Opinion
Civil Action 3:22-CV-01954
10-27-2023
ALICE STOSS, Plaintiff, v. KILOLO KIJAKAZI, Defendant.
WILSON, J.
REPORT AND RECOMMENDATION
KAROLINE MEHALCHICK CHIEF UNITED STATES MAGISTRATE JUDGE
This is an action brought under Section 1383(c) of the Social Security Act and 42 U.S.C. § 405(g), seeking judicial review of the final decision of the Commissioner of Social Security (hereinafter, “the Commissioner”) denying Plaintiff Alice Stoss (“Stoss”)'s claims for a period of disability and disability insurance benefits (“DIB”) under Title II of the Social Security Act. (Doc. 1). The matter has been referred to the undersigned United States Magistrate Judge to prepare a report and recommendation pursuant to the provisions of 28 U.S.C. § 636(b) and Rule 72(b) of the Federal Rules of Civil Procedure. For the reasons expressed herein, and upon detailed consideration of the arguments raised by the parties in their respective briefs, it is respectfully recommended that the Commissioner's decision be AFFIRMED.
I. Background and Procedural History
On July 8, 2020, Plaintiff Stoss protectively filed an application for Title II benefits, claiming disability beginning February 2, 2020, due to chronic back, neck, shoulder, knee, and hand/arm pain. (Doc. 8-2, at 17). The Social Security Administration initially denied Stoss's application on August 26, 2020, and upon reconsideration on December 23, 2020, prompting Stoss's request for a hearing, which Administrative Law Judge (“ALJ”) Howard Kauffman held on October 13, 2021. (Doc. 8-2, at 17). In a written opinion dated November 12, 2021, the ALJ determined that Stoss was not disabled and therefore not entitled to the benefits sought. (Doc. 8-2, at 14). On October 5, 2022, the Appeals Council denied Stoss's request for review. (Doc. 8-2, at 2).
On December 9, 2022, Stoss filed the instant action. (Doc. 1). The Commissioner responded on February 10, 2023, providing the requisite transcripts from the disability proceedings. (Doc. 7; Doc. 8). The parties then filed their respective briefs, with Stoss alleging two errors warranted reversal or remand. (Doc. 9; Doc. 12; Doc. 13).
II. Standards of Review
To receive benefits under Title II of the Social Security Act, 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); 20 C.F.R. § 404.1509. 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 in significant numbers in the national economy. 42 U.S.C. § 423(d)(2)(A); 20 C.F.R. § 404.1505(a). Additionally, to be eligible to receive Title II benefits, a claimant must be insured for disability insurance benefits. 42 U.S.C. § 423(a)(1)(a); 20 C.F.R. § 404.131.
A “physical or mental impairment” is defined as an impairment resulting from “anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.” 42 U.S.C. § 423(d)(3).
A. Administrative Review
In evaluating whether a claimant is disabled, the “Social Security Administration, working through ALJs, decides whether a claimant is disabled by following a now-familiar five-step analysis.” Hess v. Comm'r of Soc. Sec., 931 F.3d 198, 200-01 (3d Cir. 2019). The “burden of proof is on the claimant at all steps except step five, where the burden is on the Commissioner of Social Security.” Hess, 931 F.3d at 201; see 20 C.F.R. § 404.1512(a)(1). Thus, if the claimant establishes an inability to do past relevant work at step four, the burden shifts to the Commissioner at step five to show that jobs exist in significant numbers in the national economy that the claimant could perform consistent with his or her residual functional capacity, age, education, and past work experience. 20 C.F.R. § 404.1512(a)(1).
B. Judicial Review
The Court's review of a determination denying an application for Title ii benefits is limited “to considering whether the factual findings are supported by substantial evidence.” Katz v. Comm'r of Soc. Sec., No. 19-1268, 2019 WL 6998150, at *1 (3d Cir. Dec. 20, 2019). 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) (internal quotation marks omitted). The quantum of proof 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 if the ALJ ignores countervailing evidence or fails to resolve a conflict created by such evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). 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).
The question before the Court, therefore, is not whether Stoss is disabled, but whether the Commissioner's determination that Stoss 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.”); Burton v. Schweiker, 512 F.Supp. 913, 914 (W.D. Pa. 1981) (“The [Commissioner]'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). “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). If “the ALJ's findings of fact . . . are supported by substantial evidence in the record,” the Court is bound by those findings. Knepp v. Apfel, 204 F.3d 78, 83 (3d Cir. 2000).
III. The ALJ's Decision
In his decision, the ALJ determined that Stoss “has not been under a disability, as defined in the Social Security Act, from February 2, 2020, through the date of this decision.” (Doc. 8-2, at 28). The ALJ reached this conclusion after proceeding through the five-step sequential analysis required by the Social Security Act. See 20 C.F.R. § 404.1520(a)(4). At the onset, the ALJ determined that Stoss meets the insured status requirements of the Social Security Act through December 31, 2025. (Doc. 8-2, at 19).
A. Step One
At step one, an ALJ must determine whether the claimant is engaging in substantial gainful activity (“SGA”). 20 C.F.R. § 404.1520(a)(4)(i). If a claimant is engaging in SGA, the Regulations deem them not disabled, regardless of age, education, or work experience. 20 C.F.R. § 404.1520(b). SGA is defined as work activity-requiring significant physical or mental activity-resulting in pay or profit. 20 C.F.R. § 404.1572(a)-(b). In making this determination, the ALJ must consider only the earnings of the claimant. 20 C.F.R. § 404.1574(a)(2). Here, the ALJ determined that Stoss “has not engage in [SGA] since February 2, 2020, the alleged onset date.” (Doc. 8-2, at 19). Thus, the ALJ's analysis proceeded to step two.
B. Step Two
At step two, the ALJ must determine whether the claimant has a medically determinable impairment-or a combination of impairments-that is severe and meets the 12-month duration requirement. 20 C.F.R. § 404.1520(a)(4)(ii). If the ALJ determines that a claimant does not have an “impairment or combination of impairments which significantly limits” the claimant's “physical or mental ability to do basic work activities,” the ALJ will find that the claimant does not have a severe impairment and is therefore not disabled. 20 C.F.R. § 404.1520(c). If, however, a claimant establishes a severe impairment or combination of impairments, the ALJ proceeds to consider step three. Here, the ALJ found that the medical evidence of record established the presence of the following medically determinable severe impairments: “degenerative disc disease of the cervical, thoracis, and lumbar spine, degenerative joint disease of the knees and left shoulder, and bilateral carpal tunnel syndrome.” (Doc. 8-2, at 19). The ALJ also noted the non-severe impairment of hyperlipidemia, hypertension, gastroesophageal reflux disease (“GERD”), and chronic obstructive pulmonary disease (“COPD”). (Doc. 8-2, at 19-20).
C. Step Three
At step three, the ALJ must determine whether the severe impairment or combination of impairments meets or equals the medical equivalent of an impairment listed in the version of 20 C.F.R. § Pt. 404, Subpt. P, App. 1 that was in effect on the date of the ALJ's decision. 20 C.F.R. §§ 404.1520(a)(4)(iii), 404.1525, 404.1526. The sections in this appendix are commonly referred to as “listings.” If the ALJ determines the claimant's impairment or impairments meet a listing, then the claimant is considered disabled. 20 C.F.R. § 404.1520(d). Otherwise, the ALJ must proceed to the fourth step of the analysis. 20 C.F.R. § 404.1520(d). The ALJ determined that none of Stoss's impairments, considered individually or in combination, met or equaled a Listing. (Doc. 8-2, at 20). Specifically, the ALJ considered Listings 1.15 (disorders of the skeletal spine resulting in compromise of a nerve root(s)); 1.16 (lumbar spinal stenosis resulting in compromise of the cauda equina); and 1.18 (abnormality of a major joint(s) in any extremity). (Doc. 8-2, at 20).
D. Residual Functional Capacity
Between steps three and four, the ALJ evaluates the claimant's residual functional capacity (“RFC”), crafted upon consideration of all the evidence presented. At this intermediate step, the ALJ considers all of the claimant's symptoms and “the extent to which [they] can reasonably be accepted as consistent with the objective medical evidence and other evidence.” 20 C.F.R. § 404.1529(a). This involves a two-step inquiry according to which the ALJ must (1) determine whether an underlying medically determinable mental impairment or impairments could reasonably be expected to produce the claimant's symptoms; and, if so, (2) evaluate the intensity, persistence, and limiting effects of the claimant's symptoms to determine the extent to which they limit the claimant's functional limitations. See 20 C.F.R. § 404.1529(b)-(c).
Here, Stoss alleged that her impairments caused the following symptoms: use of a scooter and service dog, and difficulty lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, using her hands, climbing stairs, and completing tasks. (Doc. 8-2, at 21). The ALJ found that while Stoss's medically determinable impairments could reasonably be expected to cause the alleged symptoms, Stoss's statements concerning the intensity, persistence, and limiting effects of these symptoms were not entirely consistent with the medical evidence and other evidence in the record. (Doc. 8-2, at 21). The ALJ then went on to detail Stoss's medical records and treatment history. (Doc. 8-2, at 21-23). Considering all evidence in the record, the ALJ determined that Stoss had the RFC “to perform light work as defined in 20 CFR 404.1567(b),” subject to the following non-exertional limitations:
[Stoss] can lift and/or carry 20 pounds occasionally and 10 pounds frequently. She can sit, stand, or walk for 6 hours each per 8-hour workday. She can occasionally climb stairs and stairs and occasionally balance, stoop, kneel, crouch, and crawl. She cannot climb ladders, ropes, or scaffolds. No concentrated exposure to extreme cold, wetness, vibration, fumes, dusts, gases, odors, poor ventilation, unprotected heights, moving machine parts. She can perform frequent handling, fingering, and feeling with the bilateral upper extremities and no overhead reaching with the dominant left upper extremity.(Doc. 8-2, at 20).
E. Step Four
Step four requires the ALJ to determine whether the claimant had, during the relevant period, the RFC to perform the requirements of his or her past relevant work regardless of the claimant's age, education, and work experience. 20 C.F.R. § 404.1520(a)(4)(iv). Past relevant work is work that the claimant has done within the past 15 years, that was substantial gainful activity, and that lasted long enough for the claimant to learn the requirements of the work. 20 C.F.R. § 404.1520(a)(4)(iv). The ALJ considers whether the claimant retains the capacity to perform the particular functional demands and job duties of the past relevant work, either as the claimant actually performed the work or as ordinarily required by employers throughout the national economy. Garibay v. Comm'r Of Soc. Sec., 336 Fed.Appx. 152, 158 (3d Cir. 2009) (quoting SSR 82-6). “If the claimant can perform his [or her] past relevant work despite his [or her] limitations, he [or she] is not disabled.” Hess, 931 F.3d at 202 (citing 20 C.F.R. § 404.1520(a)(4)(iv)). Here, the ALJ determined that through the date last insured, Stoss is capable of performing past relevant work as a receptionist and administrative clerk as actually performed, as a sales representative, as generally performed, and as a cashier II, as generally and actually performed. (Doc. 8-2, at 26). The ALJ explained that this work does not require the performance of work-related activities precluded by Stoss's RFC. (Doc. 8-2, at 26). In addition to past relevant work, the ALJ determined that there are other jobs that exist in significant number in the national economy that Stoss can perform, considering Stoss's age, education, work experience, and RFC. (Doc. 8-2, at 26). Thus, the ALJ made alternative findings for step five of the sequential analysis.
F. Step Five
At step five of the sequential analysis, the ALJ considers the claimant's age, education, and work experience to determine whether the claimant can make the adjustment to other work. 20 C.F.R. § 404.1520(a)(4)(v). If a claimant can adjust to other work, he or she will not be considered disabled. 20 C.F.R. § 404.1520(a)(4)(v). Here, the ALJ made vocational determinations that Stoss was 50 years old on the alleged onset date, defined as an individual closely approaching advanced age, on the alleged disability onset date, by the Regulations. 20 C.F.R. § 404.1563. (Doc. 8-2, at 27). The ALJ also noted that Stoss “has at least a high school education” as considered in 20 C.F.R. § 404.1564. (Doc. 8-2, at 27). The ALJ determined that upon consideration of these factors, Stoss's RFC, and the testimony of a vocational expert, “there are other jobs that exist in significant numbers in the national economy that the claimant can also perform.” (Doc. 8-2, at 26). In making this determination, the ALJ relied on the expertise of the vocational expert, who testified that Stoss would be able to perform the requirements of occupations, such as an information clerk, travel industry, marker, and mail clerk, non-government, which are occupations with open positions ranging from 71,000 to 141,000 nationally. (Doc. 8-2, at 27). As a result of this analysis, the ALJ determined that Stoss was not disabled and denied Stoss's applications for benefits. (Doc. 8-2, at 27-28).
IV. Discussion
Stoss advances two main arguments on appeal. First, Stoss asserts that the ALJ failed to properly evaluate the opinion of treating physician, William Nasuti, D.O. (“Dr. Nasuti”). (Doc. 9, at 11-15). Second, Stoss argues the ALJ's multiple errors with symptom evaluation compel reversal. (Doc. 9, at 15-19). In response, the Commissioner contends that substantial evidence supports the ALJ's decision and that the Court should affirm those finding given the deferential standard of review applicable to the ALJ's findings. (Doc. 12, at 1-2).
A. The ALJ did not err in their evaluation of Dr. Nasuti's opinion
Stoss argues that the ALJ erred in his evaluation of the opinion of Dr. Nasuti, which stoss contends is consistent with the objective evidence of record and supported by other medical evidence, including several MRi, x-rays, and treatment notes by other providers. (Doc. 9, at 13-15; Doc. 13, at 1-6). The Commissioner asserts that the ALJ fully complied with the relevant regulations in assessing Dr. Nasuti's opinion in a detailed and comprehensive analysis. (Doc. 12, at 18).
Assessing a claimant's RFC falls within the purview of the ALJ. 20 C.F.R. § 404.1546(c); SSR 96-8p, 1996 WL 374184 (S.S.A. July 2, 1996). “[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) (quoting Hartranft v. Apfel, 181 F.3d 358, 359 (3d Cir. 1999)). Specifically, one's RFC reflects the most that an individual can still do, despite his or her limitations, and is used at steps four and five to evaluate the claimant's case. 20 C.F.R. §§ 404.1520, 404.1545; SSR 96-8P, 1996 WL 374184 at *2. In crafting the RFC, the ALJ must consider all the evidence of record, including medical signs and laboratory findings, daily activities, medical source statements, and a claimant's medical history. SSR 96-8p, 1996 WL 374184, at *5; see also Mullin v. Apfel, 79 F.Supp.2d 544, 548 (E.D. Pa. 2000). An ALJ's RFC findings, however, must be supported by the medical evidence. Doak v. Heckler, 790 F.2d 26, 28 (3d Cir. 1986). “[O]nce the ALJ has made this [RFC] determination, [a court's] 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.” Black v. Berryhill, No. 16-1768, 2018 WL 4189661 at *3 (M.D. Pa. Apr. 13, 2018). Applying this standard to the present record, the Court finds substantial evidence supports the ALJ's RFC determination.
In Cotter v. Harris, the Circuit Court clarified that the ALJ must not only state the evidence considered which supports the result but also indicate what evidence was rejected: “Since it is apparent that the ALJ cannot reject evidence for no reason or the wrong reason, an explanation from the ALJ of the reason why probative evidence has been rejected is required so that a reviewing court can determine whether the reasons for rejection were improper.” 642 F.2d 700, 704, 706-707 (3d Cir. 1981). However, the ALJ need not undertake an exhaustive discussion of all the evidence. See, e.g.,Knepp, 204 F.3d at 83. “There is no requirement that the ALJ discuss in her opinion every tidbit of evidence included in the record.” Hur v. Barnhart, 94 Fed.Appx. 130, 133 (3d Cir. 2004).
As this matter involves a claim filed after March 27, 2017, the new regulatory framework governing the evaluation of medical opinions applies to the ALJ's evaluation of the medical opinions in the record. See Revisions to Rules Regarding the Evaluation of Medical Evidence, 82 Fed. Reg. 5844 (Jan. 18, 2017) (technical errors corrected by 82 Fed. Reg. 15,132-01 (Mar. 27, 2017)); see also 82 Fed. Reg. 15263 (March 27, 2017); 82 Fed. Reg. 16869 (corrective notice) (explaining that SSR 96-2p and 96- 5p do not apply to newly filed or pending claims after March 27, 2017). Under the new regulations, rather than assigning weight to medical opinions, the Commissioner will articulate “how persuasive” he or she finds the medical opinions. 20 C.F.R. § 404.1520c(b). The Commissioner's consideration of medical opinions is guided by the following factors: supportability; consistency; relationship with the claimant (including the length of the treatment relationship, the frequency of examinations, the purpose of the treatment relationship, the extent of the treatment relationship, and the examining relationship); specialization of the medical source; and any other factors that tend to support or contradict the opinion. 20 C.F.R. § 404.1520c(c). The most important of these factors is the “supportability” of the opinion and the “consistency” of the opinion. 20 C.F.R. § 404.1520c(b)(2).
The ALJ must explain how he or she considered the “supportability” and “consistency” of a medical source's opinion. 20 C.F.R. § 404.1520c(b)(2). Generally, the ALJ may, but is not required to, explain his or her consideration of the other factors, but if there are two equally persuasive medical opinions about the same issue that are not exactly the same, then the ALJ must explain how he or she considered the other factors. 20 C.F.R. § 404.1520c(b)(3). To facilitate judicial review, the ALJ's decision must be accompanied by “a clear and satisfactory explication of the basis on which it rests” and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Cotter, 642 F.2d at 704, 706-707. An ALJ need not undertake an exhaustive discussion of all the evidence or “use particular language or adhere to a particular format in conducting his analysis.” Jones v. Barnhart, 364 F.3d 501, 505 (3d Cir. 2004); see Hur, 94 Fed.Appx. at 133 (“There is no requirement that the ALJ discuss in his opinion every tidbit of evidence included in the record.”). However, an ALJ must ensure “sufficient development of the record and explanation of findings to permit meaningful review.” Jones, 364 F.3d at 505; see, e.g.,Rivera v. Comm'r of Soc. Sec., 164 Fed.Appx. 260, 262 (3d Cir. 2006) (“The only requirement is that, reading the ALJ's decision as a whole, there must be sufficient development of the record and explanation of findings.”).
The claimant bears the burden of establishing that he “became disabled at some point between the onset date of disability and the date that [his] insured status expired.” Zirnsak v. Colvin, 777 F.3d 607, 612 (3d Cir. 2014); see 42 U.S.C § 423(a)(1)(A); 20 C.F.R. § 404.131. While evidence generated after a claimant's date last insured can shed light on his condition during the insured period, that evidence does not necessarily compel the Commissioner to conclude that the claimant's condition during the insured period was as severe as it became after the date last insured. See Zirnsak, 777 F.3d at 614 (holding the ALJ did not err in giving little weight to an assessment of claimant's “current mental status,” conducted over two years after date last insured).
On August 20, 2021, Dr. Nasuti completed a physical RFC questionnaire. (Doc. 8-7, at 492). Dr. Nasuti noted that Stoss's diagnoses include chronic pain syndrome, carpal tunnel syndrome, mild to moderate cervical spondylosis, and degenerative joint disease, and that Stoss complains of constant joint pain. (Doc. 8-7, at 492). Dr. Nasuti assessed the following functional abilities of Stoss: her experience of pain or other symptoms are constantly severe enough to interfere with attention and concentration needed to perform even simple work tasks during a typical workday; never lift or carry even less than 10 pounds; rarely look down or hold her head in static position; occasionally turn her head right or left or loop up; can sit/stand for 10 minutes at a time and walk less than 50 feet without rest for a total of “0” time total during an 8-hour workday; would need to walk for 5 minutes every 15 minutes during an 8-hour workday; requires the ability to shift position at will from sitting, standing, or walking; would need a 15-minute break every 15 minutes during the workday; and requires the use of a cane or other assistive device. (Doc. 8-7, at 492-94). Dr. Nasuti also opined that Stoss can never twist, stoop, crouch, climb ladders, climb stairs, and balance, and can rarely bend at the waist. (Doc. 8-7, at 494). Dr. Nasuti noted Stoss can grasp, turn, and twist for 5% of the workday with either hand; can finger, feel, and perform fine manipulation for 5% of the workday with either hand; can reach, including overhead, for 1% of the workday with either hand; and can push/pull for 1% of the workday with either hand. (Doc. 8-7, at 495). Finally, Dr. Nasuti opined Stoss's COPD would also affect her ability to work at a regular job on a sustained basis. (Doc. 8-7, at 495).
In this case, the ALJ's evaluation comported with the new regulatory scheme and was based on substantial evidence. (Doc. 8-2, at 25). “Nothing in the Social Security Act or governing regulations requires the ALJ to obtain matching “opinion” evidence in order to fashion a claimant's RFC.” Myers v. Berryhill, 373 F.Supp.3d 528, 538 (M.D. Pa. 2019). “[T]he ALJ is responsible for making an RFC determination . . . and he is not required to seek a separate expert medical opinion.” Mays v. Barnhart, 78 Fed.Appx. 808, 813 (3d Cir. 2003); see Butler v. Colvin, 3:15-CV-1923, 2016 WL 2756268, at *13 n.6 (M.D. Pa. May 12, 2016) (rejecting the argument that a medical opinion is required to craft an RFC). “There 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). An ALJ “is not precluded from reaching RFC determinations without outside medical expert review of each fact incorporated into the decision.” Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 362 (3d Cir. 2011). The ALJ is expressly not required to “seek outside expert assistance.” Chandler, 667 F.3d at 362 (citing 20 C.F.R. §§ 404.1546(c), 404.1527(d), and SSR 96-5p).
The ALJ determined that Dr. Nasuti's opinion is not persuasive. (Doc. 8-2, at 25). In evaluating the opinion of Dr. Nasuti, the ALJ determined its persuasiveness by considering both the consistency and supportability of the opinion. Regarding supportability, the ALJ explained that “[w]hile Dr. Nasuti is [Stoss]'s primary care provider, he provided little support for his opinion other than noting [Stoss]'s diagnoses and subjective complaints.” (Doc. 8-2, at 25); see 20 C.F.R. § 404.1520c(c)(1). Next, considering the consistency factor, the ALJ stated:
[Dr. Nasuti's] opinion is not consistent with the objective medical evidence of record, including her physical examination findings, including her March 2021 evaluation with neurosurgery, at which she presented with a normal,
independent gait and was able to stand on her heels and toes without difficulties. She found that [Stoss] had 5/5 motor strength throughout her bilateral upper extremities and intact sensation, as well. This opinion is also inconsistent with Dr. Nasuti's own treatment notes and examination findings. Dr. Nasuti's treatment note from August 27, 2021, indicates that [Stoss] was scheduled for carpal tunnel surgery, but that she presented in no apparent distress and that her review of symptoms was negative for cough, shortness of breath and wheezing and no motor weakness. She presented with her lungs clear and a normal respiratory effort.(Doc. 8-2, at 25) (citations omitted); see 20 C.F.R. § 404.1520c(c)(2).
Furthermore, the ALJ explained that “statements on issues reserved to the Commissioner, such as Dr. Nasuti's statements regarding [Stoss] remaining on ‘short-term disability,' . . . are inherently neither valuable nor persuasive to the issue of whether a claimant is disabled or blind under the Social Security Act.” (Doc. 8-2, at 25). Thus, the ALJ determined that “no analysis about how such evidence is considered is provided,” pursuant to 20 C.F.R. § 404.1520b(c). (Doc. 8-2, at 25).
Upon review of the record, the undersigned finds that the ALJ's evaluation of the opinion of Dr. Nasuti comported with the Social Security Regulations. 20 C.F.R. § 404.1520c(b)(2). The ALJ was not required to explain additional factors and Stoss has not shown the opinion of Dr. Nasuti “compels” reversal. See I.N.S. v. Elias-Zacarias, 502 U.S. 478, 481 n.1 (1992). Considering Dr. Nasuti's opinion, as well as the opinions of State Agency physicians and objective medical evidence of record, the ALJ determined that Dr. Nasuti's findings were generally persuasive, and then found Stoss even more limited, providing limitations to frequent handling, fingering, and feeling with the bilateral upper extremities and never reaching overhead with the dominant left upper extremity, given later provided evidence related to Stoss's carpal tunnel syndrome. (Doc. 8-2, at 20-26). Since the Court is obligated to sustain an ALJ's decision whether substantial evidence supports that decision, this high quantum of proof supporting the ALJ's determination of Stoss's ability to work is fatal to this appeal. See Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019) (substantial evidence, “means only-‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion'”). To the extent Stoss asks the Court to reweigh the record evidence or make new factual findings, the Court may not invade the ALJ's province as a finder of fact in disability proceedings, for “our inquiry is not whether an alternate conclusion would have been reached, but whether substantial evidence supported the ALJ's decision.” Chandler, 667 F.3d at 359 (“Courts are not permitted to re-weigh the evidence or impose their own factual determinations.”); Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005) (“In the process of reviewing the record for substantial evidence, we may not ‘weigh the evidence or substitute [our own] conclusions for those of the fact-finder.' ” (citation omitted)). Notwithstanding Stoss's argument that the opinion of Dr. Nasuti might have been viewed in a way that would have also supported a different finding, the undersigned is obliged to affirm this ruling once the undersigned finds 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, the undersigned finds that substantial evidence supported the ALJ's evaluation of Dr. Nasuti's opinion and the evidence of record.
B. Substantial evidence supports the ALJ's evaluation of Stoss's SUBJECTIVE COMPLAINTS.
Stoss argues that the ALJ erroneously determined that Stoss's subjective symptom allegations were not consistent with the objective medical evidence of record. (Doc. 9, at 15; Doc. 13, at 6). specifically, stoss argues that the ALJ improperly disregarded her testimony of severe pain simply because it is not supported by objective medical evidence, the ALJ erroneously remarked that her treatment had been only conservative, and failed to properly question her regarding her treatment motivations and decisions. (Doc. 9, at 15-19). in response, the Commissioner argues that the ALJ reasonably determined that stoss's subjective complaints were not entirely consistent with the record, recognized that stoss's subjective complaints were not entirely consistent with her level of treatment, correctly considered the nature of stoss's treatment as just one factor, and was not required to mention every piece of evidence in the record. (Doc. 12, at 25-31).
The Commissioner's regulations define “symptoms” as the claimant's own description of his or her impairment. 20 C.F.R. § 404.1502(i). The ALJ is not only permitted, but also required, to evaluate the credibility of a claimant's statements about all symptoms alleged and must decide whether and to what extent a claimant's description of his or her impairments may be deemed credible. in many cases, this determination has a significant impact upon the outcome of a claimant's application, because the ALJ need only account for those symptoms - and the resulting limitations - that are credibly established when formulating his or her RFC assessment. Rutherford, 399 F.3d at 554. To facilitate this difficult analysis, the Commissioner has devised a two-step process that must be undertaken by the ALJ to evaluate a claimant's statements about his or her symptoms.
First, the ALJ must consider whether there is an underlying medically determinable impairment that can be shown by medically acceptable clinical and laboratory diagnostic techniques that could reasonably be expected to produce the symptom alleged. 20 C.F.R. § 404.1529(b). If there is no medically determinable impairment that could reasonably produce the symptom alleged, the symptom cannot be found to affect the claimant's ability to do basic work activities. 20 C.F.R. § 404.1529(b); SSR 16-3p, 2016 WL 1119029.
Second, the ALJ must evaluate the intensity, persistence, and limiting effects of the symptoms which can be reasonably attributed to a medically determinable impairment. 20 C.F.R. § 404.1529(c)(1). Symptoms will be determined to reduce a claimant's functional capacity only to the extent that the alleged limitations and restrictions can reasonably be accepted as consistent with objective medical evidence and other evidence of record. 20 C.F.R. § 404.1529(c)(4). However, an ALJ will not reject statements about the intensity, persistence, or limiting effects of a symptom solely because it is not substantiated by objective evidence. 20 C.F.R. § 404.1529(c)(3). Instead, the ALJ will evaluate the extent to which any unsubstantiated symptoms can be credited based on the following factors: the claimant's daily activities; the location, duration, frequency, and intensity of the claimant's pain or other symptoms; any factor that precipitates or aggravates the claimant's pain or other symptoms; the type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate his or her pain or other symptoms; any treatment, other than medication, the claimant receives or has received for relief of his or her pain or other symptoms; any measures the claimant uses or has used to relieve his or her pain or other symptoms (e.g., lying flat on your back, standing for 15 to 20 minutes every hour, sleeping on a board, etc.); and any other factors concerning functional limitations and restrictions due to pain or other symptoms. 20 C.F.R. § 404.1529(c)(3).
SSR 16-3p provides, in relevant part, that:
Symptoms cannot always be measured objectively through clinical or laboratory diagnostic techniques. However, objective medical evidence is a useful indicator to help make reasonable conclusions about the intensity and persistence of symptoms, including the effects those symptoms may have on the ability to perform work-related activities for an adult or to function independently, appropriately, and effectively in an age-appropriate manner for a child with a title XVI claim. We must consider whether an individual's statements about the intensity, persistence, and limiting effects of his or her symptoms are consistent with the medical signs and laboratory findings of record.
The intensity, persistence, and limiting effects of many symptoms can be clinically observed and recorded in the medical evidence. Examples such as reduced joint motion, muscle spasm, sensory deficit, and motor disruption illustrate findings that may result from, or be associated with, the symptom of pain. These findings may be consistent with an individual's statements about symptoms and their functional effects. However, when the results of tests are not consistent with other evidence in the record, they may be less supportive of an individual's statements about pain or other symptoms than test results and statements that are consistent with other evidence in the record.
For example, an individual with reduced muscle strength testing who indicates that for the last year pain has limited his or her standing and walking to no more than a few minutes a day would be expected to have some signs of muscle wasting as a result. If no muscle wasting were present, we might not, depending on the other evidence in the record, find the individual's reduced muscle strength on clinical testing to be consistent with the individual's alleged impairment-related symptoms.
However, we will not disregard an individual's statements about the intensity, persistence, and limiting effects of symptoms solely because the objective medical evidence does not substantiate the degree of impairment-related symptoms alleged by the individual. A report of minimal or negative findings or inconsistencies in the objective medical evidence is one of the many factors we must consider in evaluating the intensity, persistence, and limiting effects of an individual's symptoms.SSR 16-3p, 2017 WL 5180304 at *5.
An ALJ's findings based on the credibility of a claimant are to be accorded great weight and deference, since an ALJ is charged with the duty of observing a witness's demeanor and credibility. Frazier v. Apfel, No. 99-CV-715, 2000 WL 288246, at *9 (E.D. Pa. Mar. 7, 2000) (quoting Walters v. Comm'r of Soc. Sec., 127 F.3d 525, 531 (6th Cir. 1997)). An ALJ is not free to discount a claimant's statements about his or her symptoms or limitations for no reason or for the wrong reason. Rutherford, 399 F.3d at 554.
In a function report, Stoss wrote:
I can't stand for longer than 10 minutes or walk very far without resting. I can't sit for longer than 10 minutes. Must lay down to relieve pain. Both arms [and] hands get numbness/tingling/burning [and] feel swollen so its difficult to handle items, they get dropped. Always in pain.(Doc. 8-6, at 46).
In addition, Stoss reported that she experiences difficulty sleeping and paying attention, and that her impairments affect her ability to: lift, squat, bend, stand, reach, walk, sit, kneel, climb stairs, complete tasks, and use her hands. (Doc. 8-6, at 47, 51). During her administrative hearing, Stoss testified that she feels chronic exhaustion due to constant pain, lays down a few times a day, takes two or three naps a day, is in bed all day about one week per month, and experiences more bad days than good. (Doc. 8-2, at 45-47, 59). Stoss testified that her knees will sometimes give out while walking, her shoulder “has a habit of freezing up,” and she experiences swelling on the knees. (Doc. 8-2, at 50, 52).
Upon consideration of the record, the undersigned finds that the ALJ expressly considered and extensively discussed both the medical and non-medical evidence in the record. (Doc. 8-2, at 20-23). This included Stoss's statements regarding the limiting effects of her symptoms and limitations, as follows:
[Stoss] alleges disability due to chronic back, neck, shoulder, knee, and hand/arm pain. She testified that her pain medication makes her tired and that she naps during the day. She testified that she will use a scooter and has a service dog with problems with her balance. She testified to having more bad days than good days. She alleges difficulty lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, using her hands, climbing stairs, and completing tasks.(Doc. 8-2, at 21).
Based on his consideration of the whole record, the ALJ properly concluded that, while Stoss's “medically determinable impairments could reasonably be expected to cause the alleged symptoms,” her “statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely consistent with the medical evidence and other evidence in the record.” (Doc. 8-2, at 21). In reaching this conclusion, the ALJ explained:
On February 3, 2020, Craig Warren Fultz, MD, with Geisinger Health Orthopaedics, examined the claimant. He noted the claimant's history of bilateral knee pain and her status post arthroscopic meniscectomy at both knees. He noted her ongoing mechanical symptoms, right more symptomatic than her left. He reviewed the claimant's MRI of the right knee performed the prior month, showing a horizontal tear in the posterior horn at the medial meniscus, adjacent cysts, and tricompartmental osteoarthritis. He recommended that the claimant try another round of treatment with viscosupplementation.
The claimant's February 19, 2020 MRI of the lumbar spine showed central disc protrusion at the L4-5 level and a broad-based bulge at the L5-S1 level. On February 27, 2020, Normal Haueisen, DO, with Susquehanna Valley Pain Management, examined the claimant. He noted the claimant's history of thoracic and low back pain with a prior history of lumbar spine surgery. He noted that her recent MRI showed disc herniation at ¶ 4-5 and degeneration at ¶ 5-S1. The claimant also reported that she feels as though her knee problems are exacerbating her back pain. She presented with normal cervical spine exam findings and good grip. She had tenderness at the lower thoracic spine and lumbosacral junction. She had good range of motion with extension but pain with flexion and bilateral rotation. She had good range of motion of both hips but with pain radiating into her left hip in a classic L4 distribution. She had pain and swelling at both knees. He recommended a lumbar epidural steroid injection.
The claimant's February 28, 2020 MRI of the left knee showed free edge fraying posterior horn medial meniscus, mild intrasubstance degeneration anterior horn lateral meniscus, osteoarthritis with tricompartmental osteophytes and chondrosis, and proximal tib-fib effusion containing debris compatible with synovitis.
The claimant's March 9, 2020 thoracic spine x-rays showed mild multi-level thoracic and upper lumbar spine degenerative disc disease with no acute osseous abnormality of the thoracic spine.
On March 16, 2020, Dr. Fultz examined the claimant. He noted her ongoing right knee symptoms with no improvement with home exercises, steroid injection treatment, and viscosupplementation. The claimant agreed to proceed with a right total knee arthroplasty. However, in May 2020, the claimant advised that she did not want to proceed with the surgery due to the COVID-19 pandemic. She reported clicking, grinding, and instability but advised that her knee pain was “tolerable.”
he claimant's May 23, 2020 left shoulder x-rays showed moderate AC joint arthropathy and evidence suggestive of calcific tendinosis of the rotator cuff tendon insertions.
The claimant's June 4, 2020 MRI of the left shoulder showed a small intrasubstance tear in the distal insertion site of the supraspinatus, mild tendinopathy of the supraspinatus, tear of the posterior labrum, calcific subacromial/subdeltoid bursitis, and mild degenerative changes of the acromioclavicular joint and glenohumeral joint. The following day, Dr. Kiser reviewed the claimant's MRI. He recommended that the claimant continue with non-operative treatment. He administrated a subacromial steroid injection at the claimant's left shoulder.
The claimant's September 25, 2020 cervical spine x-rays showed mild degenerative disc disease at the C4-5 level, moderate at the C5-6 level, severe at the C6-7 level, and moderate at the C7-T11 level. The claimant's November 2, 2020, MRI of the cervical spine showed mild-to-moderate spondylosis with partial restoration of normal lordotic curvature since her previous study though with evidence of possible residual or recurrent muscle spasm.
On December 1, 2020, Ravi Rarekh, MD, and David Giampetro, MD, with Hersey Medical pain management, examined the claimant. They noted that the claimant's chronic low back pain, neck pain, and pain in her arms. They noted the claimant's prior treatments, including cervical and lumbar epidural injection treatments. They noted that her recent MRI of the cervical spine showed mild to moderate spondylosis, mild stenosis of the central canal, and foraminal stenosis, most notably on the left at ¶ 3-4 and C6-7. They noted that
an EMG was ordered but had not yet been performed. She presented with no paraspinal tenderness, full range of motion, no focal deficits, and intact motor strength and sensation throughout. They recommended a right cervical C7-T11 interlaminar epidural steroid injection. On March 5, 2021, the claimant reported no significant improvement following her January 2021 cervical epidural steroid injection. Further evaluation with an EMG/NCS was again recommended, as well as an evaluation of neurosurgery.
On December 15, 2020, Karena Hammon, CRNP, performed a consultative physical examination of the claimant. She noted the claimant's complaints of neck pain and chronic back pain. She also noted the claimant's history of left shoulder dysfunction with weakness and pain when attempting to raise her harm above her head and bilateral knee weakness with prior surgeries at both knees. She noted that the claimant uses no assistive device but has a therapy dog. The claimant reported that she drives, does her own cooking, cleaning, laundry, and shopping, and is able to meet her personal care needs. Nurse Hammon found that the claimant presented with a normal, unassisted gait. She noted that the claimant lost her balance when attempting to walk on heels and toes and was able to squat only 25% of full due to knee pain. She noted that the claimant needed no help getting on and off the exam table and was able to rise from a chair without difficulty. She found that the claimant had negative straight leg raising bilaterally both seated and supine, crepitus in both knees, normal reflexes, and no sensory deficit. She found that the claimant presented with no evident muscle atrophy, 4/5 strength in her left upper extremity, 5/5 strength in her right upper extremity, and 4/5 strength in her bilateral lower extremities. She noted that the claimant was able to zip, button, and tie without difficulty and had 4/5 grip strength bilaterally.
The claimant's March 25, 2021 EMG/NCS showed evidence of carpal tunnel syndrome, mold on the left and moderate on the right.
On March 29, 2021, Renee Orris, CRNP, with Hershey Medical neurosurgery, examined the claimant. She noted the claimant's reported worsening neck pain and bilateral upper extremity symptoms over the last two years. The claimant reported that her hand numbness and burning type pain is not improved with her baseline narcotic medication regimen. She noted that the claimant is left-hand dominant but ambidextrous and works as a dog groomer. Nurse Orris noted the claimant's prior treatments. She found that the claimant presented with a normal, independent gait and was able to stand on her heels and toes without difficulties. She found that the claimant had 5/5 motor strength throughout her bilateral upper extremities and intact sensation, as well.
On September 9, 2021, Dr. Dailey performed the claimant's right endoscopic carpal tunnel release surgery. On September 23, 2021, Dr. Dailey performed her left endoscopic carpal tunnel release surgery.(Doc. 8-2, at 21-23).
Stoss argues that the ALJ simply disregarded her subjective complaints of pain, which she claims is consistent with the objective medical evidence, including diagnostic studies, MRIs, x-rays, and treatment notes. (Doc. 9, at 16-17). It is evident from the ALJ's written decision, however, that he considered Stoss's subjective allegations of pain fully and in accordance with the requirements of SSR 16-3p. Stoss's note that the ALJ erroneously remarked that her treatment had been conservative is also unpersuasive given that an ALJ may properly consider the fact that conservative treatment of a claimant's medical condition contradicted the degree of severity alleged by the claimant. See Myers v. Comm'r of Soc. Sec., 684 Fed.Appx. 186, 192 (3d Cir. 2017); Garrett v. Comm'r of Soc. Sec., 274 Fed.Appx. 159, 164 (3d Cir. 2008); Dietrich v. Saul, 501 F.Supp.3d 283, 297 (M.D. Pa. 2020); Antoniolo v. Colvin, 208 F.Supp.3d 587, 597 (D. Del. 2016). To the extent Stoss argues that the ALJ failed to properly question her regarding her treatment motivations and decisions, SSR 16-3p's language is permissive in that it states that the ALJ “may need to contact the individual regarding [a] lack of treatment or, at an administrative proceeding, ask why he or she has not complied with or sought treatment in a manner consistent with his or her complaints.” SSR 16-3p, 2017 WL 5180304, at *9. “The ALJ is not obligated to question a complaint; rather, [the ruling] places such a judgment within the ALJ's discretion.” Green v. Kijakazi, No. 3:21-CV-00033, 2022 WL 4091972, at *7 (M.D. Pa. July 25, 2022), report and recommendation adopted, No. 3:21-CV-00033, 2022 WL 4080766 (M.D. Pa. Sept. 6, 2022) (citing Kreitz v. Berryhill, No. 3:16-CV-02406, 2018 WL 4102861, at *5 (M.D. Pa. June 6, 2018)). Furthermore, an ALJ “need not mention every piece of evidence in the record[.]” Beety-Monticelli v. Comm'r of Soc. Sec., 343 Fed.Appx. 743, 747 (3d Cir. 2009).
Stoss points to evidence that she contends supports additional limitations, and she suggests that the Court accept her analysis of the evidence over the analysis set forth by the ALJ. (Doc. 12, at 16-17). However, as noted above, the Court cannot reweigh the evidence. See Chandler, 667 F.3d, 359; Rutherford, 399 F.3d at 552. Furthermore, “[t]he presence of evidence in the record that supports a contrary conclusion does not undermine the Commissioner's decision so long as the record provides substantial support for that decision.” Malloy v. Comm'r of Soc. Sec., 306 Fed.Appx. 761, 764 (3d Cir. 2009). Here, the ALJ fulfilled his duty in evaluating the evidence and explaining why he chose to credit some evidence over other evidence.
Accordingly, because the undersigned finds that the ALJ's evaluation of Stoss's symptoms, including subjective complaints of pain, is supported by substantial evidence and was based upon a correct application of the relevant law, it is recommended that the Court affirm the ALJ's unfavorable decision.
V. Recommendation
Based on the foregoing, it is recommended that the Commissioner's decision be AFFIRMED , and that judgment be entered in favor of the Commissioner and against Stoss. It is further recommended that the Clerk of Court be directed to CLOSE this case.
NOTICE
NOTICE IS HEREBY GIVEN that the undersigned has entered the foregoing Report and Recommendation dated October 27, 2023. Any party may obtain a review of the Report and Recommendation pursuant to Rule 72.3, which provides:
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.