Opinion
CIVIL 1:23-CV-941
04-29-2024
JAMIE DAVIES, Plaintiff, v. MARTIN O'MALLEY, Commissioner of Social Security,[1]defendant.
Judge Mariani
REPORT AND RECOMMENDATION
DARYL F. BLOOM UNITED STATES MAGISTRATE JUDGE
I. Introduction
On September 21, 2020, Jamie Davies filed an application for disability and disability insurance benefits, and she filed an application for supplemental security income on February 26, 2021. A hearing was held before an Administrative Law Judge (“ALJ”), and the ALJ found that Davies was not disabled from her alleged onset date of January 4, 2019, through the date of the ALJ's decision, April 21, 2022.
Davies 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
Jamie Davies filed for disability and disability insurance benefits, as well as supplemental security income, alleging disability due to major depressive disorder, post-traumatic stress disorder, bursitis in her hips, and fibromyalgia. (Tr. 79). She alleged an onset date of disability of January 4, 2019. (Id.). Davies was 37 years old at the time of her alleged onset, had at least a high school education, and had no past relevant work. (Tr. 29).
The medical record regarding Davies' impairments revealed that Davies suffered from both physical and mental impairments during the relevant period. Regarding her physical impairments, Davies filled out a health assessment questionnaire in January of 2019, wherein she reported an ability to do many daily activities with no difficulty, such as dressing, eating, and personal hygiene, but noted some difficulty with walking, standing up from a seated position, and running errands. (Tr. 447-48). Treatment notes from Penn State Health in February of 2019 indicate that Davies was suffering from lower back and hip pain since 2017. (Tr. 440). She reported generalized pain and stiffness, and on examination, had 12 of 18 positive fibromyalgia tender points. (Tr. 441). Treatment notes from June of 2020 indicated that Davies complained of a history of back pain and was working at Rutters at the time. (Tr. 537).
Davies underwent and internal medicine examination with nurse practitioner Karena Hammon in December of 2020. (Tr. 689). Davies reported that she did her own cooking, cleaning, and shopping, as well as personal care, but she did not drive. (Tr. 690). On examination, Davies had a normal gait, was able to rise from a chair without difficulty, exhibited 5/5 strength in her extremities and no fibromyalgia tender points, and could squat 60 percent. (Tr. 691-92). Ms. Hammon opined that Davies could frequently lift and carry up to 20 pounds; could sit for 5 hours, stand for 4 hours, and walk for 3 hours in an 8-hour workday; and could frequently climb stairs, ramps, ladders, and scaffolds but only occasionally stoop, kneel, crouch, and crawl. (Tr. 695-98).
In February of 2021, Davies reported continued lower back pain radiating to her hips. (Tr. 790). Treatment notes indicate that she had some success with massage therapy, medication, and a TENS unit. (Id.). On examination, she exhibited tenderness in her lumbar facet joints and had limited range of motion in her lumbar spine, normal range of motion in her hips with some pain, and a normal gait. (Tr. 792-93). An x-ray of Davies' lumbar spine at this time revealed minimal anterolisthesis at ¶ 4 and L5 but no spondylosis and well-maintained disc spaces. (Tr. 788). She was diagnosed with fibromyalgia and prescribed medical marijuana. (Tr. 793). In May, Davies reported an improvement in her pain after using medical marijuana and taking her other prescribed medications. (Tr. 780). Her provider noted that she was “seeing good relief with medical marijuana[.]” (Tr. 783).
Davies also received chiropractic care beginning in July of 2021. (Tr. 1061-72). Treatment notes from August further noted that Davies was trying to exercise more but was still experiencing some pain, and her provider recommended medial branch nerve blocks. (Tr. 978, 983). Around this time, Davies was seeing a nutritionist and reported she had lost 14 pounds in three months. (Tr. 904). Relevant to the instant appeal, Davies' treatment records throughout the relevant period note a BMI between 37 and 41, indicating that Davies was obese. (See e.g., Tr. 430, 535, 589, 597, 610, 637, 782, 809, 839, 847, 888, 904, 938, 981, 1084, 1164, 1309).
Davies received additional nerve blocks in September of 2021, and received trigger point injections in November. (Tr. 962-63, 1142). In January of 2022, she reported only 15 percent relief from the injections. (Tr. 1135). In March, after another round of injections, Davies reported only 10 percent relief. (Tr. 1300).
With respect to her mental health impairments, Davies attended therapy regularly with Pennsylvania Counseling Services. Treatment records from April of 2019 indicated diagnoses of major depressive disorder and post-traumatic stress disorder. (Tr. 570). It was noted that she would be starting a day program at a hospital the following week. (Tr. 571). Intake records from Wellspan Philhaven indicate that Davies started the day program in April of 2019. (Tr. 474). Davies reported a history of sexual abuse, as well as issues with her husband's health and being a caretaker for her son who is on the autism spectrum (Id.). A mental status examination revealed a depressed mood, fluent and coherent speech, goal-directed thought processes, and average intellectual functioning. (Tr. 475). She was diagnosed with major depressive disorder, attention deficit disorder, cannabis use disorder, fibromyalgia, and bursitis. (Id.). Upon discharge from the program in June, Davies reported that she felt she had made progress and has better use of coping skills. (Tr. 483).
At a medication management appointment in August of 2019, Dr. Karen Medzoyan, M.D., Davies' psychiatrist, noted that Davies had separated from her husband and was suffering from continued insomnia. (Tr. 602). A mental status examination showed a depressed and anxious mood, normal speech, logical thought processes, fair insight and judgment, and fair attention and concentration. (Tr. 602-03). However, notes from Dr. Medzoyan in February of 2020 indicated that Davies was feeling brighter, less anxious, and less depressed, and had been compliant with her medications. (Tr. 589-90). A few months later, in June of 2020, Dr. Medzoyan discharged Davies from treatment for recurrent no shows, noting that she was last seen in February. (Tr. 587).
Telemedicine appointment notes from September of 2020 indicated that Davies had been out of her anxiety medication for several months. (Tr. 534). Davies resumed therapy treatment in October of 2020, and treatment notes from November indicated that although she continued to struggle with anxiety, her progress was good and her capacity to benefit from therapy was excellent. (Tr. 664). Davies underwent a mental status evaluation with Dr. Leah Bielski, Psy.D., in December of 2020, at which time Dr. Bielski opined that Davies had only mild limitations in any area of mental functioning. (Tr. 675-81).
Davies continued to treat with therapy in January of 2021, at which time she reported anxiety regarding caring for her sons and her relationship with her boyfriend. (Tr. 738). Treatment notes from March indicated that Davies was making moderate progress, and her mood and speech were normal. (Tr. 719-20). Davies was discharged from treatment in April due to poor attendance, although it was noted that her condition at discharge was improved. (Tr. 710). Around this time, Dr. Medzoyan performed a psychiatric evaluation of Davies to resume psychiatric treatment. (Tr. 864-65). Dr. Medzoyan noted that Davies had worked sporadically over the last year. (Tr. 865). A mental status examination at this time revealed an anxious and depressed mood, logical thought processes, normal concentration, fair insight and judgment, and intact memory. (Tr. 866-67).
In September of 2021, Davies reported to Dr. Medzoyan that she had slapped her son after becoming increasingly frustrated with his behavior. (Tr. 1092-93). Dr. Medzoyan adjusted her medication. (Tr. 1093). A mental status examination at this visit indicated a depressed and anxious mood, normal concentration, logical thought processes, intact memory, and fair insight and judgment. (Tr. 1094). In November, Dr. Medzoyan noted that Davies' mood was stable with respect to her chronic depression, and that she was working part time at Burger King and as an Uber Eats driver. (Tr. 1085).
Davies continued with psychiatric treatment and therapy in January of 2022. At this time, Davies reported increased anxiety and depression surrounding her struggles caring for her autistic son. (Tr. 1081). It was noted that she was starting a job at Wendy's and continued to work as an Uber driver. (Id.). A mental status examination revealed a depressed mood, fair insight and judgment, normal concentration, cooperative attitude, and intact memory. (Tr. 1082). In February, Dr. Medzoyan noted that Davies had made positive changes in her life, including starting college courses online. (Tr. 1253). At a routine follow up appointment around this time, Davies reported continuing mental health issues, and that she had been working at Burger King but quit because of a disagreement with her manager. (Tr. 1235).
Dr. Medzoyan filled out a mental impairment questionnaire in February of 2022. (Tr. 1198-1206). Dr. Medzoyan characterized Davies' impairments as treatment-resistant depression and noted her prognosis as poor to guarded. (Tr. 1199-1200). Dr. Medzoyan opined that Davies had mostly moderate to marked limitations, noting that Davies' marked limitations included maintaining regular attendance, completing a normal workday, and dealing with normal work stress. (Tr. 1204). She noted that Davies had moderate difficulties with understanding, remembering, or applying information, and that she experienced marked limitations in concentrating, persisting, and maintaining pace, as well as adapting or managing oneself. (Tr. 1205).
Thus, it was against the backdrop of this record that an ALJ held a hearing on Davies' disability application on April 4, 2022. (Tr. 37-57). Davies and a vocational expert both appeared and testified at the hearing. (Id.). On April 21, 2022, the ALJ issued a decision denying Davies's application for disability benefits. (Tr. 10-36). In this decision, the ALJ first concluded that Davies had not engaged in substantial gainful activity since January 4, 2019, her alleged onset of disability. (Tr. 15). At Step 2 of the sequential analysis that governs disability claims, the ALJ found that Davies suffered from the following severe impairments: asthma; lumbar facet arthropathy with sciatica; fibromyalgia; bursitis and degenerative joint disease of the hips; myofascial pain syndrome; rheumatoid arthritis; obesity; major depressive disorder; post-traumatic stress disorder; substance use disorder; and attention deficit hyperactivity disorder. (Tr. 16). 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. 16-22).
Between Steps 3 and 4, the ALJ then concluded that Davies:
[H]a[d] the residual functional capacity to perform less than the full range of light work as defined in 20 CFR 404.1567(b) and 416.967(b). She is limited to occasional postural movements except never use ladders, ropes, or scaffolds, and never kneel or crawl. She mut (sic) avoid concentrated exposure to temperature extremes, humidity, fumes, odors, dust, gases, poor ventilation, dangerous machinery and unprotected heights. Work that is limited to simple and routine tasks, involving only simple, work-related decisions, and with few, if any, workplace changes, no production pace work, and only occasional interaction with supervisors, coworkers, and the public.(Tr. 22).
In reaching this RFC determination, the ALJ considered the objective medical record detailed above, the medical opinion evidence, and Davies' reported symptoms. Regarding Davies' physical limitations, the ALJ considered the opinions of the state agency consulting physicians, Dr. Deleo and Dr. Gustitus. The ALJ found Dr. Deleo's opinion-which limited Davies to lifting and carrying up to 50 pounds occasionally and sitting, standing, and walking for 6 hours in an 8-hour workday-partially persuasive. (Tr. 26, 91-92). The ALJ found that this opinion was generally consistent with Davies' medical records documenting normal clinical findings, but further found that Davies was more limited than Dr. Deleo's opinion accounted for due to her severe physical impairments. (Id.). Similarly, the ALJ considered Dr. Gustitus' August 2021 opinion, found that it was persuasive to the extent it was consistent with the normal examination findings in the record, but further found that Davies required additional limitations due to her severe physical impairments. (Tr. 26, 114-17). The ALJ also considered the opinion of Karena Hammon, the consultative examiner, and found this opinion partially persuasive to the extent it limited Davies to light work. (Tr. 28). The ALJ reasoned that this opinion was generally consistent with Hammon's own examination and the longitudinal treatment records containing largely normal examination findings. (Id.)
Regarding Davies' mental impairments, the ALJ considered Dr. Medzoyan's February 2022 opinion and found it unpersuasive. (Tr. 2829). The ALJ reasoned that Dr. Medzoyan's moderate to marked limitations were not consistent with her own treatment notes that showed normal concentration, no impairment of thought processes, intact decision-making, and normal speech. (Tr. 29). The ALJ further reasoned that Dr. Medzoyan's opinion was not consistent with Davies' activities of daily living, which were reported to Dr. Medzoyan, consisting of housekeeping, driving her son to school and boyfriend to work, and taking online classes. (Id.).
Instead, the ALJ found the opinions of the state agency psychological consultants generally persuasive. (Tr. 27). The ALJ found Dr. Plowman's January 2021 opinion-which found mild to moderate limitations in the four areas of social functioning-generally persuasive, ultimately concluding that Davies was slightly more limited than Dr. Plowman's opinion accounted for. (Tr. 27). The ALJ found Dr. Chiampi's August 2021 opinion persuasive, in that this opinion found mostly moderate limitations in the four areas of social functioning. (Id.). The ALJ reasoned that this opinion was generally consistent with Davies' medical records containing some abnormal findings but also findings of normal cognition, cooperative behavior, intact attention and concentration, good insight and judgment, and intact recent and remote memory. (Id.).
With respect to Davies' symptoms, the ALJ found that Davies' statements concerning the intensity, persistence, and limiting effects of her impairments were not entirely consistent with the medical evidence. (Tr. 23-25). Davies testified that the main reason she could not work was her mental health impairments. (Tr. 44). She reported that she experienced crying and anger outbursts, that she was forgetful, and that she had impaired concentration. (Tr. 44-45). She testified that her medications helped her to an extent, but that nausea was a severe side effect of her medications. (Tr. 47). Regarding her physical impairments, Davies testified that she suffered from back and hip pain, as well as fibromyalgia, and that these impairments affected her ability to stand, walk, bend, and sit. (Tr. 49). She reported that she had tried physical therapy, injections, and nerve blocks with no success but that medications were somewhat helpful. (Tr. 50). With respect to daily activities, Davies alleged that she was the sole caretaker of her teenage son who is on the autism spectrum, and that she was able to perform household chores, grocery shopping, and personal care. (Tr. 48, 51).
The ALJ found Davies' testimony concerning her alleged limitations to be inconsistent with the objective clinical findings. (Tr. 2325). As to her physical impairments, the ALJ noted some abnormal findings in the record, such as fibromyalgia trigger points, tenderness of the lumbar spine, and positive straight leg raise testing, as well as records indicating Davies was obese. (Tr. 24). However, the ALJ also detailed the records that indicated Davies had full range of motion, 5/5 strength, a normal gait and stance, and no swelling. (Id.). With respect to her mental impairments, the ALJ recognized that the record contained findings of sleep disturbance, racing thoughts, dysphoric moods, crying spells, fatigue, and concentration difficulties. (Id.). However, he also pointed to records indicating normal cognition, cooperative behavior, intact attention and concentration, intact memory, and logical thought processes. (Tr. 25). The ALJ further reasoned that although Davies reported significant difficulties in her activities of daily living, the documented clinical findings did not support a finding that she was as limited as she alleged. (Id.).
Having made these findings, the ALJ found at Step 4 that Davies had no past relevant work but found at Step 5 that Davies could perform the occupations of a price marker, mail sorter, and garment sorter. (Tr. 29-30). Accordingly, the ALJ found that Davies had not met the stringent standard prescribed for disability benefits and denied her claim. (Tr. 30).
This appeal followed. On appeal, Davies challenges the ALJ's evaluation of her obesity, consideration of Dr. Medzoyan's medical opinion, and his Step 5 findings. 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 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 September of 2020 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 Assessing a Claimant's Obesity
The plaintiff also challenges the ALJ's assessment of her obesity. Under the agency's regulations, the ALJ must analyze the effects of a claimant's obesity on his or her ability to function. See SSR 02-01p, SSR 00-3p. This is particularly so when the ALJ identifies the claimant's obesity as a severe impairment at Step 2. Diaz v. Comm 'r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009). The Third Circuit has explained that the ALJ need not “use particular language or adhere to a particular format in conducting his analysis” of a claimant's obesity. Diaz, 577 F.3d at 504 (citations omitted). Rather, so long as the ALJ “meaningfully consider[s] the effect of a claimant's obesity, individually and in combination with her impairments, on her workplace function at step three and at every subsequent step[,]” id. at 504, a remand is not required. See Woodson v. Comm'r Soc. Sec., 661 Fed.Appx. 762, 765 (3d Cir. 2016); Cooper v. Comm'r of Soc. Sec., 563 Fed.Appx. 904, 911 (3d Cir. 2014).
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.
Davies first contends that the ALJ erred in his consideration of her obesity, arguing that the ALJ did not consider SSR 19-2p when assessing Davies' limitations from her obesity. However, we conclude that the ALJ's consideration of Davies' obesity is supported by substantial evidence. The ALJ found Davies' obesity to be a severe impairment and noted the findings of obesity during the relevant time. (Tr. 16, 24). However, the ALJ further pointed to objective evidence showing that Davies had no swelling, full range of motion, a normal stance and gait, negative straight leg raise tests, and 5/5 strength in her extremities. (Tr. 24). Given this objective evidence, the ALJ ultimately found that Davies' obesity did not require greater limitations than set forth in the residual functional capacity. We find no error in the ALJ's analysis here.
We further conclude that the ALJ's assessment of the medical opinion evidence is supported by substantial evidence. Davies argues that the ALJ improperly discounted the opinion of her treating psychiatrist, Dr. Medzoyan. Regarding this opinion, the ALJ determined that Davies was not as limited as Dr. Medzoyan alleged, reasoning that Dr. Medzoyan's limitations were not consistent with her own treatment notes that included findings of normal concentration, cooperative attitude, intact thought processes and decision-making capabilities, and normal speech. (Tr. 29). Instead, the ALJ found the limitations set forth by the state agency consultants to be more persuasive and consistent with the objective evidence. (Tr. 27). The ALJ recounted the examination findings in the record of intact attention and concentration, normal speech, intact thought processes, and good insight and judgment, and found that these opinions demonstrating only moderate limitations were more consistent with the objective medical evidence.
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. The ALJ was confronted by several medical opinions, discussed each opinion considering the objective medical evidence, and found some more persuasive than others. The ALJ explained his reasoning for the persuasiveness afforded to each opinion. See Burnett, 220 F.3d at 119. This is all that is required of the ALJ, and we conclude that substantial evidence supports the assessment of the opinion evidence in this case.
Davies also argues that the ALJ erred in finding that she could perform the jobs listed at Step 5, arguing that these jobs require a reasoning level 2, and Davies was limited to simple, routine, repetitive tasks. However, courts in this circuit have found that reasoning level 2 jobs are not inconsistent with a limitation to a simple tasks RFC. See eg., Money v Barnhart, 91 Fed.Appx. 210, 215 (3d Cir. 2004) (non-precedential) (“Working at reasoning level 2 would not contradict” a limitation to simple, routine, repetitive tasks); Jones v. Astrue, 570 F.Supp.2d 708, 716 (E.D. Pa. 2009) (same) (collecting cases). Therefore, we find no error with the ALJ's decision at Step 5.
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.