.C. §405(g); Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D.Pa. 2012). Substantial evidence "does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial evidence is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). But in an adequately developed factual record, substantial evidence may be "something less than the weight of the evidence, and the possibility of drawing two inconsistent conclusions from the evidence does not prevent [the ALJ's decision] from being supported by substantial evidence." Consolo v. Fed. Maritime Comm'n, 383 U.S. 607, 620 (1966). "In determining if the Commissioner's decision is supported by substantial evidence the court must scrutinize the record as a whole." Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D.Pa. 2003).
The Supreme Court has underscored for us the limited scope of our review in this field, noting that:
The phrase "substantial evidence" is a "term of art" used throughout administrative law to describe how courts are to review agency factfinding. T-Mobile South, LLC v. Roswell, 574 U.S.___, ___135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-evidence standard, a court looks to an existing administrative record and asks whether it contains "sufficien[t] evidence" to support the agency"s factual determinations. Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis deleted). And whatever the meaning of "substantial" in other contexts, the threshold for such evidentiary sufficiency is not high. Substantial evidence, this Court has said, is "more than a mere scintilla." Ibid.; see, e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks omitted). It means-and means only-"such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v. Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999) (comparing the substantial-evidence standard to the deferential clearly-erroneous standard).Biestek, 139 S.Ct. at 1154.
The question before this Court, therefore, is not whether the claimant is disabled, but rather whether the Commissioner's finding that he or she is not disabled is supported by substantial evidence and was reached based upon a correct application of the relevant law. See Arnold v. Colvin, No. 3:12-CV-02417, 2014 WL 940205, at *1 (M.D.Pa. Mar. 11, 2014) ("[I]t has been held that an ALJ's errors of law denote a lack of substantial evidence.") (alterations omitted); Burton v. Schweiker, 512 F.Supp. 913, 914 (W.D. Pa. 1981) ("The Secretary's determination as to the status of a claim requires the correct application of the law to the facts."); see also Wright v. Sullivan, 900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal matters is plenary); Ficca, 901 F.Supp.2d at 536 ("[T]he court has plenary review of all legal issues . . . .").
Several fundamental legal propositions flow from this deferential standard of review. First, when conducting this review "we are mindful that we must not substitute our own judgment for that of the fact finder." Zirnsak v. Colvin, 777 F.3d 607, 611 (3d Cir. 2014) (citing Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005)). Thus, we are enjoined to refrain from trying to re-weigh the evidence. Rather our task is to simply determine whether substantial evidence supported the ALJ's findings. However, we must also ascertain whether the ALJ's decision meets the burden of articulation demanded by the courts to enable informed judicial review. Simply put, "this Court requires the ALJ to set forth the reasons for his decision." Burnett v. Comm'r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000). As the Court of Appeals has noted on this score:
In Burnett, we held that an ALJ must clearly set forth the reasons for his decision. 220 F.3d at 119. Conclusory statements . . . are insufficient. The ALJ must provide a "discussion of the evidence" and an "explanation of reasoning" for his conclusion sufficient to enable meaningful judicial review. Id. at 120; see Jones v. Barnhart, 364 F.3d 501, 505 & n. 3 (3d Cir.2004). The ALJ, of course, need not employ particular "magic" words: "Burnett does not require the ALJ to use particular language or adhere to a particular format in conducting his analysis." Jones, 364 F.3d at 505.Diaz v. Comm'r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009).
Thus, in practice, ours is a twofold task. We must evaluate the substance of the ALJ's decision under a deferential standard of review, but we must also give that decision careful scrutiny to ensure that the rationale for the ALJ's actions is sufficiently articulated to permit meaningful judicial review.
B. Initial Burdens of Proof, Persuasion, and Articulation for the ALJ.
To receive benefits under the Social Security Act by reason of disability, a claimant must demonstrate an inability to "engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. §423(d)(1)(A); 42 U.S.C. §1382c(a)(3)(A); see also 20 C.F.R. §§404.1505(a), 416.905(a). To satisfy this requirement, a claimant must have a severe physical or mental impairment that makes it impossible to do his or her previous work or any other substantial gainful activity that exists in the national economy. 42 U.S.C. §423(d)(2)(A); 42 U.S.C. §1382c(a)(3)(B); 20 C.F.R. §§404.1505(a), 416.905(a). To receive benefits under Title II of the Social Security Act, a claimant must show that he or she contributed to the insurance program, is under retirement age, and became disabled prior to the date on which he or she was last insured. 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
In making this determination at the administrative level, the ALJ follows a five-step sequential evaluation process. 20 C.F.R. §§404.1520(a), 416.920(a). Under this process, the ALJ must sequentially determine: (1) whether the claimant is engaged in substantial gainful activity; (2) whether the claimant has a severe impairment; (3) whether the claimant's impairment meets or equals a listed impairment; (4) whether the claimant is able to do his or her past relevant work; and (5) whether the claimant is able to do any other work, considering his or her age, education, work experience and residual functional capacity ("RFC"). 20 C.F.R. §§404.1520(a)(4), 416.920(a)(4).
Between Steps 3 and 4, the ALJ must also assess a claimant's residual functional capacity (RFC). RFC is defined as "that which an individual is still able to do despite the limitations caused by his or her impairment(s)." Burnett v. Comm'r of Soc. Sec., 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted); see also 20 C.F.R. §§404.1520(e), 404.1545(a)(1), 416.920(e), 416.945(a)(1). In making this assessment, the ALJ considers all of the claimant's medically determinable impairments, including any non-severe impairments identified by the ALJ at Step 2 of his or her analysis. 20 C.F.R. §§404.1545(a)(2), 416.945(a)(2).
Once the ALJ has made this determination, our review of the ALJ's assessment of the plaintiff's RFC is deferential, and that RFC assessment will not be set aside if it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d Cir. 2002); see also Metzger v. Berryhill, No. 3:16-CV-1929, 2017 WL 1483328, at *5 (M.D. Pa. Mar. 29, 2017), report and recommendation adopted sub nom. Metzgar v. Colvin, No. 3:16-CV-1929, 2017 WL 1479426 (M.D. Pa. Apr. 21, 2017); Rathbun v. Berryhill, No. 3:17-CV-00301, 2018 WL 1514383, at *6 (M.D. Pa. Mar. 12, 2018), report and recommendation adopted, No. 3:17-CV-301, 2018 WL 1479366 (M.D. Pa. Mar. 27, 2018).
At Steps 1 through 4, the claimant bears the initial burden of demonstrating the existence of a medically determinable impairment that prevents him or her from engaging in any of his or her past relevant work. Mason, 994 F.2d at 1064. Once this burden has been met by the claimant, it shifts to the Commissioner at Step 5 to show that jobs exist in significant number in the national economy that the claimant could perform that are consistent with the claimant's age, education, work experience and RFC. 20 C.F.R. §§404.1512(f), 416.912(f); Mason, 994 F.2d at 1064.
There is an undeniable medical aspect to an RFC determination, since that determination entails an assessment of what work the claimant can do given the physical limitations that the claimant experiences. Yet, when considering the role and necessity of medical opinion evidence in making this determination, courts have followed several different paths. Some courts emphasize the importance of medical opinion support for an RFC determination and state that "[r]arely can a decision be made regarding a claimant's residual functional capacity without an assessment from a physician regarding the functional abilities of the claimant." Biller v. Colvin, 962 F.Supp.2d 761, 778-79 (W.D. Pa. 2013) (quoting Gormont v. Astrue, Civ. No. 11- 2145, 2013 WL 791455 at *7 (M.D. Pa. Mar. 4, 2013)). In other instances, it has been held that "[t]here is no legal requirement that a physician have made the particular findings that an ALJ adopts in the course of determining an RFC." Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006). Further, courts have held in cases where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability that "the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided." Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015).
These seemingly discordant legal propositions can be reconciled by evaluation of the factual context of these decisions. Those cases which emphasize the importance of medical opinion support for an RFC assessment typically arise where well-supported medical sources have identified limitations supporting a disability claim, but an ALJ has rejected such a determination based upon a lay assessment of other evidence. Biller, 962 F.Supp.2d at 778-79. In this setting, these cases simply restate the commonplace idea that medical opinions are entitled to careful consideration when making a disability determination, particularly when those opinions support a finding of disability. In contrast, when no medical opinion supports a disability finding or when an ALJ is relying upon other evidence, such as contrasting clinical or opinion evidence or testimony regarding the claimant's activities of daily living, to fashion an RFC courts have adopted a more pragmatic view and have sustained the ALJ's exercise of independent judgment based upon all the facts and evidence. See Titterington, 174 Fed.Appx. 6; Cummings, 129 F.Supp.3d at 214-15. In either event, once the ALJ has made this determination, our review of the ALJ's assessment of the plaintiff's RFC is deferential, and that RFC assessment will not be set aside if it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113; see also Metzger v. Berryhill, 2017 WL 1483328, at *5; Rathbun v. Berryhill, 2018 WL 1514383, at *6.
The ALJ's disability determination must also meet certain basic substantive requisites. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, the ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-07. In addition, "[t]he ALJ must indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding." Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999).
C. Legal Benchmarks for the ALJ's Assessment of Medical Opinions
The plaintiff filed this disability application in December of 2017 following a paradigm shift in the manner in which medical opinions were evaluated when assessing Social Security claims. Prior to March 2017, ALJs were required to follow regulations which defined medical opinions narrowly and created a hierarchy of medical source opinions with treating sources at the apex of this hierarchy. However, in March 0f 2017, the Commissioner's regulations governing medical opinions changed in a number of fundamental ways. The range of opinions that ALJs were enjoined to consider were broadened substantially and the approach to evaluating opinions was changed from a hierarchical form of review to a more holistic analysis. As one court as aptly observed:
The regulations regarding the evaluation of medical evidence have been amended for claims filed after March 27, 2017, and several of the prior Social Security Rulings, including SSR 96-2p, have been rescinded. According to the new regulations, the Commissioner "will no longer give any specific evidentiary weight to medical opinions; this includes giving controlling weight to any medical opinion." Revisions to Rules Regarding the Evaluation of Medical Evidence ("Revisions to Rules"), 2017 WL 168819, 82 Fed.Reg. 5844, at 5867-68 (Jan. 18, 2017), see 20 C.F.R. §§ 404.1520c(a), 416.920c(a). Instead, the Commissioner must consider all medical opinions and "evaluate their persuasiveness"
based on the following five factors: supportability; consistency; relationship with the claimant; specialization; and "other factors." 20 C.F.R. §§ 404.1520c(a)-(c), 416.920c(a)-(c).
Although the new regulations eliminate the perceived hierarchy of medical sources, deference to specific medical opinions, and assigning "weight" to a medical opinion, the ALJ must still "articulate how [he or she] considered the medical opinions" and "how persuasive [he or she] find[s] all of the medical opinions." Id. at §§ 404.1520c(a) and (b)(1), 416.920c(a) and (b)(1). The two "most important factors for determining the persuasiveness of medical opinions are consistency and supportability," which are the "same factors" that formed the foundation of the treating source rule. Revisions to Rules, 82 Fed.Reg. 5844-01 at 5853.
An ALJ is specifically required to "explain how [he or she] considered the supportability and consistency factors" for a medical opinion. 20 C.F.R. §§ 404.1520c (b)(2), 416.920c(b)(2). With respect to "supportability," the new regulations provide that "[t]he more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion(s) or prior administrative medical finding(s), the more persuasive the medical opinions or prior administrative medical finding(s) will be." Id. at §§ 404.1520c(c)(1), 416.920c(c)(1). The regulations provide that with respect to "consistency," "[t]he more consistent a medical opinion(s) or prior administrative medical finding(s) is with the evidence from other medical sources and nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical finding(s) will be." Id. at §§ 404.1520c(c)(2), 416.920c(c)(2).
Under the new regulations an ALJ must consider, but need not explicitly discuss, the three remaining factors in determining the persuasiveness of a medical source's opinion. Id. at §§ 404.1520c(b)(2), 416.920c(b)(2). However, where the ALJ has found two or more medical opinions to be equally well supported and consistent with the record, but not exactly the same, the ALJ must articulate how he or she
considered those factors contained in paragraphs (c)(3) through (c)(5). Id. at §§ 404.1520c(b)(3), 416.920c(b)(3).Andrew G. v. Comm'r of Soc. Sec., No. 3:19-CV-0942 (ML), 2020 WL 5848776, at *5 (N.D.N.Y. Oct. 1, 2020).
Oftentimes, as in this case, an ALJ must evaluate various medical opinions. Judicial review of this aspect of ALJ decision-making is still guided by several settled legal tenets. First, when presented with a disputed factual record, it is well-established that "[t]he ALJ - not treating or examining physicians or State agency consultants - must make the ultimate disability and RFC determinations." Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 361 (3d Cir. 2011). Thus, when evaluating medical opinions" the ALJ may choose whom to credit but 'cannot reject evidence for no reason or for the wrong reason."" Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (quoting Mason, 994 F.2d at 1066). Therefore, provided that the decision is accompanied by an adequate, articulated rationale, it is the province and the duty of the ALJ to choose which medical opinions and evidence deserve greater weight.
Further, in making this assessment of medical evidence:
An ALJ is [also] entitled generally to credit parts of an opinion without crediting the entire opinion. See Thackara v. Colvin, No. 1:14-CV- 00158-GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015); Turner v. Colvin, 964 F.Supp.2d 21, 29 (D.D.C. 2013) (agreeing that "SSR 96-2p does not prohibit the ALJ from crediting some parts of a
treating source's opinion and rejecting other portions"); Connors v. Astrue, No. 10-CV-197-PB, 2011 WL 2359055, at *9 (D.N.H. June 10, 2011). It follows that an ALJ can give partial credit to all medical opinions and can formulate an RFC based on different parts from the different medical opinions. See e.g., Thackara v. Colvin, No. 1:14-CV- 00158-GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015).Durden v. Colvin, 191 F.Supp.3d 429, 455 (M.D. Pa. 2016). Finally, where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability "the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided." Cummings, 129 F.Supp.3d at 214-15.
D. Legal Benchmarks for Assessing a claimant's Obesity
The interplay between this deferential substantive standard of review, and the requirement that courts carefully assess whether an ALJ has met the standards of articulation required by law, is aptly illustrated by those cases which consider analysis of the compounding effect of obesity upon disability claimants. In this regard, the leading case addressing this issue is Diaz v. Comm'r of Soc. Sec., 577 F.3d 500 (3d Cir. 2009). In Diaz, the ALJ found at Step 2 of the analytical process that Diaz's obesity was a severe impairment, but then neglected to address the exacerbating effect of this condition at Step 3 or in any other subsequent steps in the disability analysis.
On these facts, the Court of Appeals remanded the case for further consideration by the Commissioner and provided guidance regarding the duty of articulation required from ALJs in this setting. Thus, the Court of Appeals explained that "an ALJ must meaningfully consider the effect of a claimant's obesity, individually and in combination with her impairments, on her workplace function at step three and at every subsequent step." Diaz, 577 F.3d at 504. While imposing this responsibility of articulation upon ALJs, the appellate court did not endeavor to impose some strict formulaic requirements upon these administrative adjudicators. Quite the contrary, the Court made it clear that "[t]he ALJ, of course, need not employ particular 'magic" words: '[Case law] does not require the ALJ to use particular language or adhere to a particular format in conducting his analysis."" Diaz, 577 F.3d at 504 (citations omitted).
The Court of Appeals also made it abundantly clear that its decision related to the ALJ's duty to adequately articulate the rationale underlying any decision denying benefits and did not in any way alter the very deferential substantive standard of review in these cases. As the Court noted,
Were there any discussion of the combined effect of [obesity upon] Diaz's impairments, we might agree with the District Court [and affirm the ALJ decision]. However, absent analysis of the cumulative impact
of Diaz's obesity and other impairments on her functional capabilities, we are at a loss in our reviewing function.Diaz, 577 F.3d at 504 (emphasis in original). By noting that "any discussion of the combined effect of [obesity upon] Diaz's impairments" would have been sufficient, the appellate court underscored the continuing vitality of the deferential standard of review that applies in these cases.
Thus, fairly construed, Diaz holds that where an ALJ has defined a claimant's obesity as a severe impairment at Step 2 of this analysis, there is a basic duty of articulation that is owed the claimant, explaining how that obesity affects the issue of disability. However, once that duty of articulation is met, the substantive standard of review remains highly deferential. Applying this analytical paradigm, following Diaz it has been held that a single cursory assurance that an ALJ has considered a claimant's obesity may be insufficient to satisfy the requirement that "an ALJ must meaningfully consider the effect of a claimant's obesity, individually and in combination with her impairments, on her workplace function at step three and at every subsequent step." Diaz, 577 F.3d at 504; see also Sutherland v. Berryhill, No. 3:17-CV-00124, 2018 WL 2187795, at *9 (M.D. Pa. Mar. 6, 2018), report and recommendation adopted sub nom. Sutherland v. Berryhill, No. CV 3:17-0124, 2018 WL 2183359 (M.D. Pa. May 11, 2018). However, a statement by an ALJ in a decision denying benefits that the ALJ has "considered any additional and cumulative effects of obesity," when coupled with even a brief factual analysis of the medical evidence as it relates to obesity and impairment is sufficient to satisfy this duty of articulation. Cooper v. Comm'r of Soc. Sec., 563 Fed.Appx. 904, 911 (3d Cir. 2014). Further, when an ALJ considers the role of a claimant's obesity, evaluating it within the context of the overall record, consistent with the appropriate guidelines, this duty is satisfied. Woodson v. Comm'r Soc. Sec., 661 Fed.Appx. 762, 765 (3d Cir. 2016). Finally, this responsibility is met when the ALJ explicitly considers the claimant's obesity when assessing that claimant's residual functional capacity. Hoyman v. Colvin, 606 Fed.Appx. 678, 680 (3d Cir. 2015). Medina v. Berryhill, No. 3:17-CV-1941, 2018 WL 3433290, at *6-7 (M.D. Pa. June 8, 2018), report and recommendation adopted, No. CV 3:17-1941, 2018 WL 3426408 (M.D. Pa. July 16, 2018).
E. Legal Benchmarks for the ALJ's Assessment of a claimant's Alleged Symptoms
The interplay between the deferential substantive standard of review that governs Social Security appeals, and the requirement that courts carefully assess whether an ALJ has met the standards of articulation required by law, is also illustrated by those cases which consider analysis of a claimant's reported pain. When evaluating lay testimony regarding a claimant's reported degree of pain and disability, we are reminded that:
[T]he ALJ must necessarily make certain credibility determinations, and this Court defers to the ALJ's assessment of credibility. See Diaz v. Comm'r, 577 F.3d 500, 506 (3d Cir.2009) ("In determining whether there is substantial evidence to support an administrative law judge's decision, we owe deference to his evaluation of the evidence [and] assessment of the credibility of witnesses...."). However, the ALJ must specifically identify and explain what evidence he found not credible and why he found it not credible. Adorno v. Shalala, 40 F.3d 43, 48 (3d Cir.1994) (citing Stewart v. Sec'y of Health, Education and Welfare, 714 F.2d 287, 290 (3d Cir.1983)); see also Stout v. Comm'r, 454 F.3d 1050, 1054 (9th Cir.2006) (stating that an ALJ is required to provide "specific reasons for rejecting lay testimony"). An ALJ cannot reject evidence for an incorrect or unsupported reason. Ray v. Astrue, 649 F.Supp.2d 391, 402 (E.D.Pa.2009) (quoting Mason v. Shalala, 994 F.2d 1058, 1066 (3d Cir.1993)).Zirnsak v. Colvin, 777 F.3d 607, 612-13 (3d Cir. 2014).
Yet, it is also clear that:
Great weight is given to a claimant's subjective testimony only when it is supported by competent medical evidence. Dobrowolsky v. Califano, 606 F.2d 403, 409 (3d Cir. 1979); accord Snedeker v. Comm'r of Soc. Sec., 244 Fed.Appx. 470, 474 (3d Cir. 2007). An ALJ may reject a claimant's subjective testimony that is not found credible so long as there is an explanation for the rejection of the testimony. Social Security Ruling ("SSR") 96-7p; Schaudeck v. Comm'r of Social Security, 181 F.3d 429, 433 (3d Cir. 1999). Where an ALJ finds that there is an underlying medically determinable physical or mental impairment that could reasonably be expected to produce the individual's pain or other symptoms, however, the severity of which is not substantiated by objective medical evidence, the ALJ must make a
finding on the credibility of the individual's statements based on a consideration of the entire case record.McKean v. Colvin, 150 F.Supp.3d 406, 415-16 (M.D. Pa. 2015)(footnotes omitted). Thus, we are instructed to review an ALJ's evaluation of a claimant's subjective reports of pain under a standard of review which is deferential with respect to the ALJ's well-articulated findings, but imposes a duty of clear articulation upon the ALJ so that we may conduct meaningful review of the ALJ's conclusions.
In the same fashion that medical opinion evidence is evaluated, the Social Security Rulings and Regulations provide a framework under which the severity of a claimant's reported symptoms are to be considered. 20 C.F.R. §§ 404.1529, 416.929; SSR 16-3p. It is important to note that though the "statements of the individual concerning his or her symptoms must be carefully considered, the ALJ is not required to credit them." Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 363 (3d. Cir. 2011) (referencing 20 C.F.R. §404.1529(a) ("statements about your pain or other symptoms will not alone establish that you are disabled."). It is well-settled in the Third Circuit that "[a]llegations of pain and other subjective symptoms must be supported by objective medical evidence." Hantraft v. Apfel, 181 F.3d 358, 362 (3d Cir. 1999) (referring to 20 C.F.R. §404.1529). When evaluating a claimant's symptoms, the ALJ must follow a two-step process in which the ALJ resolves whether a medically determinable impairment could be the cause of the symptoms alleged by the claimant, and subsequently must evaluate the alleged symptoms in consideration of the record as a whole. SSR 16-3p.
First, symptoms, such as pain or fatigue, will only be considered to affect a claimant's ability to perform work activities if such symptoms result from an underlying physical or mental impairment that has been demonstrated to exist by medical signs or laboratory findings. 20 C.F.R. §§ 404.1529(b), 416.929(b); SSR 16-3p. During the second step of this credibility assessment, the ALJ must determine whether the claimant's statements about the intensity, persistence or functionally limiting effects of his or her symptoms are substantiated based on the ALJ's evaluation of the entire case record. 20 C.F.R. § 404.1529(c), 416.929(c); SSR 16- 3p. This includes, but is not limited to: medical signs and laboratory findings, diagnosis and other medical opinions provided by treating or examining sources, and other medical sources, as well as information concerning the claimant's symptoms and how they affect his or her ability to work. Id. The Social Security Administration has recognized that individuals may experience their symptoms differently and may be limited by their symptoms to a greater or lesser extent than other individuals with the same medical impairments, signs, and laboratory findings. SSR 16-3p.
Thus, to assist in the evaluation of a claimant's subjective symptoms, the Social Security Regulations identify seven factors which may be relevant to the assessment of the severity or limiting effects of a claimant's impairment based on a claimant's symptoms. 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3). These factors include: activities of daily living; the location, duration, frequency, and intensity of the claimant's symptoms; precipitating and aggravating factors; the type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate his or her symptoms; treatment, other than medication that a claimant has received for relief; any measures the claimant has used to relieve his or her symptoms; and, any other factors concerning the claimant's functional limitations and restrictions. Id.; see George v. Colvin, No. 4:13-CV-2803, 2014 WL 5449706, at *4 (M.D.Pa. Oct. 24, 2014); Koppenaver v. Berryhill, No. 3:18-CV-1525, 2019 WL 1995999, at *9 (M.D. Pa. Apr. 8, 2019), report and recommendation adopted sub nom. Koppenhaver v. Berryhill, No. 3:18-CV-1525, 2019 WL 1992130 (M.D. Pa. May 6, 2019);Martinez v. Colvin, No. 3:14-CV-1090, 2015 WL 5781202, at *8- 9 (M.D. Pa. Sept. 30, 2015).
It is against these benchmarks that we assess this appeal.
F. The Commissioner's Decision Should Be Affirmed.
In this setting, we are mindful that we are not free to substitute our independent assessment of the evidence for the ALJ's determinations. Rather, we must simply ascertain whether the ALJ's decision is supported by substantial evidence, a quantum of proof which is less than a preponderance of the evidence but more than a mere scintilla, Richardson, 402 U.S. at 401, and "does not mean a large or considerable amount of evidence," Pierce, 487 U.S. at 565, but rather "means- and means only-'such relevant evidence as a reasonable mind might accept as adequate to support a conclusion."" Biestek, 139 S.Ct. at 1154. Judged against these deferential standards of review, we find that the evidence supported the ALJ's decision that Berry was not entirely disabled, but rather could perform a limited range of light work.
1. The ALJ's Symptom Evaluation Was Supported by Substantial Evidence.
At the outset, we note that substantial evidence, that is, "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion," Biestek, 139 S.Ct. at 1154, supported the ALJ's symptom evaluation in this case. That symptom evaluation analysis was careful, thorough, and detailed. It focused upon an array of clinical and opinion evidence derived from multiple medical sources over a span of two years. Much of this evidence revealed unremarkable findings, including the frequent reports of Berry's treating physician in which Berry reported no chest pain or palpitations, and denied experiencing coughing, dizziness or blurred vision. (Tr. 414, 418, 420, 977, 981, 983). Moreover, Berry's activities of daily living also provided factual support for the ALJ's conclusion that Billings was not totally disabled. While Berry may invite us to re-weigh this evidence, on appeal we are forbidden from undertaking a de novo review of this record. Our task is simply to ascertain whether substantial evidence supported the ALJ's evaluation of Berry's symptoms and confirm that this evaluation was conducted in a manner which comported with the applicable regulations. Here, we find that there is substantial evidentiary support for this symptom evaluation and the ALJ's decision. Moreover, the ALJ's symptom evaluation correctly focused upon the factors identified in the pertinent regulations: Berry's activities of daily living; the location, duration, frequency, and intensity of her reported symptoms; and the treatment she has received for these conditions. Therefore, there is no need to remand this case for further symptom evaluation.
2. The ALJ Properly Evaluated Dr. Reinhardt's Opinion.
Likewise, the ALJ's analysis of the persuasiveness of Dr. Reinhardt's medical opinion draws adequate support from the administrative record. Under the new analytical paradigm prescribed by Social Security regulations, persuasiveness is the touchstone for any medical opinion evaluation. Further, it is well-settled that "supportability ... and consistency ... are the most important factors [to] consider when [ ] determine[ing] how persuasive [to] find a medical source's medical opinions . . . to be." 20 C.F.R. § 404.1520c(b)(2). In this context, supportability means that "[t]he more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion(s) or prior administrative medical finding(s), the more persuasive the medical opinions or prior administrative medical finding(s) will be." Consistency, in turn, is defined to mean that: "[t]he more consistent a medical opinion(s) or prior administrative medical finding(s) is with the evidence from other medical sources and nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical finding(s) will be." 20 C.F.R. § 404.1520c(c)(1)-(2).
In this case, the ALJ aptly concluded that Dr. Reinhardt's highly restrictive medical opinion was not congruent with his own treatment notes. Nor was that opinion consistent with other treatment records, clinical test results, the state agency expert"s opinion, or Berry's self-reported activities of daily living. Thus, with respect to this medical opinion, the ALJ properly found that the elements of supportability and consistency that are essential to a finding of persuasiveness in a medical opinion were lacking. There was no error here.
3. The ALJ Adequately Considered Berry's Obesity.
Finally, the ALJ's decision adequately considered Berry's obesity in arriving at this RFC determination which restricted the plaintiff to a range of light work. In this regard, the ALJ's decision identified Berry's obesity as a severe impairment. (Tr. 21). The ALJ then addressed Berry's obesity, both in the listing analysis in this case and when crafting an RFC for Berry. (Tr. 27, 31). As part of this analysis, the ALJ acknowledged that Berry suffered from mild to moderate obesity. However, the ALJ also found that neither the medical records nor Berry identified any specific limitations stemming from this obesity, and the medical history showed only very conservative treatment of this condition in the form of diet and exercise recommendations. (Id.)
When presented with disability claims brought by persons who are obese "an ALJ must meaningfully consider the effect of a claimant's obesity, individually and in combination with her impairments, on her workplace function at step three and at every subsequent step." Diaz, 577 F.3d at 504. However, this duty of articulation is minimal and is satisfied if an ALJ attests that he has "considered any additional and cumulative effects of obesity," and provides a brief factual analysis of the medical evidence as it relates to obesity and impairment is sufficient to satisfy this duty of articulation. Cooper, 563 Fed.Appx. at 911. Further, when an ALJ considers the claimant's obesity, evaluating it within the context of the overall record this duty is satisfied. Woodson, 661 Fed.Appx. at 765. Likewise, this responsibility is met when the ALJ explicitly considers the claimant's obesity when assessing that claimant's residual functional capacity. Hoyman, 606 Fed.Appx. at 680.
In the instant case, the ALJ's analysis satisfied the requirements of the law. The ALJ acknowledged Berry's obesity, deemed it severe, and expressly addressed this condition both in the listing analysis and when fashioning a limited light work RFC for the plaintiff. The ALJ also aptly explained that Berry's obesity was mild to moderate, was treated in a conservative fashion, and led to no specific, identifiable workplace constraints for the plaintiff. Substantial evidence supported these findings and the ALJ's discussion of Berry's obesity meets the duty of articulation that exists here. This issue therefore provides no grounds for a remand or reconsideration of this case.
In closing, the ALJ's assessment of the evidence in this case complied with the dictates of the law, was properly articulated by the ALJ, and was supported by substantial evidence. This is all that the law requires, and all that a claimant can demand in a disability proceeding. Thus, notwithstanding the argument that this evidence might have been viewed in a way which would have also supported a different finding, we are obliged to affirm this ruling once we find that it is "supported by substantial evidence, 'even [where] this court acting de novo might have reached a different conclusion."" Monsour Med. Ctr. v. Heckler, 806 F.2d 1185, 1190-91 (3d Cir. 1986) (quoting Hunter Douglas, Inc. v. NLRB, 804 F.2d 808, 812 (3d Cir. 1986)). Accordingly, under the deferential standard of review that applies to appeals of Social Security disability determinations, we find that substantial evidence supported the ALJ's evaluation of this case.
IV. Recommendation
Accordingly, for the foregoing reasons, IT IS RECOMMENDED that the final decision of the Commissioner denying these claims be AFFIRMED.
The parties are further placed on notice that pursuant to Local Rule 72.3:
Any party may object to a magistrate judge's proposed findings, recommendations or report addressing a motion or matter described in 28 U.S.C. § 636 (b)(1)(B) or making a recommendation for the disposition of a prisoner case or a habeas corpus petition within fourteen (14) days after being served with a copy thereof. Such party shall file with the clerk of court, and serve on the magistrate judge and all parties, written objections which shall specifically identify the portions of the proposed findings, recommendations or report to which objection is made and the basis for such objections. The briefing requirements set forth in Local Rule 72.2 shall apply. A judge shall make a de novo determination of those portions of the report or specified proposed findings or recommendations to which objection is made and may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge. The judge, however, need conduct a new hearing only in his or her discretion or where required by law, and may consider the record developed before the magistrate judge, making his or her own determination on the basis of that record. The judge may also receive further evidence, recall witnesses or recommit the matter to the magistrate judge with instructions.