Opinion
C. A. 9:21-02489-DCN-MHC
07-28-2022
Tamala Riley, Plaintiff, v. Commissioner of Social Security Administration, Defendant.
REPORT AND RECOMMENDATION
Molly H. Cherry, United States Magistrate Judge
Plaintiff filed the complaint in this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3), seeking judicial review of the final decision of Defendant Commissioner of Social Security (the Commissioner) denying her claims for Disability Insurance Benefits (DIB) under Title II and Supplemental Security Income (SSI) under Title XVI of the Social Security Act. This case was referred to the undersigned for a report and recommendation pursuant to 28 U.S.C. § 636(b) and Local Civil Rule 73.02(B)(2)(a) (D.S.C.). Having carefully considered the parties' submissions and the applicable law, the undersigned recommends that the Commissioner's decision be affirmed for the reasons that follow.
I. BACKGROUND
A. Procedural History
Plaintiff applied for DIB and SSI on January 10, 2019, alleging disability beginning November 16, 2014. R.pp. 15, 170-173, 176-179. Plaintiff's claims were denied initially and upon reconsideration, and Plaintiff then requested a hearing before an ALJ. R.pp. 15, 74-75, 104-105, 120-122. A telephonic hearing, at which Plaintiff and a vocational expert testified, was held on December 2, 2020. R.pp. 29-56. The ALJ thereafter denied Plaintiff's claims in a decision issued on February 3, 2021, finding that Plaintiff was not disabled during the relevant time period. R.pp. 15-24.
The Appeals Council denied Plaintiff's request for review on June 17, 2021, making the ALJ's decision the final decision of the Commissioner for purposes of judicial review. R.pp. 1-6. Thereafter, Plaintiff brought this action seeking judicial review of the Commissioner's decision.
B. Medical Evidence
On February 4, 2014, because of complaints of persistent abdominal pain, Plaintiff underwent an abdominal CT at Coastal Carolina Medical Center. Two midline ventral hernias were noted, one with a significant amount of mesenteric fat and suspected mild inflammatory changes. R.pp. 402-403.
Plaintiff was treated at Chelsea Health Center on October 8, 2014, for continued complaints of abdominal pain. R.pp. 432-434. On October 15, 2014, a CT of Plaintiff's abdomen showed a series of 4 midline ventral hernia defects all containing fat with no acute intra-abdominal abnormality observed. R.pp. 383. After consultation with Dr. Carlos Montenegro of Southern Surgery specialists on November 3, 2014, Plaintiff underwent laparoscopic repair with mesh on November 13, 2014. R.pp. 320-323.
Plaintiff followed up at the Chelsea Center on January 7, 2015, at which time she reported abdominal pain and fatigue after her surgery. She complained of difficulty getting out of bed and moving herself into her car. Physician Assistant Monet Planter assessed Plaintiff with multifocal abdominal pain, prescribed Tylenol #3 for abdominal pain, and encouraged Plaintiff to follow up with Dr. Montenegro for further evaluation. R.pp. 430-431. On February 5, 2015, a CT showed a recurrent midline pelvic ventral hernia measuring 65mm that contained loops of small bowel. It was suspected that there were two separate abdominal wall defects involved and prominent wall scarring was suspected. R.pp. 377-378.
On March 5, 2015, Dr. Montenegro examined Plaintiff for recurrent hernia. He assessed Plaintiff with heartburn and pain following surgery. She was referred for an endoscopy, which showed active chronic gastritis. R.pp. 314-315, 327-328.
On August 5, 2016, Nurse Practitioner (NP) J. R. Mynatt, in consultation with Dr. Robert L. Thomas, assessed Plaintiff with morbid obesity, EDS, and severe obstructive sleep apnea (OSA). A CPAP trial was ordered and Plaintiff was advised of the importance of weight control, diet, exercise, stress management, and the need to check blood pressure. R.pp. 491-492; see R.p. 493. On September 6, 2016, Plaintiff underwent nocturnal polysomnography and CPAP titration with Dr. Thomas. It was noted that it was not an optimum CPAP trial, but there was improvement in obstructive events with the CPAP and it was recommended that Plaintiff use the CPAP with oxygen supplementation, lose weight, and receive sleep hygiene education. R.p. 494.
In September 2016, an office note indicated that Plaintiff had not showed for her last three appointments scheduled at Southern Surgery Specialists. R.p. 326.
Plaintiff was treated at the Beaufort Memorial Hospital emergency department for abdominal pain and right index finger swelling on January 19, 2017. Examination revealed a soft and nontender abdomen with no masses and normal bowel sounds. She was alert and had a normal gait. Plaintiff had normal cerebellar function, no focal motor or sensory deficits, and no cranial nerve deficits. Her extremities were nontender, there was no edema, and she had full range of motion and symmetric peripheral pulses. A CT scan of her abdomen and pelvis showed prior hernia repair with mesh anterior abdominal wall with no acute findings. Plaintiff had some improvement with medications and was referred to gastroenterology for follow-up. R.p. 337-345.
In November 2017, December 2017, and February 2018, Plaintiff was treated by providers at the Chelsea Center for sleep apnea, hypertension, high cholesterol, abdominal pain, stage one chronic kidney disease, unstable blood sugar/pre-diabetes, and morbid obesity. In November 2017, Plaintiff reported she had been out of her blood pressure medication for months and had not used her CPAP as prescribed for about two to three months. R.pp. 412-419. On February 12, 2018, an ultrasound of Plaintiff's abdomen revealed no acute abnormality. R.p. 357.
On March 1, 2018, Plaintiff complained to nurse practitioner (NP) Laura Heatley, a provider in the office of Dr. Thomas, of waking up with headaches every morning and daytime sleepiness after she had been off her CPAP machine for a few months because medical resources sent her the wrong CPAP mask and supplies. NP Heatley diagnosed Plaintiff with sleep apnea for which Plaintiff was to continue using her CPAP, and with acute sinusitis and a cough for which medication was prescribed. She was to call the office back if she had further difficulty obtaining a new mask. R.pp. 495-497. On May 30, 2018, Plaintiff reported to NP Heatley, in consultation with Dr. Thomas, that she finally received her supplies and would restart her CPAP that night. She was also directed to use supplemental oxygen at night. R.pp. 498-500.
On July 11, 2018, Plaintiff reported to NP Heatley, in consultation with Dr. Thomas, that she was “fighting to breath[e] under her CPAP.” Plaintiff's daughter stated that Plaintiff did not seem to get air under her CPAP resulting in Plaintiff waking up multiple times nightly to get air, the mask leaked air around Plaintiff's nose, Plaintiff was accidentally falling asleep on the toilet, and Plaintiff reported waking up from a dream in which she was fighting to breathe. Plaintiff was referred for an overnight sleep study, multiple sleep latency test (MSLT), and BiPap trial. R.pp. 501-503
The impression of an October 2018 sleep study was severe OSA, sleep-related hypoxemia, snoring, and hyposomnia. Improvement of obstructive events was noted with the use of a BiPap. MSLT results indicated narcolepsy type two, super obesity, severe OSA, and hypoxemia during sleep. The recommendation was for use of BiPap with water pressure during sleep, sleep hygiene education, and weight loss. R.p. 470-473.
On November 7, 2018, NP Heatley, in consultation with Dr. Thomas, saw Plaintiff to review the sleep study results. Plaintiff complained of excessive daytime sleepiness, episodes of falling asleep in the bathroom two to three times nightly, two instances of falling off the toilet, and trouble with her memory. A BiPap was to be ordered and Plaintiff was prescribed Contrave for morbid obesity. R.pp. 504-506.
Plaintiff consulted with Dr. Thomas by telephone on April 21, 2020. She reported headaches, shortness of breath, and chest pain at night. She said she was unable to fill her prescription for Modafinil because her insurance would not pay for it, but also stated that the dosage she was on had not been helping. Plaintiff reported compliance with her CPAP and that she benefitted from it. Dr. Thomas changed her medication from Modafinil to Sunosi. R.pp. 584585.
Plaintiff was examined for abdominal pain by Dr. Robert James Brockman on June 17, 2020. A benign abdominal examination was noted and a CT was ordered. R.pp. 558-561. On June 26, 2020, a CT of Plaintiff's abdomen and pelvis showed prior hernia repair with mesh appearing noncongruent on the left and no other significant findings. R.pp. 562-563. Plaintiff returned to Dr. Brockman for follow up on July 27, 2020. He reviewed the CT scan and noted that the left side of the mesh appeared to be partially detached but with no evidence of any bowel trapped or impinging upon the mesh or between the mesh and the abdominal wall, no evidence of obstruction, and no evidence of any inflammation. He did not think intervention surgically was warranted at that time, did not recommend any laparoscopy or laparotomy for lysis of adhesions or in an attempt to repair the mesh, and noted that she was set up for multiple complications from a general surgical standpoint because of her weight. R.pp. 554-557.
C. ALJ's Decision
The ALJ found, in pertinent part:
1. The claimant meets the insured status requirements of the Social Security Act through September 30, 2019.
2. The claimant has not engaged in substantial gainful activity since November 16, 2014, the alleged onset date (20 CFR 404.1571 et seq.).
3. The claimant has the following severe impairments: obesity, history of hernia, obstructive sleep apnea, and narcolepsy (20 CFR 404.1520(c) and 416.920(c).
4. The claimant does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926).
5. After careful consideration of the entire record, the [ALJ] finds that the claimant has the residual functional capacity to perform medium work as defined in 20 CFR 404.1567(c) and 416.967(c) except that she cannot climb ladders, ropes, or scaffolds; she can occasionally climb ramps and stairs; and she must avoid working at unprotected heights or hazardous machinery. Due to obstructive sleep apnea with narcolepsy, she has the mental ability to perform work that needs little specific vocational preparation where the duties can be learned on the job in 30 days or less; and time off task can be accommodated by employer-afforded breaks ([e.g.], 15 minutes in the morning, a 30[-]minute lunch break, and 15 minutes in the afternoon).
6. The claimant is unable to perform any past relevant work (20 CFR 404.1565 and 416.965).
7. The claimant was born on.... and was 40 years old, which is defined as a younger individual age 18-49, on the alleged disability onset date (20 CFR 404.1563 and 416.963).
8. The claimant has at least a high school education (20 CFR 404.1564 and 416.964).
9. Transferability of job skills is not material to the determination of disability because using the Medical-Vocational Rules as a framework supports a finding that the claimant is “not disabled,” whether or not the claimant has transferable job skills (See SSR 82-41 and 20 CFR Part 404, Subpart P, Appendix 2).
10. Considering the claimant's age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform (20 CFR 404.1569, 404.1569(a), 416.969, and 416.969(a)).
11. The claimant has not been under a disability, as defined in the Social Security Act from November 16, 2014, through the date of this decision (20 CFR 404.1520(g) and 416.920(g)).R.pp. 17-23.
II. APPLICABLE LAW
A. Scope of Review
Jurisdiction of this Court is pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). Under § 405(g), judicial review of a final decision regarding disability benefits is limited to determining (1) whether the factual findings are supported by substantial evidence, and (2) whether the correct legal standards were applied. 42 U.S.C. § 405(g); Walls v. Barnhart, 296 F.3d 287, 290 (4th Cir. 2002) (citing Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990)). Accordingly, a reviewing court must uphold the final decision when “an ALJ has applied correct legal standards and the ALJ's factual findings are supported by substantial evidence.” Brown v. Comm r Soc. Sec. Admin., 873 F.3d 251, 267 (4th Cir. 2017) (internal quotation marks omitted).
“Substantial evidence” is an evidentiary standard that is not high: it is “more than a mere scintilla” and means only “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019). A reviewing court does not reweigh conflicts in evidence, make credibility determinations, or substitute its judgment for that of the ALJ. Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012). “Where conflicting evidence allows reasonable minds to differ as to whether a claimant is disabled, the responsibility for that decision falls on the [ALJ].” Id. (alteration in original) (internal quotation marks and citation omitted). However, this limited review does not mean the findings of an ALJ are to be mechanically accepted, as the “statutorily granted review contemplates more than an uncritical rubber stamping of the administrative action.” Howard v. Saul, 408 F.Supp.3d 721, 725-26 (D.S.C. 2019) (quoting Flack v. Cohen, 413 F.2d 278, 279 (4th Cir. 1969)).
B. Social Security Disability Evaluation Process
To be considered “disabled” within the meaning of the Social Security Act, a claimant must show that she has an impairment or combination of impairments which prevent her from engaging in all substantial gainful activity for which she is qualified by her age, education, experience, and functional capacity, and which has lasted or could reasonably be expected to last for a continuous period of not less than twelve months. See 42 U.S.C. § 423. The Social Security Administration established a five-step sequential procedure in order to evaluate whether an individual is disabled for purposes of receiving DIB and SSI. See 20 C.F.R. §§ 404.1520, 416.920; see also Mascio v. Colvin, 780 F.3d 632, 634-35 (4th Cir. 2015) (outlining the questions asked in the five-step procedure). The burden rests with the claimant to make the necessary showings at each of the first four steps to prove disability. Mascio, 780 F.3d at 634-35. If the claimant fails to carry her burden, she is found not disabled. Lewis v. Berryhill, 858 F.3d 858, 861 (4th Cir. 2017). If the claimant is successful at each of the first four steps, the burden shifts to the Commissioner at step five. Id.
With certain exceptions not applicable here, the SSA and implementing regulations regarding DIB (contained in Title II) and SSI (contained in Title XVI) are substantially identical. Accordingly, wherever only one Title's regulation is cited herein, the analysis is equally applicable to the Plaintiff's claims under the other Title. See, e.g., Barnhart v. Thomas, 540 U.S. 20, 24 (2003) (“For simplicity's sake, we will refer only to the Title II provisions, but our analysis applies equally to Title XVI.”).
At the first step, the ALJ must determine whether the claimant has engaged in substantial gainful activity since her alleged disability onset date. 20 C.F.R. §§ 404.1520(b), 416.920(b). At step two, the ALJ determines whether the claimant has an impairment or combination of impairments that meet the regulations' severity and duration requirements. Id. §§ 404.1520(c), 416.920(c). At step three, the ALJ considers whether the severe impairment meets the criteria of an impairment listed in Appendix 1 of 20 C.F.R. part 404, subpart P (the “Listings”) or is equal to a listed impairment. If so, the claimant is automatically eligible for benefits; if not, before moving on to step four, the ALJ assesses the claimant's residual functional capacity (RFC). Id. §§ 404.1520(d), (e), 416.920(d), (e); Lewis, 858 F.3d at 861.
The RFC is “the most the claimant can still do despite physical and mental limitations that affect her ability to work.” Mascio, 780 F.3d at 635 (internal quotation marks and citations omitted).
At step four, the ALJ determines whether, despite the severe impairment, the claimant retains the RFC to perform her past relevant work. 20 C.F.R. §§ 404.1520(e), (f), 416.920(e), (f). If the ALJ finds the claimant capable of performing her past relevant work, she is not disabled. Id. §§ 404.1520(f), 416.920(f). If the requirements to perform the claimant's past relevant work exceed her RFC, then the ALJ goes on to the final step.
At step five, the burden of proof shifts to the Social Security Administration to show that the claimant can perform other jobs existing in significant numbers in the national economy, considering the claimant's age, education, work experience, and RFC. Id. §§ 404.1520(g), 416.920(g);Mascio, 780 F.3d at 634-35. Typically, the Commissioner offers this evidence through the testimony of a vocational expert answering hypotheticals that incorporate the claimant's limitations. Mascio, 780 F.3d at 635. “If the Commissioner meets her burden, the ALJ finds the claimant not disabled and denies the application for benefits.” Id.
III. DISCUSSION
Plaintiff contends the ALJ's RFC assessment was not supported by substantial evidence. For the following reasons, her alleged errors do not warrant remand.
A. Subjective Complaints
Within her discussion of the alleged errors in the RFC, Plaintiff also argues that the ALJ failed to properly analyze her subjective complaints about narcolepsy. She claims the ALJ failed to identify the specific complaints he accepted or rejected, did not reference any of the relevant criteria laid out in SSR 16-3p, and failed to address the issue “at all” other than to state that her complaints were “not entirely consistent with the evidence.” The Commissioner contends that the ALJ properly considered Plaintiff's subjective complaints in making his RFC determination.
SSR 16-3p provides a two-step process for evaluating an individual's symptoms. First, the ALJ must determine whether the individual has a medically determinable impairment “that could reasonably be expected to produce the individual's alleged symptoms, such as pain.” SSR 16-3p, 2017 WL 5180304, at *3. At the second step, the ALJ must “evaluate the intensity and persistence of an individual's symptoms such as pain and determine the extent to which an individual's symptoms limit his or her ability to perform work-related activities ....” Id. at *4. “In considering the intensity, persistence, and limiting effects of an individual's symptoms, we examine the entire case record, including the objective medical evidence; an individual's statements about the intensity, persistence, and limiting effects of symptoms; statements and other information provided by medical sources and other persons; and any other relevant evidence in the individual's case record.” Id.; see also 20 C.F.R. §§ 404.1529(a) and 416.929(a).
The ALJ's decision “must contain specific reasons for the weight given to the individual's symptoms, be consistent with and supported by the evidence, and be clearly articulated so the individual and any subsequent reviewer can assess how the adjudicator evaluated the individual's symptoms.” SSR 16-3p, 2017 WL 5180304, at *10. The adjudicator is instructed to “consider all of the evidence in an individual's record.” The factors to consider in evaluating the intensity, persistence, and limiting effects of the claimant's symptoms include the claimant's daily activities; the location, duration, frequency, and intensity of the claimant's pain or other symptoms; factors that precipitate or aggravate the symptoms; the type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate pain or other symptoms; treatment, other than medication, the claimant receives or has received for relief of pain or other symptoms; any measures other than treatment the individual uses or has used to relieve pain or other symptoms; and any other factors concerning the individual's functional limitations and restrictions due to pain or other symptoms. SSR 16-3p, at *2, *8; see also 20 C.F.R. §§ 404.1529(c) and 416.929(c). The ALJ need not accept the claimant's subjective complaints “to the extent they are inconsistent with the available evidence, including objective evidence of the underlying impairment.” Craig v. Chater, 76 F.3d 585, 594 (4th Cir. 1996).
In the present case, the ALJ properly cited the applicable law (20 C.F.R. §§ 404.1529 and 416.929 and SSR 16-3p) and applied the two-part test. R.p. 19-20, 22. The ALJ specifically found that although Plaintiff's medically determinable impairments could be expected to cause the alleged symptoms, her statements concerning the intensity, persistence, and limiting effects of those symptoms was not entirely consistent with the medical and other evidence of record. R.p. 20. In doing so, the ALJ noted that he “considered all symptoms and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence[.]” R.p. 19.
The ALJ also discussed Plaintiff's testimony concerning her subjective complaints, including her narcolepsy symptoms. R.p. 20. As to her testimony concerning her narcolepsy, the ALJ wrote:
The claimant testified that she cannot stand to wash dishes and can only sit for 30 minutes at a time. She indicated that she frequently falls asleep. She estimated that
she falls asleep 6-7 times a day.Id.
In assessing Plaintiff's subjective complaints, the ALJ discussed not only the objective medical records, but also considered Plaintiff's testimony and her subjective complaints to her medical providers. R.pp. 19-22. Moreover, despite his conclusion that objective evidence did not support the degree of limitation alleged by Plaintiff, the ALJ found her more limited by restricting her to work that needed little specific vocational preparation. R.pp. 19, 22. The ALJ wrote that although Plaintiff's “allegations of such significant limitations and pain were not fully consistent with the medical evidence of record, [he] accorded [Plaintiff] the benefit of the doubt and further reduced the residual functional capacity to include her limitations as described above.” R.p. 22.
Although Plaintiff appears to allege that the ALJ should not have discounted her complaints of falling asleep, any error is harmless as she has not pointed to any credible limitations from her narcolepsy. There is no indication that any of Plaintiff's treating providers found that she had any limitations from her narcolepsy. After she received and was compliant with her BiPap machine, Plaintiff reported that she benefitted from using it. R.pp. 585-586. The ALJ's findings are also supported by state agency physician Dr. R. Warren's opinion, in February 2020, that Plaintiff had the ability to understand and remember simple instructions and attend and concentrate for periods of two hours as required in the workplace. R.pp. 88, 102.
Based on the above, there is substantial evidence that supports the ALJ's consideration of Plaintiff's subjective allegations in accordance with the provisions of 20 C.F.R. §§ 416.929 and 404.1529 and SSR 16-3p. The undersigned does not find that the ALJ conducted an improper subjective complaint analysis in reaching his conclusion, nor does the undersigned find that the ALJ's decision otherwise reflects a failure to properly consider the records and evidence in this case. See Bowen v. Yuckert, 482 U.S. 137, 146 n. 5 (1987) (noting that the plaintiff has the burden to show that he has a disabling impairment); Kellough v. Heckler, 785 F.2d 1147, 1149 (4th Cir. 1986) (“If the [Commissioner's] dispositive factual findings are supported by substantial evidence, they must be affirmed, even in cases where contrary findings of an ALJ might also be so supported.”). Accordingly, remand is not warranted on this issue.
B. RFC
Plaintiff contends that the ALJ's RFC analysis is not supported by substantial evidence because he failed to explain how her severe impairment of narcolepsy factored into the RFC assessment. The Commissioner argues that substantial evidence supports the RFC assessment.
In evaluating a claimant's RFC, an ALJ must “consider all of the claimant's ‘physical and mental impairments, severe and otherwise, and determine, on a function-by-function basis, how they affect [her] ability to work.'” Thomas v. Berryhill, 916 F.3d 307, 311 (4th Cir. 2019) (quoting Monroe v. Colvin, 826 F.3d 176, 188 (4th Cir. 2016)). “[A]n ALJ's RFC assessment must include an evaluation of the claimant's ability to perform the physical functions listed in 20 C.F.R. §[§ 404.1545(b),] 416.945(b).” Dowling v. Comm'r of Soc. Sec. Admin., 986 F.3d 377, 387 (4th Cir. 2021) (citing SSR 96-8p, 1996 WL 374184, at *1). “‘Only after such a function-by-function analysis may an ALJ express RFC in terms of the exertional levels of work' of which he believes the claimant to be capable.” Id. (quoting Monroe, 826 F.3d at 179) (emphasis added). Moreover, every conclusion reached by an ALJ when evaluating a claimant's RFC must be accompanied by “a narrative discussion describing [] the evidence” that supports it. Id. (quoting Thomas, 916 F.3d at 311) (alteration in original).
These physical functions are “sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical functions [that] may reduce [a claimant's] ability to do past work and other work.” 20 C.F.R. § 404.1545(b).
Consequently, “a proper RFC analysis has three components: (1) evidence, (2) logical explanation, and (3) conclusion.” Thomas, 916 F.3d at 311. The ALJ's logical explanation is just as important as the ALJ's discussion of evidence and his conclusion. Id. Thus, in conducting an RFC analysis, an ALJ must identify both the evidence that backs his conclusion, and “build an accurate and logical bridge from [that] evidence to his conclusion.” Woods v. Berryhill, 888 F.3d 686, 694 (4th Cir. 2018) (alteration in original) (quoting Monroe, 826 F.3d at 189).
Here, the ALJ cited the correct standard (citing to 20 C.F.R. §§ 404.1545, 416.920(e), 416.945, and SSR 96-8p) as to his determination of Plaintiff's RFC and explained his RFC findings. R.pp. 17, 19, 21-22. The ALJ discussed the medical evidence from the relevant time period, the assessments by the State Agency medical consultants, and Plaintiff's testimony in reaching his decision. R.pp. 20-22. The ALJ did not disregard Plaintiff's complaints or the positive medical findings. See Smith v. Colvin, No. 6:15-CV-1750-PMD-KFM, 2016 WL 2619474, at *3 (D.S.C. May 9, 2016) (“[T]he ALJ's decision shows he carefully considered all the evidence in the record and, where appropriate, even made findings that favored [the claimant.”].
The ALJ's physical RFC determination is supported by the record, as none of Plaintiff's treating or examining medical providers placed any limitations on her physical ability to perform work. Nor did the state agency medical consultants place any limitations on Plaintiff's physical ability to perform work. See R.pp. 57-72, 76-103. Additionally, the ALJ gave Plaintiff the benefit of the doubt by finding that Plaintiff's obesity limited her to less than the full range of medium work. See R.pp. 17, 21.
The ALJ's mental RFC determination is also supported by the record. None of Plaintiff's treating medical providers placed any limitations on her mental ability to perform work. The determination is also supported by the opinion of state agency physician Dr. Warren, which the ALJ found persuasive. R.pp. 21-22. On February 28, 2020, Dr. Warren opined that Plaintiff had the ability to understand and remember simple instructions, “attend to” and concentrate for periods of two hours as required in the workplace, interact with peers and supervisors, and adapt to normal workplace changes. R.pp. 88, 102.
A consultative mental status evaluation was conducted by Dr. Joy Welcker, a psychologist, on January 29, 2020. Testing revealed mental functioning within normal limits. Dr. Welcker opined that there was no impairment as to Plaintiff's ability to handle familiar and detailed instructions, sustain attention to promote simple task completion, and get along with others in the general public. She thought Plaintiff had only mild impairments to the ability to maintain concentration, persistence, and pace; engage in selfcare; and effectively manage funds independently. However, Dr. Welcker thought that Plaintiff had a moderate impairment in the ability to understand, recall, and carry out simple instructions; moderate impairment in the ability to grasp new concepts or handle new complex or multi-stepped instructions; and marked impairment in the ability to withstand routine demands, pressure, or expectations. R.pp. 538-542. The ALJ noted (R.p. 21) that Dr. Welcker's opinions were admittedly based, at least in part, on Plaintiff's own subjective complaints and was not persuaded by these opinions as they were generally unsupported by the weight of the medical evidence and inconsistent with Plaintiff's presentation upon routine examination. Plaintiff has not challenged the ALJ's decision to discount Dr. Welcker's opinion.
Plaintiff alleges that the RFC determination is flawed because the ALJ failed to explain how her narcolepsy affected her ability to sustain work-related functioning. However, review of the decision reveals that the ALJ considered Plaintiff's testimony concerning her limitations from narcolepsy and considered the medical evidence. R.pp. 20-21. The ALJ specifically noted:
In October 2018, the claimant underwent snoring analysis and multiple sleep latency testing. She was found to have narcolepsy type 2, severe obstructive sleep apnea, and hypoxemia during sleep. Dr. Robert Thomas educated the claimant in sleep hygiene measures and encouraged her to maintain lean body weight. He recommended that she avoid sleeping in the supine position. He started her on a trial of Modafinil during the day time and Xyrem at bed time.R.p. 21. Additionally, the ALJ found that because of Plaintiff's sleep apnea with narcolepsy, she was limited to work that needed little specific vocational preparation where the duties could be learned on the job in 30 days or less and that time off task could be accommodated by employer- afforded breaks (which he indicated was 15 minutes in the morning, a 30-minute lunch break, and 15 minutes in the afternoon). R.p. 19.
Plaintiff alleges that the ALJ failed to review all relevant evidence because he did not specifically discuss all of Dr. Thomas's treatment notes as he “did not even acknowledge evidence after October 2019.” ECF No. 11 at 9. However, the ALJ referenced Exhibit 15F (R.pp. 584-588), which contains Dr. Thomas's treatment notes from April and November 2020, in his discussion of Plaintiff's severe impairment of obesity. R.p. 21. Even if the ALJ failed to consider the treatment notes referenced by Plaintiff, which she has not shown, these notes do not contain any limitations on Plaintiff's ability to work and do not contradict the ALJ's RFC findings.
The ALJ also discussed Dr. Brookman's treatment of Plaintiff (he referenced Exhibit 13Fsee R.pp. 552-563) after October 2019 (the ALJ discussed treatment notes from June to August 2020 and a July 2020 CT scan).
Further, to the extent that the ALJ did not fully recite the evidence as Plaintiff may have preferred or failed to mention evidence, the mere omission of some evidence does not require remand. See Reid v. Comm'r of Soc. Sec., 769 F.3d 861, 865 (4th Cir. 2014) (“[T]here is no rigid requirement that the ALJ specifically refer to every piece of evidence in his decision.” (quotation marks and citation omitted)); Russell v. Chater, 60 F.3d 824, 1995 WL 417576, at *3 (4th Cir. 1995)(unpublished) (rejecting an argument that the ALJ's analysis was insufficiently specific and noting Fourth Circuit precedent “does not establish an inflexible rule requiring an exhaustive point-by-point discussion in all cases”); see also Craig v. Apfel, 212 F.3d 433, 836 (8th Cir. 2000)(“[A]n ALJ is not required to discuss all the evidence submitted, and an ALJ's failure to cite specific evidence does not indicate that it was not considered.”) (citation omitted)).
When read as a whole, the ALJ's decision does not leave the Court guessing as to why the ALJ came to the conclusions he did. Contrary to Plaintiff's allegations, the ALJ properly considered Plaintiff's narcolepsy and found that this impairment did not prevent her from performing a reduced range of unskilled medium work. Further, Plaintiff has not identified any specific functional limitation resulting from her narcolepsy that was not accounted for in the RFC. See 20 C.F.R. §§ 404.1512(a), 416.912(a) (“[Y]ou have to prove to us that you are...disabled); Shinseki v. Sanders, 556 U.S. 396, 409-10 (2009) (finding that a party seeking to overturn an agency's administrative decision normally bears the burden of showing that an error was harmful); Pass v. Chater, 65 F.3d 1200, 1203 (4th Cir. 2000) (“The applicant bears the burden of production and proof during the first four steps of the sequential evaluation process.”).
To the extent Plaintiff argues other evidence in the record supports her position, this Court may not overturn a decision that is supported by substantial evidence just because the record may contain conflicting evidence. See Smith v. Chater, 99 F.3d 635, 638 (4th Cir. 1996) (“We must sustain the ALJ's decision, even if we disagree with it, provided the determination is supported by substantial evidence ... [t]he duty to resolve conflicts in the evidence rests with the ALJ, not with a reviewing court.”). It is the job of the ALJ to weigh evidence and resolve any evidentiary conflicts, not this Court. See Johnson v. Barnhart, 434 F.3d 650, 653 (4th Cir. 2005) (“In reviewing for substantial evidence, we do not undertake to reweigh conflicting evidence, make credibility determinations, or substitute our judgment for that of the [ALJ].” (citation omitted)). Plaintiff appears to be suggesting the Court accept her interpretation over the ALJ's and read the evidence differently. That is not the role of this Court. See Hancock, 667 F.3d at 472 (noting a reviewing court does not reweigh conflicts in evidence, make credibility determinations, or substitute its judgment for that of the ALJ).
Thus, the undersigned finds no reversible error here. To the contrary, the ALJ adequately explained the RFC, and the Court is not left to guess at how he came to his conclusions. See Biestek, 139 S.Ct. at 1154 (noting substantial evidence is an evidentiary standard that is not hi “more than a mere scintilla” and means only “such relevant evidence as a reasonable min accept as adequate to support a conclusion”).
IV. CONCLUSION
For the foregoing reasons, it is RECOMMENDED that the decision of the Comm be AFFIRMED.
The parties' attention is directed to the important notice on the next page.
Notice of Right to File Objections to Report and Recommendation
The parties are advised that they may file specific written objections to this Report and Recommendation with the District Judge. Objections must specifically identify the portions of the Report and Recommendation to which objections are made and the basis for such objections. “[I]n the absence of a timely filed objection, a district court need not conduct a de novo review, but instead must ‘only satisfy itself that there is no clear error on the face of the record in order to accept the recommendation.'” Diamond v. Colonial Life & Acc. Ins. Co., 416 F.3d 310 (4th Cir. 2005) (quoting Fed.R.Civ.P. 72 advisory committee's note).
Specific written objections must be filed within fourteen (14) days of the date of service of this Report and Recommendation. 28 U.S.C. § 636(b)(1); Fed.R.Civ.P. 72(b); see Fed.R.Civ.P. 6(a), (d). Filing by mail pursuant to Federal Rule of Civil Procedure 5 may be accomplished by mailing objections to:
Robin L. Blume, Clerk
United States District Court
Post Office Box 835
Charleston, South Carolina 29402
Failure to timely file specific written objections to this Report and Recommendation will result in waiver of the right to appeal from a judgment of the District Court based upon such Recommendation. 28 U.S.C. § 636(b)(1); Thomas v. Arn, 474 U.S. 140 (1985); Wright v. Collins, 766 F.2d 841 (4th Cir. 1985); United States v. Schronce, 727 F.2d 91 (4th Cir. 1984).