Opinion
4:20-CV-00146-M
01-05-2022
Whit Steven Williams, Plaintiff, v. Kilolo Kijakazi, Acting Commissioner of Social Security, Defendant.
MEMORANDUM & RECOMMENDATION
Robert T. Numbers, II United States Magistrate Judge
Plaintiff Whit Williams challenges Administrative Law Judge (“ALJ”) Kelly Davis's denial of his application for social security income. Williams claims that ALJ Davis erred in (1) determining his residual functional capacity (“RFC”), (2) evaluating his subjective statements, (3) determining his ability to perform other work, and (4) disregarding his ability to afford treatment. Both Williams and Defendant Kilolo Kijakazi, Acting Commissioner of Social Security, have moved for a judgment on the pleadings in their favor. D.E. 20, 22.
After reviewing the parties' arguments, the court has determined that ALJ Davis reached the appropriate determination. Substantial evidence supports ALJ Davis's RFC determination that Williams can perform a reduced range of light work. And she explained how Williams's subjective statements differed from the record. The undersigned cannot find that ALJ Davis applied the incorrect Medical-Vocational Guideline (“Grid Rule”) or posed an inaccurate hypothetical question to the Vocational Examiner (“VE”) at step five. And ALJ Davis was not required to examine Williams's financial circumstances. So the undersigned recommends that the court deny Williams's motion, grant Kijakazi's motion, and affirm the Acting Commissioner's determination.
The court has referred this matter to the undersigned for entry of a Memorandum and Recommendation. 28 U.S.C. § 636(b).
I. Background
In May 2017, Williams applied for disability benefits, alleging a disability that began in March 2013. After the Social Security Administration denied his claim at the initial level and upon reconsideration, Williams appeared before ALJ Davis for a hearing to determine whether he was entitled to benefits. ALJ Davis determined that Williams had no right to benefits because he was not disabled. Tr. at 16-25.
ALJ Davis found that Williams's degenerative disc disease, coronary artery disease, hypertension, hyperlipidemia, and chronic pain syndrome were severe impairments. Tr. at 19. ALJ Davis also found that Williams's impairments, either alone or in combination, did not meet or equal a Listing impairment. Id.
ALJ Davis then determined that Williams had the residual functional capacity to perform light work with other limitations. Tr. at 20. He can occasionally climb ramps and stairs but he cannot climb ladders, ropes, or scaffolds. Id. Williams can occasionally kneel, crouch, and crawl, and he can occasionally reach overhead bilaterally. Id. Finally, Williams must avoid concentrated exposure to hazards such as dangerous machinery and unprotected heights. Id.
ALJ Davis concluded that Williams could not perform his past work as an electrician, electrician supervisor, or contractor. Tr. at 23-24. But considering his age, education, work experience, and RFC, ALJ Davis found that jobs existed in significant numbers in the national economy that Williams could perform. Tr. at 24-25. These include marker, router, and photocopy machine operator. Id. Thus, ALJ Davis found that Williams was not disabled. Tr. at 25.
After unsuccessfully seeking review by the Appeals Council, Williams began this action in July 2020. D.E. 5.
II. Analysis
A. Standard for Review of the Commissioner's Final Decision
When a social security claimant appeals a final decision of the Commissioner, the district court's review is limited to determining whether, based on the entire administrative record, there is substantial evidence to support the Commissioner's findings. 42 U.S.C. § 405(g); Richardson v. Perales, 402 U.S. 389, 401 (1971). Substantial evidence is defined as “evidence which a reasoning mind would accept as sufficient to support a particular conclusion.” Shively v. Heckler, 739 F.2d 987, 989 (4th Cir. 1984) (quoting Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966)). The court must affirm the Commissioner's decision if it is supported by substantial evidence. Smith v. Chater, 99 F.3d 635, 638 (4th Cir. 1996).
B. Standard for Evaluating Disability
In making a disability determination, the ALJ engages in a five-step evaluation process. 20 C.F.R. § 404.1520; see Johnson v. Barnhart, 434 F.3d 650 (4th Cir. 2005). The ALJ must consider the factors in order. At step one, if the claimant is engaged in substantial gainful activity, the claim is denied. At step two, the claim is denied if the claimant does not have a severe impairment or combination of impairments significantly limiting him or her from performing basic work activities. At step three, the claimant's impairment is compared to those in the Listing of Impairments. See 20 C.F.R. Part 404, Subpart P, App. 1. If the impairment is listed in the Listing of Impairments or if it is equivalent to a listed impairment, disability is presumed. But if the claimant's impairment does not meet or equal a listed impairment, the ALJ assesses the claimant's RFC to determine, at step four, whether he can perform his past work despite his impairments. If the claimant cannot perform past relevant work, the analysis moves on to step five: establishing whether the claimant, based on his age, work experience, and RFC can perform other substantial gainful work. The burden of proof is on the claimant for the first four steps of this inquiry but shifts to the Commissioner at the fifth step. Pass v. Chater, 65 F.3d 1200, 1203 (4th Cir. 1995).
C. Medical Background
In March 2013, Williams underwent bypass surgery for critical right coronary artery stenosis with unstable angina symptoms. Tr. at 21. Prior to surgery, providers noted that Williams was mobile, required no assistive device, and performed activities of daily living independently. Id.
After surgery, a follow-up visit showed no remarkable findings. Id. Two months after surgery, Dr. Jerry Simpson, a cardiologist, stated that Williams could return to light duty work for one month, and then he could resume full work duties. Tr. at 23.
Williams would not partake in routine post-surgery care and would only accept pain medication. Tr. at 21. So providers discharged him from treatment for non-compliance. Id.
The next year, Williams sought treatment for chest pain. Id. Testing revealed sinus bradycardia but no acute ST changes suggestive of ischemia. Id. A cardiac catheterization confirmed there was no obstructive coronary artery disease. Id. Providers assessed hypertension, hyperlipidemia, and coronary artery disease. Id. They directed Williams to continue his medication regimen. Id.
At a January 2017 visit, Williams reported that he was doing well and had an active lifestyle. Id. He denied symptoms associated with angina and heart failure. Id. An examination showed normal heart sounds, acceptable blood pressure, clear lungs, and no edema. Id.
Williams also has a history of neck and back pain. Id. Before his disability onset date, Williams underwent laminectomy surgeries in 1995 and 2006. Tr. at 21-22. A March 2008 MRI of his cervical spine revealed degenerative changes. Tr. at 22. The next year, an MRI of his lumbar spine showed a herniated disc abutting, and slightly displacing, the left nerve root. Id.
In May 2013, Williams sought pain management for neck, shoulder, and non-radiating back pain. Tr. at 21. An examination found tenderness and a limited range of motion. Id. But he had a steady gait, full strength and sensation, and negative results on straight leg raise testing. Id.
A few weeks later, providers remarked that Williams had been more active and had improved functioning with medication. Id. Williams reported his pain was moderately-well controlled. Id. Five months later, Williams again noted adequate pain control with his treatment regimen. Id. And he continued to report similar results through February 2015. Id.
At a June 2016 pain management visit, Williams stated that medication controlled his pain. Id. An examination showed a steady gait, normal strength, and intact sensation. Id. But he had limited range of motion in his back and neck. Id. Providers continued his medications. Id.
Providers discovered no remarkable findings aside from reduced range of motion in January 2017. Id. And three months later, Williams again showed no abnormalities except for a diminished range of motion in his back. Id.
X-rays taken in October 2017 revealed minimal degenerative changes in Williams's cervical spine and mild degeneration in his lumbar spine. Id. The next month, Williams visited the emergency department for acute back pain. Id. An examination noted no neurological deficits and normal range of motion. Id. Providers discharged Williams with medications. Id.
State agency medical consultants concluded that Williams could perform light work with postural, manipulative, and environmental limitations. Tr. at 23.
Williams testified that he experienced diffuse pain. Tr. at 21. He has trouble looking up and down because of his neck pain, so he cannot climb ladders. Id. Williams claimed that he cannot sit, stand, or walk for prolonged periods. Id. He estimated he could walk for 10 minutes, stand for 15 minutes, and sit for one hour. Id.
Williams experiences numbness in his hands upon waking. Id. And his heart surgery caused residual chest pain and shortness of breath. Id.
D.Residual Functional Capacity
Williams contends that ALJ Davis erred in determining his RFC by limiting him to light, not sedentary, work. He also argues that ALJ Davis failed to examine his ability to work regularly. Kijakazi asserts that the evidence supports a finding that Williams can perform a reduced range of light work. The undersigned finds that substantial evidence supports ALJ Davis's RFC determination.
The RFC is a determination, based on all the relevant medical and non-medical evidence, of what a claimant can still do despite her impairments; the assessment of a claimant's RFC is the responsibility of the ALJ. See 20 C.F.R. §§ 404.1520, 404.1545, 404.1546; Social Security Ruling (“SSR”) 96-8p, 1996 WL 374184, at *2. If more than one impairment is present, the ALJ must consider all medically determinable impairments, including medically determinable impairments that are not “severe, ” when determining the claimant's RFC. Id. §§ 404.1545(a), 416.945(a). The ALJ must also consider the combined effect of all impairments without regard to whether any such impairment, if considered separately, would be of sufficient severity. Id. § 404.1523; see Walker v. Bowen, 889 F.2d 47, 50 (4th Cir. 1989) (“[I]n evaluating the effect[] of various impairments upon a disability benefit claimant, the [Commissioner] must consider the combined effect of a claimant's impairments and not fragmentize them.”).
The ALJ must provide “findings and determinations sufficiently articulated to permit meaningful judicial review.” DeLoatche v. Heckler, 715 F.2d 148, 150 (4th Cir. 1983); see also Wyatt v. Bowen, 887 F.2d 1082, 1989 WL 117940, at *4 (4th Cir. 1989) (per curiam). The ALJ's RFC determination “must include a narrative discussion describing how the evidence supports each conclusion, citing specific medical facts (e.g. laboratory findings) and nonmedical evidence (e.g. daily activities, observations).” Mascio v. Colvin, 780 F.3d 632, 636 (4th Cir. 2015) (quoting SSR 96-8p). Furthermore, “[t]he record should include a discussion of which evidence the ALJ found credible and why, and specific application of the pertinent legal requirements to the record evidence.” Radford v. Colvin, 734 F.2d 288, 295 (4th Cir. 2013). Fourth Circuit precedent “makes it clear that it is not [the court's] role to speculate as to how the ALJ applied the law to [her] findings or to hypothesize the ALJ's justifications that would perhaps find support in the record. Fox v. Colvin, 632 Fed.Appx. 750, 755 (4th Cir. 2015).
Social Security Ruling 96-8p explains how adjudicators should assess residual functional capacity. The Ruling instructs that the residual functional capacity “assessment must first identify the individual's functional limitations or restrictions and assess his or her work-related abilities on a function-by-function basis, including the functions” listed in the regulations. “Only after that may [residual functional capacity] be expressed in terms of the exertional levels of work, sedentary, light, medium, heavy, and very heavy.” SSR 96-8p. The Ruling further explains that the residual functional capacity “assessment must include a narrative discussion describing how the evidence supports each conclusion, citing specific medical facts (e.g., laboratory findings) and nonmedical evidence (e.g., daily activities, observations).” Id.
There is no “per se rule requiring remand when the ALJ does not perform an explicit function-by-function analysis[.]” Mascio, 780 F.3d at 636. But “[r]emand may be appropriate . . . where an ALJ fails to assess a claimant's capacity to perform relevant functions, despite contradictory evidence in the record, or where other inadequacies in the ALJ's analysis frustrate meaningful review.” Id. (quoting Cichocki v. Astrue, 729 F.3d 172, 177 (2d Cir. 2013)). The function-by-function requirement can be satisfied by reference to a properly conducted analysis by a state agency consultant. See, e.g., Linares v. Colvin, No. 5:14-CV-00129, 2015 WL 4389533, at *3 (W.D. N.C. July 17, 2015) (“Because the ALJ based his RFC finding, in part, on the function-by-function analysis of the State agency consultant, the ALJ's function-by-function analysis complied with [Soc. Sec. Ruling] 96-8p.” (citing Lemken v. Astrue, No. 5:07-CV-33-RLV-DCK, 2010 WL 5057130, at *8 (W.D. N.C. July 26, 2010))).
1. Exertional Demands of Light Work
ALJ Davis found that Williams could perform light work with postural, manipulative, and environmental limitations. Tr. at 20. But Williams argues that he cannot sit, stand, or walk for six hours in an eight-hour workday-as light work requires-because of his neck, back, and leg pain. He claims his functional abilities limit him to less than sedentary work. And Williams maintains that the medical evidence and testimony support his position.
The undersigned finds no error in ALJ Davis's RFC determination. State agency medical consultants found that Williams could perform light work with postural, manipulative, and environmental limitations. Tr. at 23. ALJ Davis found these assessments partially persuasive. Id.
For Williams's heart condition, ALJ Davis noted his 2013 bypass surgery and unremarkable follow-up visit. Tr. at 21. Two months after surgery, his cardiologist released him to light work, and allowed him to resume full duty work a month later. Tr. at 23. As Williams declined to participate in routine post-bypass care, and would only take pain medications, providers dismissed him from treatment. Tr. at 21.
The next year, he experienced chest pain, but there was no evidence of ischemia or obstructive coronary artery disease. Id. He underwent cardiac catheterization and continued his medication regimen. Id. Three years later, Williams reported that he was doing well and had an active lifestyle. Id. So the evidence does not show that his heart and related conditions preclude light work.
ALJ Davis also examined Williams's degenerative disc disease and chronic pain. Tr. at 21-23. Williams underwent laminectomy surgeries in 1995 and 2006. Tr. at 21-22. But he has worked after these surgeries. Tr. at 18. MRI studies showed degenerative changes in his cervical spine and a herniated disc impacting the nerve root in his lumbar spine. Tr. at 22. But providers noted that Williams was mobile and independent in his daily activities. Tr. at 21.
ALJ Davis also discussed Williams's pain management treatment for neck, shoulder, and back pain. Id. He had tenderness and a limited range of motion, but retained a steady gait and full strength and sensation. Tr. at 22. And straight leg raise testing produced negative results. Id.
Shortly after starting pain management, Williams claimed more activity and improved functioning with medications. Id. He reported that his medications generally controlled his pain. Id. Later visits revealed no remarkable findings except for diminished range of motion. Id. And through the next few years, Williams continued to report that medications provided general control of his pain symptoms. Id.
X-rays taken in October 2017 revealed minimal degenerative changes in Williams's cervical spine and mild degeneration in his lumbar spine. Id. When he sought emergency treatment for back pain the next month, Williams displayed a normal range of motion and required only medication to treat his symptoms. Id.
ALJ Davis remarked that Williams's severe impairments, although limiting, were not disabling. Id. Testing revealing degenerative disc disease, combined with reduced range of motion upon examination, partially corroborated Williams's claims of persistent neck and back pain. Id. But the evidence also revealed only minimal or mild arthritis along with full strength and sensation and a normal gait. Id. Williams also had normal cardiac findings after his surgery. Id. And he could perform home improvement work during the relevant period, which suggested a capability of strenuous activity. Id.
As discussed below, ALJ Davis declined to fully endorse Williams's statements of his functional limitations. And she provided sound reasons to support her assessment that Williams's statements contradicted other evidence.
In sum, the evidence supports ALJ Davis's finding that Williams could perform a limited range of light work. As Williams has failed to establish his ability to sit, stand, and walk are more limited than the exertional demands of light work, the undersigned recommends that the court deny his claim on this issue.
2. Full-Time Work
Williams also argues that ALJ Davis failed to determine whether he could sustain regular, full-time work. The undersigned disagrees.
The assessment of a claimant's RFC examines the individual's ability to do sustained work-related physical and mental activities in a work setting on a regular and continuing basis. The Regulations define “regular and continuing basis” to mean eight hours a day, five days a week, or an equivalent work schedule. SSR 96-8p, at *1. And the Fourth Circuit has found “that RFC determinations may contain implicit findings.” Jackson v. Berryhill, No. 5:15-2994-FDW, 2017 WL 586648 (D.S.C. Feb. 14, 2017) (citing Hines v. Barnhart, 453 F.3d 559, 563 (4th Cir. 2006) (“In light of SSR 96-8p, ... [the ALJ's] conclusion implicitly contained a finding that [plaintiff] physically is able to work an eight hour day.”)).
Along with explicit findings about exertional ability and limitations, the RFC implicitly found that Williams can perform full-time work on a regular basis. The court should thus reject Williams's argument on this issue as it lacks merit.
E. Subjective Statements
Williams contends that ALJ Davis erred in evaluating his statements about the intensity, persistence, or limiting effects of his impairments. Kijakazi posits that ALJ Davis provided sufficient reasons why she declined to endorse all of Williams's subjective statements about his functioning. The undersigned finds no error in ALJ Davis's consideration of this evidence.
Under the regulations implementing the Social Security Act, an ALJ follows a two-step analysis when considering a claimant's subjective statements about impairments and symptoms. SSR 16-3p, 2017 WL 5180304 (Oct. 25, 2017); 20 C.F.R. §§ 404.1529(b)-(c), 416.929(b)-(c). First, the ALJ looks for objective medical evidence showing a condition that could reasonably produce the alleged symptoms, such as pain. Id. at *3, §§ 404.1529(b), 416.929(b). Second, the ALJ must evaluate the intensity, persistence, and limiting effects of the claimant's symptoms to determine how much they limit the claimant's ability to work. Id. §§ 404.1529(c), 416.929(c). In making that determination, the ALJ must “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.
The ALJ has full discretion to weigh the subjective statements with the objective medical evidence and other matters of record. Craig v. Chater, 76 F.3d 585, 595 (4th Cir. 1996) (holding that claimant's allegations of pain need not be accepted to extent that they conflict with the record). The ALJ may not discredit a claimant's subjective complaints just because the objective medical evidence does not confirm them. Id. at 595-96. But neither is the ALJ obligated to accept the claimant's statements at face value. Hawley v. Colvin, No. 5:12-CV-260-FL, 2013 WL 6184954, at *15 (E.D. N.C. Nov. 14, 2013). In a district court's review, the ALJ's findings are entitled to great weight because of the ALJ's ability to observe and evaluate testimony firsthand. Shively, 739 F.2d at 989-90.
ALJ Davis declined to fully credit Williams's statements about his functioning. Tr. at 21. She observed that his statements conflicted with other evidence. Id.
Noting that pain itself can be disabling, Williams claims that ALJ Davis improperly relied on the objective medical evidence to discredit his statements about the intensity, persistence, and limiting effects of his impairments. He points out that he has good days and bad days, and the intermittent nature of his symptoms preclude substantial gainful activity. And Williams argues that the record documents his continued neck, back, and leg pain which affect his ability to sit, stand, and walk.
Substantial evidence supports ALJ Davis's assessment. The record shows inconsistencies between Williams's claims and other evidence, as ALJ Davis observed.
ALJ Davis's decision noted that objective testing showed no more than mild results. Examinations uncovered few remarkable findings, like occasional tenderness and reduced range of motion, but strength, sensation, and gait were normal.
And Williams claimed improvement in symptoms with pain medication many times. Providers noted he had an active lifestyle. And ALJ Davis noted that his work in home improvement after his disability onset date suggested he was capable of strenuous tasks. So the overall record shows that Williams's conditions are not as limiting as he claims.
Williams cites a recent Fourth Circuit case to support his argument. In Arakas v. Commissioner of Social Security, the Court of Appeals held that “ALJs may not rely on objective medical evidence (or the lack thereof)-even as just one of multiple factors-to discount a claimant's subjective complaints regarding symptoms of [diseases] that do[] not produce such evidence.” 983 F.3d 83, 97 (4th Cir. 2020). Because the ALJ relied on a lack of objective medical evidence, such as normal range of motion and joint inflammation, to discredit the claimant, the Court of Appeals remanded the case. Id.
But Arakas is distinguishable from this matter. Williams has not shown he suffers from another condition that produces no objective evidence. And the Regulations make clear that an ALJ must consider the entire record, including objective medical evidence, to assess the intensity, persistence, and limiting effects of a claimant's symptoms and how they limit a claimant's ability to work. 20 C.F.R.§ 404.1529(c).
ALJ Davis did not discount Williams's statements of symptoms because the objective evidence could not confirm them but because they conflicted with other evidence in the record. Because substantial evidence supports ALJ Davis's findings, the undersigned recommends that the court reject Williams's argument.
E. Step Five
Williams also challenges ALJ Davis's step five finding. Extending his argument that he is limited to sedentary work, Williams claims that ALJ Davis applied the incorrect Grid Rule to find he was not disabled. And he argues that the hypothetical questions to the Vocational Examiner (“VE”) omitted limitations. The Acting Commissioner argues, and the undersigned agrees, that substantial evidence supports ALJ Davis's step five finding.
As noted above, while a claimant has the burden at steps one through four, it is the Commissioner's burden at step five to show that work the claimant can perform is available. Pass, 65 F.3d at 1203 (citing Hunter v. Sullivan, 993 F.2d 21, 35 (4th Cir. 1992)). “The Commissioner may meet this burden by relying on the Medical-Vocational Guidelines (Grids) or by calling a vocational expert [(“VE”)] to testify.” Aistrop v. Barnhart, 36 Fed.Appx. 145, 146 (4th Cir. 2002) (citing 20 C.F.R. § 404.1566)). The Grids are published tables that take administrative notice of the number of unskilled jobs at each exertional level in the national economy. 20 C.F.R. Pt. 404, Subpt. P, App. 2 § 200.00(a).
When a claimant suffers solely from exertional impairments, the Grids may satisfy the Commissioner's burden of coming forward with evidence on the availability of jobs the claimant can perform. Grant v. Schweiker, 699 F.2d 189, 192 (4th Cir. 1983). When a claimant: (1) suffers from a non-exertional impairment that restricts his ability to perform work of which he is exertionally capable, or (2) suffers an exertional impairment which restricts him from performing the full range of activity covered by a work category, the ALJ may not rely on the Grids and must produce specific vocational evidence showing that the national economy offers employment opportunities to the claimant. See Walker, 889 F.2d at 49; Hammond v. Heckler, 765 F.2d 424, 425-26 (4th Cir. 1985); Cook v. Chater, 901 F.Supp. 971 (D. Md. 1995); 20 C.F.R. Pt. 404, Subpt. P, App. 2, § 201.00(h).
The Regulations permit testimony from a VE to determine “whether [a claimant's] work skills can be used in other work and the specific occupations in which they can be used[.]” 20 C.F.R. §§ 404.1566(e), 416.966(e). For a VE's testimony to be relevant, an ALJ's hypothetical question must represent all of a claimant's substantial impairments. Walker, 889 F.2d at 50; Burnette v. Astrue, No. 2:08-CV-0009-FL, 2009 WL 863372, at *4 (E.D. N.C. Mar. 24, 2009) (relevant hypothetical question should adequately reflect claimant's RFC and fairly set out a claimant's limitations). If limitations are omitted, the VE's testimony is of limited value, and may not constitute substantial evidence. See Johnson, 434 F.3d at 659 (citing Walker, 889 F.2d at 50). Before relying on a VE's testimony an ALJ must “[i]dentify and obtain a reasonable explanation for any conflicts between occupational evidence provided by VEs . . . and information in the Dictionary of Occupational Titles (DOT), . . . and [e]xplain in the determination or decision how any conflict that has been identified was resolved.” SSR 00-4p, 2000 WL 1898704 (Dec. 4, 2000). “Occupational evidence provided by a VE . . . generally should be consistent with the occupational information supplied by the DOT.” Id. “When there is an apparent unresolved conflict between VE . . . and the DOT, the adjudicator must elicit a reasonable explanation for the conflict before relying on the VE . . . to support a determination or decision about whether the claimant is disabled.” Id. “At the hearings level, as part of the adjudicator's duty to fully develop the record, the adjudicator will inquire, on the record, as to whether or not there is such consistency.” Id.
1. Grid Rule
Williams argues that ALJ Davis applied the incorrect Grid Rule. ALJ Davis concluded that if Williams could perform a full range of light work, the Medical-Vocational Guidelines would direct a finding of “not disabled” under Grid Rule 202.21 and 202.14. Tr. at 24.
Williams maintains that Rule 201.14 is the correct Grid Rule. But Williams premises his argument on a finding that he is limited to sedentary work. Yet substantial evidence supports ALJ Davis's RFC determination concluding that Williams can perform a reduced range of light work. As discussed above, the undersigned rejects his argument that ALJ Davis incorrectly determined the RFC. Because his present argument parallels his unsuccessful RFC argument, the court should deny Williams's claim on this issue.
2. Hypothetical Questions
Williams also argues that ALJ Davis failed to include all of his mental and physical limitations in the hypothetical questions to the VE. He asserts that ALJ Davis failed to accept the VE's testimony that there would be no available work that allowed Williams to rest or recline for two hours, lie down outside normal breaks, alternate sitting or standing every 30 minutes, use his dominant upper extremity less than occasionally, be off-task more than 15% of the workday, or be absent from work more than one day a month.
The hypothetical questions included all the limitations set forth in Williams's RFC determination. Although the VE testified that there would be no work available to a claimant who required additional limitations proposed by Williams, ALJ Davis did not credit these limitations or include them in the RFC. And substantial evidence supports ALJ Davis's RFC determination. While Williams contends that he has additional limitations, this claim lacks support in the record.
So ALJ Davis committed no error in omitting these added restrictions or adopting the VE's testimony in response to a hypothetical question that included them. Thus the undersigned recommends that the court reject Williams's argument on this issue.
G. Financial Considerations
Williams's final argument is that ALJ Davis failed to explore his inability to afford medical treatment. Kijakazi claims there was no evidence that Williams did not seek treatment because of financial circumstances. The undersigned finds no error on this issue.
The Fourth Circuit has held that “[a] claimant may not be penalized for failing to seek treatment she cannot afford.” Lovejoy v. Heckler, 790 F.2d 1114, 1117 (4th Cir. 1986) (holding that the ALJ erred in determining that the plaintiff's impairment was not severe based on her failure to seek treatment where the record reflected that she could not afford treatment); see also Gordon v. Schweiker, 725 F.2d 231, 237 (4th Cir. 1984) (“It flies in the face of the patent purposes of the Social Security Act to deny benefits to someone because he is too poor to obtain medical treatment that may help him”). So “an ALJ should not discount a claimant's subjective complaints on the basis of her failure to seek medical treatment when she has asserted-and the record does not contradict-that she could not afford such treatment.” Dozier v. Colvin, 2015 WL 4726949, *3 (D.S.C. Aug. 10, 2015) (citing Lovejoy, 790 F.2d at 1117).
The Regulations direct that
[I]f the frequency or extent of the treatment sought by an individual is not comparable with the degree of the individual's subjective complaints . . . we may find the alleged intensity and persistence of an individual's symptoms are inconsistent with the overall evidence of record. We will not find an individual's symptoms inconsistent with the evidence in the record on this basis without considering possible reasons he or she may not . . . seek treatment consistent with the degree of his or her complaints. We may . . . ask why he or she has not complied with or sought treatment in a manner consistent with his or her complaints. When we consider the individual's treatment history, we may consider . . . [a]n individual may not be able to afford treatment and may not have access to free or low-cost medical services.SSR 16-3p, at *9-10.
There was some testimony about Williams's inability to afford treatment. He stated that he dropped out of the pain clinic after he lost insurance coverage in 2017 because he could not afford it. Tr. at 42. And Williams also testified that he could not afford prescription medication. Tr. at 46.
ALJ Davis made no finding about Williams's inability to obtain treatment or the resources available to him. Yet she also made no determination that he failed to seek medical treatment.Here, there is no evidence that Williams failed to pursue recommended treatment, or that ALJ Davis drew a negative inference from a lack of treatment.
ALJ Davis noted that providers discharged Williams because he declined to participate in routine care following his 2013 bypass surgery. But this was four years before he lost insurance coverage.
As discussed above, ALJ Davis declined to fully endorse Williams's subjective statements because they conflicted with other evidence. Objective testing showed only minimal or mild findings. And examinations revealed a reduced range of motion and occasional tenderness, but also full strength, intact sensation, and a steady gait.
Williams underwent heart and back surgeries, but he appeared to recover well. He reported doing well, leading an active lifestyle, and that pain medications controlled his symptoms. Williams was independent in his daily activities and mobile, requiring no assistive device. Even after his disability onset date, Williams performed some home improvement work which, ALJ Davis remarked, suggested he could perform strenuous activity.
The only treatment Williams claimed he had to forgo because of his financial circumstances was obtaining prescription medication. After losing insurance coverage, Williams managed to get medications went he visited the emergency department for back pain.
So the undersigned cannot find that ALJ Davis erred in failing to examine Williams's financial circumstances. Although there is some evidence of his financial constraints, there was no finding by ALJ Davis that Williams did not seek or follow treatment consistent with the degree of his complaints. Rather, the evidence shows that his complaints and conditions required little treatment because they were mild in nature, presented few clinical signs, and did not prevent some strenuous work activity or independence in daily activities. So they were not disabling.
Because Williams's argument lacks merit, the undersigned recommends that the court deny his claim on this issue.
III. Conclusion
For these reasons, the undersigned recommends that the court deny Williams's Motion for Judgment on the Pleadings (D.E. 20), grant Kijakazi's Motion for Judgment on the Pleadings (D.E. 22), and affirm the Acting Commissioner's determination.
The Clerk of Court must serve a copy of this Memorandum and Recommendation (“M&R”) on each party who has appeared in this action. Any party may file a written objection to the M&R within 14 days from the date the Clerk serves it on them. The objection must specifically note the portion of the M&R that the party objects to and the reasons for their objection. Any other party may respond to the objection within 14 days from the date the objecting party serves it on them. The district judge will review the objection and make their own determination about the matter that is the subject of the objection. If a party does not file a timely written objection, the party will have forfeited their ability to have the M&R (or a later decision based on the M&R) reviewed by the Court of Appeals.