Opinion
CIVIL 1:22-CV-1821
10-30-2023
KLAYTON AMSPACHER, Plaintiff, v. KILOLO KIJAKAZI, Acting Commissioner of Social Security, Defendant.
Mariani, Judge
REPORT AND RECOMMENDATION
Daryl F. Bloom United States Magistrate Judge
I. Introduction
Klayton Amspacher filed an application for disability and disability insurance benefits, as well as supplemental security income, on December 13, 2019. A hearing was held before an Administrative Law Judge (“ALJ”), and the ALJ found that Amspacher was not disabled from his alleged onset date of February 5, 2018, through the date of the ALJ's decision, November 4, 2021.
Amspacher now appeals this decision, arguing that the ALJ's decision is not supported by substantial evidence. After a review of the record, and mindful of the fact that substantial evidence “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), we conclude that substantial evidence supported the ALJ's findings in this case. Therefore, we recommend that the district court affirm the decision of the Commissioner denying this claim.
II. Statement of Facts and of the Case
Klayton Amspacher filed for disability and disability insurance benefits, as well as supplemental security income, alleging disability due to hemiplegic migraines, inappropriate sinus tachycardia, and anxiety. (Tr. 64). He alleged an onset date of disability of February 5, 2018. (Id.). Amspacher was 36 years old at the time of his alleged onset, had at least a high school education, and had past relevant work as a store laborer. (Tr. 27).
The medical record regarding Amspacher's impairments revealed that he suffered from left-sided neck pain and headaches in January of 2018. (Tr. 1047). Treatment notes indicate that spasms were the suspected cause of his headaches and the numbness in his face. (Id.). Results of an MRI showed mild disc bulging but no impingement. (Id.). On examination, Amspacher had full range of motion of his head and neck, intact grip strength, and full sensation. (Tr. 1049). Similarly, an examination in February of 2018 indicated that Amspacher had appropriate range of motion and strength, negative Tinel signs, and 5/5 strength in his bilateral upper and lower extremities. (Tr. 1041).
Amspacher also began physical therapy in February of 2018. (Tr. 885). An initial evaluation at WellSpan Rehabilitation indicated that Amspacher's primary diagnoses were paresthesia and pain of extremities. (Id.). He also reported headaches and extremities numbness, as well as weakness of his entire left side. (Tr. 886). These notes further indicated that Amspacher had undergone a brain MRI that was within normal limits. (Id.). At this time, Amspacher was employed at Giant foods but had been on medical leave since February 6, 2018. (Id.). A visit in March revealed that Amspacher demonstrated improved sitting posture and exercise tolerance. (Tr. 865).
Amspacher was discharged from physical therapy at the end of March, as it was noted his left upper extremity paresthesia had persisted without improvement since the beginning of therapy. (Tr. 840). However, treatment notes around this time from his primary care physician, Dr. Daniel Eckert, D.O., indicated that he retained full range of motion with side bending bilaterally, he had mildly diminished grip strength on his left side, mildly decreased sensation along his left upper extremity, and full strength with flexion extension of his knees bilaterally. (Tr. 1028). Dr. Eckert referred Amspacher to pain management and started him on gabapentin. (Tr. 1026).
In April, Dr. Eckert noted that Amspacher had undergone an extensive workup, including bloodwork, MRIs, and an EMG, all of which were unrevealing. (Tr. 1022). Amspacher reported that his weakness and numbness were becoming more frequent. (Id.). On physical examination, Amspacher had decreased range of motion with side bending and head rotating, full right grip strength and 4/5 left grip strength, and 5/5 strength bilaterally with flexion extension of his elbows. (Tr. 1023). Later that month, Amspacher reported that he had experienced a few days of complete resolution of his symptoms but that his symptoms returned the following week. (Tr. 1018). In June, Dr. Eckert recommended that Amspacher get a second opinion regarding his neck and back after Amspacher reported worsening symptoms. (Tr. 1003).
In July of 2018, Amspacher was treated by Dr. Robert Lackey, M.D., a pain specialist. (Tr. 905). On examination, Amspacher had a non-antalgic gait and 4/5 left knee extension, left elbow flexion, and wrist extension on his left side. (Tr. 907). Dr. Lackey ordered an additional workup to rule out neurological issues, including a cervical MRI. (Tr. 908). He also encouraged Amspacher to continue his home exercises. (Id.). Amspacher followed up with Dr. Eckert in September, who noted that no provider had determined an underlying cause of Amspacher's symptoms. (Tr. 995). Treatment notes indicate that Amspacher had been out of work since February due to his symptoms, and that he was in the process of applying for long-term disability. (Id.). On examination, Amspacher had 4/5 strength in his left upper extremity, full range of motion with bilateral side bending and rotation of his head, full strength with his right extremities, and somewhat decreased sensation over his left forearm and left leg. (Tr. 996).
Amspacher was treated at Penn State Hershey Medical Center in October of 2018 for his extremity pain and weakness as well as his migraine headaches. (Tr. 1101). His physical and neurological examinations were largely unremarkable. (Tr. 1102-03). The provider ordered a new cervical MRI, an MRI of the head, and an EMG nerve conduction study. (Tr. 1103). The results of the EMG were normal, with no evidence of polyneuropathy, radiculopathy, or myopathy in the extremities. (Tr. 1115). The MRIs of his brain and cervical spine were also normal. (Tr. 1117). In January of 2019, Dr. Eckert referred Amspacher to neurology for his migraines. (Tr. 985).
Neurology notes from January of 2019 indicate that Amspacher reported experiencing six migraines per month. (Tr. 1120). Dr. William Jens, D.O., opined that the most likely diagnosis was atypical hemiplegic migraines. (Tr. 1122). On examination, Amspacher had normal 5/5 tone in his upper and lower extremities, a normal gait, was able to walk on his heels and toes, his sensation was intact to light touch, and he had intact coordination. (Tr. 1121). Dr. Jens also noted that Amspacher was on antidepressants for his anxiety, and a mental status examination was normal. (Tr. 1120-21). He recommended trigger point injections and physical therapy. (Tr. 1122). Amspacher was scheduled for trigger point injections and an occipital nerve block. (Tr. 1128). While Amspacher was prescribed medications for his migraines, he stopped taking them due to experiencing frequent heart palpitations. (Tr. 981).
In March of 2019, Amspacher presented to the emergency room with sinus tachycardia. (Tr. 920). It was noted that he was “noncompliant with beta blockers he is supposed to take daily[.]” (Id.). At a follow-up with cardiology later that month, it was noted that Amspacher had a history of palpitations, but no abnormal rhythm was identified on his EKG. (Tr. 947).
Amspacher continued treatment with Dr. Eckert, who noted in May of 2019 that Amspacher reported worsening symptoms of numbness and weakness. (Tr. 963). At a neurology follow-up in June, Amspacher reported worsening neck pain. (Tr. 1147). On examination, he had normal motor tone, 5/5 in his left upper and lower extremities, and mildly impaired sensation in the left upper extremity compared to the right. (Tr. 1148). It was recommended that he continue symptomatic treatment for his migraines, and an updated cervical MRI was ordered. (Id.). Dr. Eckert's October 2019 notes indicate that neurology was recommending repeat trigger point injections for Amspacher's migraines and a possible Botox trial. (Tr. 952). Amspacher was also taking medication for panic attacks. (Id.). Pain management notes from this time indicate that trigger point injections did not provide much relief, and Amspacher was again prescribed gabapentin. (Tr. 1155-56). Providers also recommended Botox injections in January of 2020. (Tr. 1178). While the record indicates Amspacher tried physical therapy again, he was discharged in January of 2020, at which time it was noted that his symptoms remained unchanged, and he had limited consultations due to family conflicts. (Tr. 1052).
A telehealth visit in April of 2020 reveled that Amspacher was still experiencing symptoms of migraines and neck pain. (Tr. 1186). Tylenol and Ibuprofen had not helped, although it was noted that ice and a TENS unit had provided some relief. (Id.). He was started on a different migraine medication and advised to follow up in six weeks. (Tr. 1188). Treatment notes from July of 2020 revealed continuing symptoms, with Amspacher reporting three to four headaches per week. (Tr. 1189). He further reported that he was experiencing some right-side numbness and weakness when his left-side symptoms were very severe. (Id.). A physical examination reveled normal coordination, normal gait, and an ability to tandem walk without difficulty. (Tr. 1190). Amspacher requested to hold off on any new interventions until an appointment with a specialist in September. (Tr. 1191). Around this time, Amspacher also received an occipital nerve block. (Tr. 1202).
Amspacher presented to the emergency room in October of 2020 for palpitations and tachycardia. (Tr. 1353). A physical examination at this time was unremarkable except for high blood pressure. (Tr. 1354, 1358). Amspacher was discharged home in stable condition. (Tr. 1362). At a visit with neurology in January of 2021, it was noted that Amspacher did not respond well to trigger point injections, and that he had an episode of tachycardia afterward. (Tr. 1229). Amspacher refused Botox and instead restarted his venlafaxine. (Tr. 1231).
Dr. Eckert filled out both a physical and mental residual functional capacity questionnaire in April of 2021. (Tr. 1327-31; 1333-41). Regarding Amspacher's physical limitations, Dr. Eckert opined that Amspacher's impairments frequently interfered with his attention and concentration; that he could tolerate low stress jobs; that he would need unscheduled breaks during the workday; he would be absent more than four days per month; and that he could never lift or carry more than ten pounds. (Tr. 1327-31). Regarding Amspacher's mental limitations, Dr. Eckert noted his history of anxiety and panic attacks and opined that Amspacher had unlimited or very good abilities to do unskilled work. (Tr. 1333-41).
Thus, it was against the backdrop of this record that an ALJ held a hearing on Amspacher's disability application on May 17, 2021. (Tr. 3561). Amspacher and a Vocational Expert both appeared and testified at this hearing. (Id.). Following this hearing, on November 4, 2021, the ALJ issued a decision denying Amspacher's application for disability benefits. (Tr. 16-29). In this decision, the ALJ first concluded that Amspacher had not engaged in substantial gainful activity since February 5, 2018, his alleged onset of disability. (Tr. 19). At Step 2 of the sequential analysis that governs disability claims, the ALJ found that Amspacher suffered from the following severe impairments: degenerative disc disease, migraine, and supraventricular tachycardia. (Id.). The ALJ further concluded that Amspacher's anxiety caused no more than mild limitations, and thus, found this impairment to be nonsevere. (Tr. 19-20). At Step 3, the ALJ concluded that none of these impairments met or equaled the severity of a listed impairment under the Commissioner's regulations. (Tr. 20).
Between Steps 3 and 4, the ALJ then concluded that Amspacher:
[H]a[d] the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) and he can occasionally balance, kneel, crouch, crawl, and climb ramps and stairs; and never climb ladders, ropes, or scaffolds. He can occasionally reach overhead bilaterally. He can work at no greater than noise level three; should avoid concentrated exposure to extreme cold, wetness, noise, vibration, fumes, odors, dust, and poor ventilation; and must avoid all hazards such as heights or machinery. He can perform routine, repetitive tasks.(Tr. 20-21).
In reaching this RFC determination, the ALJ considered the objective medical record detailed above, the medical opinion evidence, and Amspacher's reported symptoms. Regarding Amspacher's physical limitations, the ALJ considered the opinions of the state agency consulting physicians, Dr. David Hutz, M.D., and Dr. Joanna Deleo, D.O., and found these opinions persuasive. (Tr. 23-24). These consulting sources opined in March of 2020 and January of 2021, respectively, that Amspacher could perform less than the full range of light work. (Tr. 7585, 87-103). The ALJ reasoned that these opinions were supported by the longitudinal treatment notes that generally showed Amspacher had a normal gait and station, normal range of motion, good strength, normal muscle tone, and no focal deficits. (Tr. 23). The ALJ further found that these opinions were consistent with Amspacher's activities of daily living, including taking care of his young daughter, fishing, and performing personal care activities and household chores. (Id.).
The ALJ also considered the opinions and statements of Dr. Eckert, the plaintiff's treating physician, but ultimately found these opinions and statements unpersuasive. (Tr. 24). The ALJ found that Dr. Eckert's opinion that Amspacher's impairments frequently interfered with his attention and concentration, that he was capable of only low stress jobs, that he could only lift up to ten pounds, and that he would need unscheduled breaks were not supported by or consistent with the treatment notes. (Id.). The ALJ reasoned that Dr. Eckert's statements were noted in a check box form with little to no explanation. (Id.). He further noted that these restrictions were inconsistent with Amspacher's activities of daily living and with the progress notes during the relevant period. (Id.).
The ALJ further considered the statement of Nicolas Gohn, P.T., who performed a functional capacity evaluation of Amspacher in 2018 and found that he was functioning in the light work category, and the ALJ found this opinion persuasive. (Tr. 24). The ALJ reasoned that this statement was consistent with Amspacher's activities of daily living. (Id.).
Regarding any mental limitations, the ALJ considered Dr. Eckert's 2021 opinion that Amspacher did not suffer from a severe mental health impairment and found this statement persuasive. (Tr. 26). The ALJ also considered the opinions of Dr. Dennis Gold, Ph.D., and Dr. Thomas Fink, Ph.D., and found these state agency consulting opinions to be persuasive. (Id.). These opinions found only mild limitations in the four broad areas of mental functioning, which the ALJ reasoned was supported by the Amspacjer's progress notes and the lack of ongoing mental health treatment. (Id.).
With respect to Amspacher's symptoms, the ALJ found that Amspacher's statements concerning the intensity, persistence, and limiting effects of his impairments were not entirely consistent with the medical evidence. (Tr. 21-23). Amspacher testified that he suffered from migraines three to four times per week, left-sided weakness and numbness, facial numbness, dizziness, and impaired coordination. (Tr. 41-42). He stated that he believed these were brought on by his anxiety and neck pain, and that he had experienced almost no improvement on medications. (Tr. 42-43). He also testified that he experienced side effects from his medications, such as fatigue. (Tr. 44). He further testified that he believed his tachycardia was brought on by his anxiety. (Tr. 45). He stated that he experienced panic attacks two to four times per month, but that his medication helped some. (Tr. 45-46). Regarding his neck pain, he reported receiving trigger point injections, to which he had a bad reaction, and that physical therapy made his pain worse. (Tr. 47). He treated his pain with Ibuprofen. (Id.). He testified that he could lift between 20 and 30 pounds on a good day and only ten pounds on a bad day. (Tr. 48). Regarding his activities, he stated that he took care of his four-year-old daughter while his wife was at work, and he fished in his spare time. (Tr. 49). He further testified that when he has a migraine, it is somewhat difficult to concentrate but he can do simple activities around the home. (Tr. 53).
The ALJ found Amspacher's testimony to be inconsistent with the objective clinical findings. (Tr. 21-23). The ALJ noted that while Amspacher testified to near constant muscle weakness, the treatment notes consistently showed good or full strength in his upper and lower extremities. (Tr. 21-22). The ALJ further noted that during the relevant period, Amspacher was noncompliant with his medication at times. (Tr. 22). The ALJ further pointed to the imaging studies performed during the relevant time, which resulted in largely normal findings and did not indicate a correlation to Amspacher's symptoms. (Id.). Further, the ALJ reasoned that Amspacher's allegations were inconsistent with his activities of daily living, which included taking care of his young daughter, performing household chores such as cleaning, cooking, and mowing, shopping, driving, and performing personal care. (Id.).
Having made these findings, the ALJ found at Step 4 that Amspacher was unable to perform his past work but found at Step 5 that Amspacher could perform the occupations of a final assembler, optical goods; dowel inspector; and carding machine operator. (Tr. 28). Accordingly, the ALJ found that Amspacher had not met the stringent standard prescribed for disability benefits and denied his claim. (Tr. 29).
This appeal followed. On appeal, Amspacher presents two issues. He argues that the ALJ erred in his consideration of Dr. Eckert's medical opinion, as well as in his consideration of plaintiff's subjective symptoms. This case is fully briefed and is therefore ripe for resolution. For the reasons set forth below, we recommend that the court affirm the decision of the Commissioner.
III. Discussion
A. Substantial Evidence Review - the Role of this Court
This Court's review of the Commissioner's decision to deny benefits is limited to the question of whether the findings of the final decisionmaker are supported by substantial evidence in the record. See 42 U.S.C. §405(g); Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D. Pa. 2012). Substantial evidence “does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial evidence means less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971).
A single piece of evidence is not substantial evidence if the ALJ “ignores, or fails to resolve, a conflict created by countervailing evidence.” Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993) (quoting Kent v. Schweiker, 710 F.2d 110, 114 (3d Cir. 1983)) (internal quotations omitted). However, where there has been 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 court must “scrutinize the record as a whole” to determine if the decision is supported by substantial evidence. Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D. Pa. 2003).
The Supreme Court has explained the limited scope of our review, noting that “[substantial evidence] means-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) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). Under this standard, we must look to the existing administrative record to determine if there is “‘sufficient evidence' to support the agency's factual determinations.” Id. Thus, the question before us is not whether the claimant is disabled, but rather whether the Commissioner's finding that he or she is not disabled is supported by substantial evidence and was based upon a correct application of the law. See Arnold v. Colvin, No. 3:12-CV-02417, 2014 WL 940205, at *1 (M.D. Pa. Mar. 11, 2014) (“[I]t has been held that an ALJ's errors of law denote a lack of substantial evidence”) (alterations omitted); Burton v. Schweiker, 512 F.Supp. 913, 914 (W.D. Pa. 1981) (“The Secretary's determination as to the status of a claim requires the correct application of the law to the facts”); see also Wright v. Sullivan, 900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal matters is plenary); Ficca, 901 F.Supp.2d at 536 (“[T]he court has plenary review of all legal issues . . . .”).
When conducting this review, we must remain mindful that “we must not substitute our own judgment for that of the fact finder.” Zirnsak v. Colvin, 777 F.3d 607, 611 (3d Cir. 2014) (citing Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005)). Thus, we cannot re-weigh the evidence. Instead, we must determine whether there is substantial evidence to support the ALJ's findings. In doing so, we must also determine whether the ALJ's decision meets the burden of articulation necessary to enable judicial review; that is, the ALJ must articulate the reasons for his decision. Burnett v. Commr of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000). This does not require the ALJ to use “magic” words, but rather the ALJ must discuss the evidence and explain the reasoning behind his or her decision with more than just conclusory statements. See Diaz v. Commr of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009) (citations omitted). Ultimately, the ALJ's decision must be accompanied by “a clear and satisfactory explication of the basis on which it rests.” Cotter v Harris, 642 F.2d 700, 704 (3d Cir. 1981).
B. Initial Burdens of Proof, Persuasion, and Articulation for the ALJ
To receive disability benefits under the Social Security Act, a claimant must show that he or she is unable to “engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. §423(d)(1)(A); 42 U.S.C. §1382c(a)(3)(A); see also 20 C.F.R. §§404.1505(a), 416.905(a). This requires a claimant to show a severe physical or mental impairment that precludes [him/her] from engaging in previous work or “any other substantial gainful work which exists in the national economy.” 42 U.S.C. §423(d)(2)(A); 42 U.S.C. §1382c(a)(3)(B); 20 C.F.R. §§404.1505(a), 416.905(a). To receive benefits under Title II of the Social Security Act, a claimant must show that he or she is under retirement age, contributed to the insurance program, and became disabled prior to the date on which he or she was last insured. 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
In making this determination, the ALJ follows a five-step evaluation. 20 C.F.R. §§404.1520(a), 416.920(a). The ALJ must sequentially determine whether the claimant: (1) is engaged in substantial gainful activity; (2) has a severe impairment; (3) has a severe impairment that meets or equals a listed impairment; (4) is able to do his or her past relevant work; and (5) is able to do any other work, considering his or her age, education, work experience and residual functional capacity (“RFC”). 20 C.F.R. §§404.1520(a)(4), 416.920(a)(4).
Between Steps 3 and 4, the ALJ must also determine the claimant's residual functional capacity (RFC). RFC is defined as “that which an individual is still able to do despite the limitations caused by his or her impairment(s).” Burnett, 220 F.3d at 121 (citations omitted); see also 20 C.F.R. § 404.1545(a)(1). In making this assessment, the ALJ must consider all the claimant's medically determinable impairments, including any non-severe impairments identified by the ALJ at step two of his or her analysis. 20 C.F.R. §§404.1545(a)(2), 416.945(a)(2). Our review of the ALJ's determination of the plaintiff's RFC is deferential, and that determination will not be set aside if it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d Cir. 2002).
The claimant bears the burden at Steps 1 through 4 to show a medically determinable impairment that prevents him or her from engaging in any past relevant work. Mason, 994 F.2d at 1064. If met, the burden then shifts to the Commissioner to show at Step 5 that there are jobs in significant numbers in the national economy that the claimant can perform consistent with the claimant's RFC, age, education, and work experience. 20 C.F.R. §§404.1512(f), 416.912(f); Mason, 994 F.2d at 1064.
With respect to the RFC determination, courts have followed different paths when considering the impact of medical opinion evidence on this determination. While some courts emphasize the necessity of medical opinion evidence to craft a claimant's RFC, see Biller v. Acting Comm'r of Soc. Sec., 962 F.Supp.2d 761, 778-79 (W.D. Pa. 2013), other courts have taken the approach that “[t]here is no legal requirement that a physician have made the particular findings that an ALJ adopts in the course of determining an RFC.” Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006). Additionally, in cases that involve no credible medical opinion evidence, courts have held that “the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided.” Cummings v Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015).
Given these differing approaches, we must evaluate the factual context underlying an ALJ's decision. Cases that emphasize the importance of medical opinion support for an RFC assessment typically arise in the factual setting where well-supported medical sources have found limitations to support a disability claim, but an ALJ has rejected the medical opinion based upon an assessment of other evidence. Biller, 962 F.Supp.2d at 778-79. These cases simply restate the notion that medical opinions are entitled to careful consideration when making a disability determination. On the other hand, when no medical opinion supports a disability finding or when an ALJ relies upon other evidence to fashion an RFC, courts have routinely sustained the ALJ's exercise of independent judgment based upon all of the facts and evidence. See Titterington, 174 Fed.Appx. 6; Cummings, 129 F.Supp.3d at 214-15. Ultimately, it is our task to determine, considering the entire record, whether the RFC determination is supported by substantial evidence. Burns, 312 F.3d 113.
C. Legal Benchmarks for the ALJ's Assessment of Medical Opinions
The plaintiff filed this disability application in December of 2019 after Social Security Regulations regarding the consideration of medical opinion evidence were amended. Prior to March of 2017, the regulations established a hierarchy of medical opinions, deeming treating sources to be the gold standard. However, in March of 2017, the regulations governing the treatment of medical opinions were amended. Under the amended regulations, ALJs are to consider several factors to determine the persuasiveness of a medical opinion: supportability, consistency, relationship with the claimant, specialization, and other factors tending to support or contradict a medical opinion. 20 C.F.R. § 404.1520c(c).
Supportability and consistency are the two most important factors, and an ALJ must explain how these factors were considered in his or her written decision. 20 C.F.R. §§ 404.1520c(b)(2), 416.920c(b)(2); Blackman v. Kijakazi, 615 F.Supp.3d 308, 316 (E.D. Pa. 2022). Supportability means “[t]he more relevant the objective medical evidence and supporting explanations . . . are to support his or her medical opinion(s) ....the more persuasive the medical opinions . . . will be.” 20 C.F.R. §§ 404.1520c(c)(1), 416.920c(c)(1). The consistency factor focuses on how consistent the opinion is “with the evidence from other medical sources and nonmedical sources.” 20 C.F.R. §§ 404.1520c(c)(2), 416.920c(c)(2).
While there is an undeniable medical aspect to the evaluation of medical opinions, it is well settled that “[t]he ALJ - not treating or examining physicians or State agency consultants - must make the ultimate disability and RFC determinations.” Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 361 (3d Cir. 2011). When confronted with several medical opinions, the ALJ can choose to credit certain opinions over others but “cannot reject evidence for no reason or for the wrong reason.” Mason, 994 F.2d at 1066. Further, the ALJ can credit parts of an opinion without giving credit to the whole opinion and may formulate a claimant's RFC based on different parts of different medical opinions, so long as the rationale behind the decision is adequately articulated. See Durden v. Colvin, 191 F.Supp.3d 429, 455 (M.D. Pa. 2016). On the other hand, in cases where no medical opinion credibly supports the claimant's allegations, “the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided.” Cummings, 129 F.Supp.3d at 214-15.
D. Legal Benchmarks for the ALJ's Assessment of a Claimant's Alleged Symptoms
When evaluating lay testimony regarding a claimant's reported degree of pain and disability, the ALJ must make credibility determinations. See Diaz v. Comm'r 577 F.3d 500, 506 (3d Cir. 2009). Our review of those determinations is deferential. Id. However, it is incumbent upon the ALJ to “specifically identify and explain what evidence he found not credible and why he found it not credible.” Zirnsak v. Colvin, 777 F.3d 607, 612 (3d Cir. 2014) (citations omitted). An ALJ should give great weight to a claimant's testimony “only when it is supported by competent medical evidence.” McKean v. Colvin, 150 F.Supp.3d 406, 415-16 (M.D. Pa. 2015) (citations omitted). As the Third Circuit has noted, while “statements of the individual concerning his or her symptoms must be carefully considered, the ALJ is not required to credit them.” Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 363 (3d. Cir. 2011) (referencing 20 C.F.R. §404.1529(a) (“statements about your pain or other symptoms will not alone establish that you are disabled”).
The Social Security Rulings and Regulations provide a framework for evaluating the severity of a claimant's reported symptoms. 20 C.F.R. §§ 404.1529, 416.929; SSR 16-3p. Thus, the ALJ must follow a two-step process: first, the ALJ must determine whether a medically determinable impairment could cause the symptoms alleged; and second, the ALJ must evaluate the alleged symptoms considering the entire administrative record. SSR 16-3p.
Symptoms such as pain or fatigue will be considered to affect a claimant's ability to perform work activities only if medical signs or laboratory findings establish the presence of a medically determinable impairment that could reasonably be expected to produce the alleged symptoms. 20 C.F.R. §§ 404.1529(b), 416.929(b); SSR 16-3p. During the second step of this assessment, the ALJ must determine whether the claimant's statements regarding the intensity, persistence, or limiting effects of his or her symptoms are substantiated when considered considering the entire case record. 20 C.F.R. § 404.1529(c), 416.929(c); SSR 16-3p. This includes, but is not limited to, medical signs and laboratory findings; diagnoses; medical opinions provided by treating or examining sources and other medical sources; and information regarding the claimant's symptoms and how they affect his or her ability to work. 20 C.F.R. § 404.1529(c), 416.929(c); SSR 16-3p.
The Social Security Administration recognizes that individuals may be limited by their symptoms to a greater or lesser extent than other individuals with the same medical impairments, signs, and laboratory findings. SSR 16-3p. Thus, to assist in the evaluation of a claimant's subjective symptoms, the Social Security Regulations set forth seven factors that may be relevant to the assessment of the claimant's alleged symptoms. 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3). These factors include: the claimant's daily activities; the “location, duration, frequency, and intensity” of the claimant's pain or symptoms; the type, dosage, and effectiveness of medications; treatment other than medications; and other factors regarding the claimant's functional limitations. 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3).
E. The ALJ's Decision is Supported by Substantial Evidence.
Our review of the ALJ's decision denying an application for benefits is significantly deferential. Our task is simply to determine whether the ALJ's decision is supported by substantial evidence in the record; that is “only- ‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'” Biestek, 139 S.Ct. at 1154. Judged against this deferential standard of review, we conclude that substantial evidence supported the ALJ's decision in this case.
Amspacher first contends that the ALJ erred in finding Dr. Eckert's opinion unpersuasive. He asserts that the ALJ's reasoning-that the statement was a check box form, and that the restrictions were not consistent with the claimant's activities of daily living or the progress notes-was reversible error. However, it is clear from the ALJ's opinion that the ALJ discussed the supportability and consistency of this opinion considering the medical evidence in the record. Regarding Amspacher's first argument, the Third Circuit has suggested that “[f]orm reports in which a physician's obligation is only to check a box or fill in a blank are weak evidence at best.” Mason, 994 F.2d at 1065. We find this to be particularly the case here, where the limitations set forth in the form are contradicted by the physician's own treatment notes that largely reflected good strength and good range of motion, as well as a normal gait and only mildly decreased sensation and grip strength at times.
Further, the ALJ was entitled to discount parts of Dr. Eckert's opinion to the extent he found the limitations to be inconsistent with Amspacher's activities of daily living. While Dr. Eckert opined that Amspacher was unable to perform even simple work tasks due to deficits in his attention and concentration, the ALJ noted that Amspacher was able to take care of his young daughter, perform personal care and household activities, and go fishing. In short, the ALJ was entitled to consider the consistency of this opinion with the claimant's activities of daily living. See eg., Snyder v Kijakazi, 2022 WL 2734410, at *6 (M.D. Pa. May 5, 2022) (Mehalchick, M.J.) (concluding that the ALJ appropriately considered the claimant's activities of daily living when evaluating medical opinion evidence).
Additionally, the ALJ adequately explained why he found Dr. Eckert's opinion to be inconsistent with the progress notes. While Amspacher points to evidence in the record of abnormal findings, the ALJ noted the largely unremarkable findings in the record, such as good strength, good range of motion, and equal reflexes. Although there are some abnormal findings during the relevant period, we are not permitted at this stage to reweigh the evidence, Chandler, 667 F.3d at 359, and instead must simply determine whether the ALJ's decision was supported by “substantial evidence.” Biestek, 139 S.Ct. at 1154. We conclude that the ALJ's consideration of Dr. Eckert's opinion is supported by substantial evidence.
We similarly conclude that substantial evidence supports the ALJ's consideration of Amspacher's subjective symptoms. Amspacher contends that the ALJ's reliance on his activities of daily living, as well as certain progress notes, was error. However, the ALJ explained that Amspacher's allegations regarding his migraines, weakness, and palpitations were inconsistent with his ability to care for his daughter, perform personal care, take care of household chores such as mowing and cooking, and go fishing. The ALJ further noted the unremarkable physical examination findings, as well as his noncompliance with medications at times.
Given the objective evidence in the record undermining the plaintiff's allegations regarding the severity of his impairments, the ALJ properly considered Amspacher's symptoms but ultimately found that he was not as limited as he alleged. Thus, there is no basis for a remand on these grounds. Accordingly, under the deferential standard of review that applies to appeals of Social Security disability determinations, we conclude that substantial evidence supported the ALJ's evaluation of this case and recommend that this decision be affirmed.
IV. Recommendation
For the foregoing reasons, IT IS RECOMMENDED that the decision of the Commissioner in this case should be affirmed, and the plaintiff's appeal denied.
The parties are further placed on notice that pursuant to Local Rule 72.3:
Any party may object to a magistrate judge's proposed findings, recommendations or report addressing a motion or matter described in 28 U.S.C. § 636 (b)(1)(B) or making a recommendation for the disposition of a prisoner case or a habeas corpus petition within fourteen (14) days after being served with a copy thereof. Such party shall file with the clerk of court, and serve on the magistrate judge and all parties, written objections which shall specifically identify the portions of the proposed findings, recommendations or report to which objection is made and the basis for such objections. The briefing requirements set forth in Local Rule 72.2 shall apply. A judge shall make a de novo determination of those portions of the report or specified proposed findings or recommendations to which objection is made and may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge. The judge, however, need conduct a new hearing only in his or her discretion or where required by law, and may consider the record developed before the magistrate judge, making his or her own determination on the basis of that record. The judge may also receive further evidence, recall witnesses or recommit the matter to the magistrate judge with instructions.