Opinion
Civil Action 3:22-cv-00915
08-09-2023
MELISSA DAWN GROVE, Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY, Defendant.
MANNION, J.
REPORT AND RECOMMENDATION
JOSEPH F. SAPORITO, UNITED STATES MAGISTRATE JUDGE
In this matter, the plaintiff, Melissa Dawn Grove, seeks judicial review of the final decision of the Commissioner of Social Security denying her claims for disability insurance benefits and supplemental security income, pursuant to 42 U.S.C. § 405(g) and 42 U.S.C. § 1383(c)(3). The matter has been referred to the undersigned United States magistrate judge to prepare a report and recommended disposition pursuant to the provisions of 28 U.S.C. § 636(b)(1)(B) and Rule 72(b) of the Federal Rules of Civil Procedure. For the reasons expressed herein, we recommend that the final decision of the Commissioner be affirmed.
I. Background
On June 25, 2020, Grove protectively filed an application for disability insurance benefits and supplemental security income, asserting a disability onset date of December 23, 2018. Her application was initially denied by state agency reviewers on October 216, 2020, and upon reconsideration on April 5, 2021. The plaintiff then requested an administrative hearing.
A hearing was subsequently held on August 9, 2021, before an administrative law judge, Richard E. Guida (the "ALJ"). In addition to the plaintiff herself, the ALJ received testimony from an impartial vocational expert, Andrew D. Caporale. The plaintiff was represented by counsel at the hearing.
On September 3, 2021, the ALJ denied Grove's application for benefits in a written decision. The ALJ followed the familiar five-step sequential evaluation process in determining that Grove was not disabled under the Act. See generally Myers v. Berryhill, 373 F.Supp.3d 528, 534 (M.D. Pa. 2019) (describing the five-step sequential evaluation process). At step one, the ALJ found that Grove had not engaged in substantial gainful activity since her alleged onset date. At step two, the ALJ found that Grove had the severe impairments of: multiple! sclerosis, obesity, depressive dis, and anxiety disorder.
At step three, the ALJ found that Grove did not have an impairment or combination of impairments that meets or medically equals the severity of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. In doing so, the ALJ considered Grove's limitations in four broad functional areas as a result of her mental impairments, finding no more than moderate limitations in any of the four functional areas. See generally 20 C.F.R. §§ 404.1520a(c), 416.920a(c) (explaining functional limitation rating process for mental impairments); 20 C.F.R. pt. 404, subpt. P, app.1, § 12.00(E) (explaining the four areas of mental functioning); id. §12.00(F) (explaining process for using paragraph B criteria to evaluate mental impairments). In connection with listings 12.04 and 12.06, the ALJ also considered whether Grove's mental disorders were "serious and persistent," finding that her impairments had not required medical treatment, mental health therapy, psychosocial support, or a highly structured setting that is ongoing and that diminished the symptoms and signs of her mental disorders, nor that she had achieved only marginal adjustment as a result. See generally id. § 12.00(G) (explaining process for using alternative paragraph C criteria to evaluate certain mental impairments).
These four areas are: (1) understanding, remembering, or applying information; (2) interacting with others; (3) concentrating,; persisting, or maintaining pace; and (4) adapting or managing oneself. The ALJ found only mild limitations in Grove's ability to understand, remember, or apply information, her ability to interact with others, and her ability to adapt or manage herself. The ALJ found moderate limitations in her ability to concentrate, persist, or maintain pace.
Between steps three and four of the sequential-evaluation process, the ALJ assessed Grove's residual functional capacity ("RFC"). See generally Myers, 373 F.Supp.3d at 534 n.4 (defining RFC). After evaluating the relevant evidence of record, the ALJ found that Grove had the RFC to perform light work as defined in 20 C.F.R. § 404.1567(c) and § 416.967(c) with the following limitations:
The Social Security regulations define "light work" as a job that "involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighting up to 10 pounds." 20 C.F.R. §§ 404.1567(b), 416.967(b).
[S]he is capable of standing and/or walking for four (4) hours in an eight (8) hour workday. The claimant is capable of frequent performing of postural movements except occasional climbing of ladders, ropes and scaffolds and balancing. The claimant retains the mental capacity to perform simple and routine tasks involving only simple work related decisions with few, if
any, work place changes.(Tr. 16.)
In making these factual findings regarding Grove's RFC, the ALJ considered her symptoms and the extent to which they could reasonably be accepted as consistent with the objective medical evidence and other evidence of record. See generally 20 C.F.R. §§ 404.1529, 416.929; Soc. Sec. Ruling 16-3p, 2017 WL 5180304 (revised Oct. 25, 2017). The ALJ also considered and articulated how persuasive he found the medical opinions and prior administrative medical findings of record. See generally 20 C.F.R. §§ 404.1520c, 416.920c.
At step four, based on this RFC and on testimony by the vocational expert, the ALJ concluded that, since her alleged onset date, Grove was unable to perform past relevant work as a cashier checker or a stores laborer, as actually or generally performed.
At step five, the ALJ concluded that Grove was capable of performing other work that exists in significant numbers in the national economy. Based on her age, education, work experience, and RFC, the ALJ concluded that Grove was capable of performing the requirements; of representative occupations such as information clerk (DOT # 237.367-018), electrical accessories assembler (DOT # 729.687-010), agricultural produce sorter (DOT # 529.687-186), food and beverage order clerk (DOT # 209.567-014), or call-out operator (DOT # 237.367-014). Based on this finding, the ALJ concluded that Grove was not disabled for Social Security purposes.
The plaintiff sought further administrative review of her claims by the Appeals Council, but her request was denied on April 4, 2022, making the ALJ's September 2021 decision the final decision of the Commissioner subject to judicial review by this court.
Grove timely filed her complaint in this court on June 8, 2022. The Commissioner has filed an answer to the complaint, together with a certified copy of the administrative record. Both parties have filed their briefs, and this matter is now ripe for decision.
II. Discussion
Under the Social Security Act, the question before this court is not whether the claimant is disabled, but whether the Commissioner's finding that he or she is not disabled is supported by substantial evidence and was reached based upon a correct application of the relevant law. See generally 42 U.S.C. § 405(g) (sentence five); Myers, 373 F.Supp.3d at 533 (describing standard of judicial review for social security disability insurance benefits administrative decisions).
Grove asserts on appeal that the ALJ's decision is not supported by substantial evidence because the ALJ failed to properly evaluated the medical opinions of her treating neurologist, Ravi Dukkipati, M.D.
The plaintiff contends that the ALJ's decision is not supported by substantial evidence because the ALJ erred in his evaluation of conflicting medical opinions and prior administrative findings presented in the administrative proceedings below. As a preface, we note the well-established principle that, in evaluating the medical opinion evidence of record, an "ALJ is not only entitled, but required to choose between" conflicting medical opinions. Cotter v. Harris, 642 F.2d 700, 706 (3d Cir. 1981)."[T]he possibility of drawing two inconsistent conclusions from the evidence does not prevent [an ALJ's decision] from being supported by substantial evidence." Consolo v. Fed. Maritime Comm'n, 383 U.S. 607, 620 (1966). Moreover, "[i]n the process of reviewing the record for, substantial evidence, we may not 'weigh the evidence or substitute [our own] conclusions for those of the fact-finder.'" Rutherford v. Barrihart, 399 F.3d 546, 552 (3d Cir. 2005) (quoting Williams v. Sullivan, 970 F.2d 1178, 1182 (3d Cir. 199% Ultimately, to reverse the ALJ's findings and decision, "we must find that the evidence not only supports [a contrary] conclusion, but compels it." Immigration & Naturalization Serv: v. Elias-Zacarias, 502 U.S. 478, 481 n.1 (1992); see also Smith v. Chater, 99 F.3d 780, 782 & N.3 (6th Cir. 1996) (citing Elias-Zacarias in the context of social security disability benefits); Hert v. Barnhart, 234 F.Supp.2d 832, 837 (N.D. 111. 2002) ("The court may reverse the Commissioner's decision . only if the evidence 'compels' reversal, not merely because the evidence supports a contrary decision.") (citing Elias-Zacarias).
Here, the plaintiff originally filed her administrative claim for benefits in June 2020. Thus, a relatively new regulatory framework governing the evaluation of medical opinion evidence applies to this case.
"The new regulations have been described as a 'paradigm shift' in the way medical opinions are evaluated." Knittle v. Kijakazi, Civil No. 1:20-CV-00945, 2021 WL 5918706, at *4 (M.D. Pa. Dec. 15, 2021). "Prior to March 2017, ALJs were required to follow regulations which defined medical opinions narrowly and created a hierarchy of medical source!opinions with treating sources at the apex of this hierarchy." Densberger v. Saul, Civil No. 1:20-CV-772, 2021 WL 1172982, at *7 (M.D.; Pa. Mar. 29, 2021).
Under this prior regulatory scheme, the Social; Security Administration "followed the 'treating physician rule,' which required the agency to give controlling weight to a treating source's opinion, so long as it was 'well-supported by medically acceptable clinical and laboratory diagnostic techniques' and not 'inconsistent with the other substantial evidence' in the record." Michelle K. v. Comm'r of Soc. Sec, 527 F.Supp.3d 476, 481 (W.D. Pa. 2021). However, the regulations governing the evaluation of medical evidence were amended and the treating physician rule was eliminated effective March 27, 2017. See Revisions to Rules Regarding the Evaluation of Medical Evidence, 82 Fed.Reg. 5,844 (Jan. 18, 2017); see also Densberger, 202 WL 1172982, at *7-*8; Michelle K, 527 F.Supp.3d at 481. "The range of opinions that ALJs were enjoined to consider were broadened substantially and the approach to evaluating opinions was changed from a hierarchical form of review to a more holistic analysis." Densberger, 2021 WL 1172982, at *7.
Under these new regulations, the agency "will not defer or give any, specific evidentiary weight, including controlling weight, to any medical opinion(s) or prior administrative medical finding(s), including those from [the claimant's] medical sources." 20 C.F.R. §§ 404.1520c(a), 416.920c(a). "Rather than assigning weight to medical opinions,' [aii ALJ] will articulate 'how persuasive' he or she finds the medical opinions." Knittle, 2021 WL 5918706, at *4; see also 20 C.F.R. §§ 404.1520c(b), 416.920c(b). If a medical source provides one or more medical opinions, the agency will consider those medical opinions from that medical source together using the following factors: "(1) supportability; (2) consistency; (3) relationship with the claimant, including the length of the treatment relationship, the frequency of examinations, purpose and extent of the treatment relationship, and the examining relationship; (4) specialization; and (5) any other factors that 'tend to support or contradict a medical opinion or prior administrative medical finding."' Michelle K, 527 F.Supp.3d at 481; see also 20 C.F.R. §§ 404.1520c(a), 416.920c(a); Densberger, 2021 WL 1172982, at *8, Under the new regulations, "[t]he two 'most important factors for determining the persuasiveness of medical opinions are consistency and supportability,' which are the 'same factors' that formed the foundation of the treating source rule." Densberger, 2021 WL 1172982, at *8; see also 20 C.F.R. §§ 404.1520c(b)(2), 416920c(b); Michelle K., 527 F.Supp.3d at 481; compare 20 C.F.R. §§ 404.1520c(c)(1), 416.920c(b) (supportability), and id. §§-404,1520c(c)(2), 416.920(c)(2) (consistency), with Id. §§404.1527(c)(3), 416.927(c)(3) (supportability), and id. §§404.1527(c)(4), 416.927(c)(4) (consistency). An ALJ is specifically required to address these two factors in his or her decision. See 20 C.F.R. § 404.1520c(b)(2), 416.920c(b)(2); see also Densberger, 20211172982, at *8; Michelle K, 527 F.Supp.3d at 482. "The ALJ may-but is not required to-explain how he considered the remaining factors." Michelle K, 527 F.Supp.3d at 482; see also 20 C.F.R. §§ 404.1520c(b)(2), 416.920c(b)(2); Densberger, 2021 WL 1172982, at *8. "However, when the ALJ has found two or more medical opinions to be equally well supported and consistent with the record, but not exactly the same, the ALJ must articulate how he or she considered [the remaining] factors . . . ." Densberger, 2021 WL 1172982, at *8; see also 20 C.F.R. §§ 404.1520c(b)(3), 416.920c(b)(3); Michelle K, 527 F.Supp.3d at 482.
With respect to supportability, the new regulations provide that "[t]he more relevant the objective medical evidence and supporting explanations presented by a medical source, are to support his Or her medical opinion(s) or prior administrative medical finding(s), the more; persuasive the medical opinions or prior administrative medical finding(s) will be." 20 C.F.R. §§ 404.1520c(c)(1), 416.920c(c)(1). With1 respect to consistency, the new regulations provide that "[t]he more: consistent a medical opinion(s) or prior administrative medical finding(s): is with the evidence from other medical sources and nonmedical sources! in the claim, the more persuasive the medical opinion(s) or prior administrative medical finding(s) will be." Id. §§ 404.1520c(c)(2), 416.920c(c)(2).
A. Prior Administrative Findings
The ALJ considered the prior administrative findings in this case, which included the medical opinions of state agency medical and psychological consultants. (Tr. 22-24).
The prior administrative findings included the opinion of a state agency psychological consultant, William Anzalone, Jr., Psy.D., who found that, although Grove had medically determinable impairments of unspecified depressive disorder and unspecified anxiety disorder, Grove had no more than mild limitations in any of the four areas of mental functioning, and therefore the evidence did not establish a severe psychiatric impairment. (Tr. 80-81; Tr. 91.) In evaluating the opinion of Dr. Anzalone, the ALJ found the state agency psychological consultant's opinion to be only "partially persuasive." (Tr. 23.)
Dr. Anzalone found mild limitations in Grove's ability to understand, remember, or apply information, her ability to interact with| others, and her ability to adapt or manage herself, but no limitations whatsoever in her ability to concentrate, persist, or maintain pace. See generally supra note 1.
As noted above, the ALJ's findings echoed Dr. Anzalone's findings of mild limitations in three functional areas, but the ALJ found a moderate limitation in Grove's ability to concentrate, persist, or maintain pace. See supra note 1.
The prior administrative findings included the opinion of a second state agency psychological consultant, Lori Young, Psy.D., who concurred with Dr. Anzalone on reconsideration that Grove had only mild limitations in her ability to understand, remember, or apply information, her ability to interact with others, and her ability to adapt or manage herself. But Dr. Young disagreed with Dr. Anzalone and found that Grove had moderate limitations in her ability to concentrate, persist, or maintain pace. Dr. Young found that Grove was moderately limited in her ability to carry out detailed instructions, her ability to maintain attention and concentration for extended periods, her ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances, and her ability to complete anormal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods. No other . mental functional limitations were noted. (Tr. 108-110, 114-17; Tr. 132-34, 138-41.) In evaluating the opinion of Dr. Young, the ALJ found this; second state agency psychological consultant's opinion to be "persuasive." (Tr. 22.)
The prior administrative findings included the opinion of a state agency medical consultant, Lawrence Schaffzin, M.D., who found the claimant capable of performing light work with some postural limitations. Based on his review of Grove's medical records, Dr. Schaffzin found that Grove was capable of lifting or carrying up to 20 pounds occasionally and up to 10 pounds frequently. Dr. Schaffzin found that Grove was capable of sitting, standing, or walking up to 6 hours per 8-hour workday. Dr. Schaffzin found that Grove was capable of frequently balancing, stooping, kneeling, crouching, crawling, or climbing ramps or stairs, but only occasionally climbing ladders, ropes, or scaffolds. He found no other physical limitations. (Tr. 82-83; Tr. 93-94.) In evaluating the opinion of Dr: Schaffzin, the ALJ found the state agency medical consultant's opinion to be only "partially persuasive." (Tr. 24.)
The prior administrative findings included the opinion of a second: state agency medical consultant, Robert Czwalina, D.Q., who concurred! with Dr. Schaffzin on reconsideration that Grove was capable of lifting or; carrying up to 20 pounds occasionally and up to 10 pounds frequently, and that Grove was capable of sitting up to 6 hours per 8-hour workday. But Dr. Czwalina found that Grove was capable of standing or walking only up to 4 hours per 8-hour workday. Dr. Czwalina found that Grove was capable of frequently stooping, kneeling, crouching, or climbing ramps or stairs, but only occasionally balancing or climbing ladders, ropes, or scaffolds. He found no other physical limitations. (Tr. 111-14;.Tr. 135-38.) In evaluating the opinion of Dr. Czwalina, the ALJ found this second state agency medical consultant's opinion to be "persuasive." (Tr. 23.)
The plaintiff has not challenged the ALJ's evaluation of these prior administrative findings.
B. Opinion of Consultative Examining Psychologist
On September 14, 2020, Grove was seen and examined by a consultative examining psychologist, Leah Bielski, Psy.D. She rioted that Grove reported no history of psychiatric hospitalizations or outpatient; treatment, past or present. Grove reported difficulty sleeping through the j night. She reported depressive symptoms, including dysphoric mood, loss! of usual interest in activities, a sense of worthlessness, and diminished sense of pleasure. Grove denied any current suicidal ideation, but she reported an attempt to commit suicide with pills two or three:years; earlier. Grove denied any homicidal ideation. Grove reported anxiety-related symptoms as well, including excessive apprehension and worry. Grove denied any phobic responses, trauma, panic attacks, manic symptomatology, or thought disorder. Grove did report experiencing cognitive symptoms, including short-term memory deficit, long-term memory deficit, difficulty learning new material, and planning difficulties. On examination, Dr. Bielski observed that Grove was dressed appropriately and well-groomed, with normal posture, normal motor behavior, and appropriate eye contact. Dr. Bielski noted that Grove's; speech intelligibility was fluent, her quality of voice was clear, and her expressive and receptive languages were both adequate. Dr. Bielski observed that Grove's affect was full range and appropriate to speech and thought content. She noted that Grove reported feeling euthymic at the-time of examination. Dr. Bielski observed that Grove presented with clear sensorium, oriented to person, place, and time, and with intact attention and concentration. Dr. Bielski noted, however, that Grove's• recent and remote memory skills appeared to be mildly impaired. Dr.1 Bielski observed that Grove's intellectual functioning was average, her general fund of information was appropriate to experience,, and her insight and judgment were both good. Dr. Bielski recorded mental health diagnoses of unspecified depressive disorder and unspecified anxiety disorder, with a fair prognosis. Dr. Bielski recommended that Grove continue with her current psychiatric treatment and begin individual psychotherapy. (Tr. 779-83.)
Dr. Bielski also completed an agency form report on Grove's ability to do work-related activities due to her mental health conditions. She opined that Grove had mild limitations in her ability to understand, remember, and carry out complex instructions and her ability to make judgments on complex work-related decisions, but no limitations with respect to simple instructions or simple work-related decisions. Dr. Bielski opined that Grove had mild limitations in her ability to interact appropriately with supervisors, co-workers, and the public arid her ability to respond appropriately to usual work situations and to changes in a routine work setting. (Tr. 784-86.)
In evaluating the opinion of Dr. Bielski, the ALJ found the opinion: to be "partially persuasive." In particular, the ALJ noted his finding that Grove had moderate limitations in her ability to concentrate, persist, or maintain pace-greater than the limitations found by Dr. Bielski in this area of mental functioning-he explained that
to the extent [Dr. Bielski's] opinions otherwise are suggestive that mental health symptoms pose no more than minimal functional limitations, they are supported by the absence of documentation of inpatient psychiatric hospitalization, participation in a partial hospitalization or intensive outpatient program, emergency treatment, medication management with a psychiatric provider or therapy or treatment with a psychological or other specialized mental health provider for mental health symptoms, the record indicating that the claimant realized improvement in mental health symptoms with medications prescribed by providers not specializing in mental health symptoms without the claimant's need for any more intensive interventions and the record does not reflect the claimant's exhibition of significant behavioral, cognitive, memory or attentional deficits.(Tr. 23.)
The plaintiff has not challenged the ALJ's evaluation of this' medical opinion.
C. Opinion of Consultative Examining Nurse Practitioner
On March 29, 2021, Grove was seen and examined by a consultative examining nurse practitioner, Karena Hammon, N.P., who noted that-Grove had been diagnosed with multiple sclerosis in 2020, characterized; by numbness on the right side of her body, floaters in her right eye, "tired and heavy" legs, urgent urination with some incontinence, and slight tremors of the lower extremities and hands. Grove also reported mental health diagnoses of anxiety and depression. NP Hammon noted that Grove brought a cane with her and required a cane or walker to ambulate. On examination, NP Hammon observed that Grove's gait was short-strided and a bit unsteady, but the use of a cane helped to stabilize Grove's gait. She noted that Grove lost her balance when attempting to walk on heels and toes, and Grove was capable of demonstrating only 60% of a full squat. NP Hammon observed that Grove's stance was normal, she needed no help getting on and off the exam table, and she was able to rise from a chair without difficulty. NP Hammon noted that, although Grove had some restriction in her right temporal and inferior vision fields, the superior vision field in her right eye and all vision fields in her left eye were within normal limits. NP Hammon observed no scoliosis, kyphosis, or abnormality in the thoracic spine, and she found straight leg raise negative bilaterally both seated and supine. NP Hammon found no evident joint deformity, stable and nontender joints, \' and no redness, heat or effusion. NP Hammon observed physiologic and equal reflexes in upper and lower extremities, no sensory deficit, 4/5; strength in right lower extremity, and 5/5 strength in left lower extremity and bilateral upper extremities. She found no cyanosis, clubbing, or edema, physiologic and equal pulses, no significant varicosities or trophic changes, and no muscle atrophy. NP Hammon observed that Grove's hands exhibited a range of motion within normal limits, and that Grove was able to zip, button, and tie without difficulty. NP Hammon noted that Grove had maintained good eye contact and appeared oriented in all spheres. She found no evidence of hallucinations or delusions, no evidence of impaired judgment, and no evidence of significant memory impairment. NP Hammon observed that Grove exhibited normal affect and denied suicidal or homicidal ideation. She recorded diagnoses of multiple sclerosis with right-sided numbness and poor vision in the right eye, anxiety, and depression, with a fair prognosis. (Tr. 906-09, 916-17.)
NP Hammon also completed an agency form report on Grove's ability to do work-related activities due to her medical conditions. NP Hammon opined that, due to unsteady gait and right-side weakness, Grove was capable of lifting up to 20 pounds occasionally and carrying up to 10 pounds occasionally, but never more. NP Hammon opined that; Grove was capable of sitting up to 4 hours, standing 45 minutes, and walking 30 minutes at a time without interruption, and that Grove was capable of sitting for a total of 6 hours, standing for a total of 90 minutes, and walking for a total of one hour in an 8-hour workday. She noted that Grove required a cane to ambulate more than 25 feet, but she could use her free hand to carry small objects while ambulating. NP Hammon opined that Grove was capable of frequent reaching or pushing and pulling with either hand, frequent handling, fingering, Or feeling with her left hand, but only occasional handling, fingering, or feeling with her right hand due to right-side weakness and numbness. NP Hammon found that Grove could frequently operate of foot controls with her left foot, but only occasionally with her right foot. She opined that Grove was capable of only occasional balancing, stooping, kneeling, crouching, crawling, or climbing of ramps, stairs, ladders, or scaffolds. With respect to visual impairments, NP Hammon found that Grove was able to view a computer screen, to read ordinary newspaper or book print, or to determine differences in shape and color of small objects, but, due to her impaired peripheral vision, Grove was unable to read very small print or to avoid; ordinary hazards in the workplace, such as boxes on the floor, doors ajar,! or approaching people, or vehicles. NP Hammon also found that Grove; was subject to certain environmental limitations: although Grove could tolerate extreme temperatures, humidity and wetness, and dust> odors, fumes, and pulmonary irritants on a frequent basis Grove could only tolerate vibrations or operate a motor vehicle occasionally, and she could never be exposed to Unprotected heights or moving mechanical parts. NP Hammon further opined that Grove was limited to moderate noise levels, such as ordinary office background noise. NP Hammon also noted that Grove was unable to walk a block at a reasonable pace on rough or uneven surfaces due to her unsteady gait. (Tr. 910-15)
In evaluating the opinion of NP Hammon, the ALJ found the opinion to be "partially persuasive." In particular, the ALJ found that:
The standing and walking limitations and the finding that the claimant requires a cane to ambulate and is unable to walk one (1) block at a reasonable pace over rough or uneven surfaces is not supported by notes of treatment that have described the claimant's gait as normal as close to the consultative examination as April 20, 2021 [,] and notes of treatment that do not document consistent cane or assistive device use at appointments aside from that consultative examination. The reading very small print limitation is not supported by the record indicating that the claimant has exhibited 20/25 vision at twenty-five (25) feet on a Snellen chart at the consultative examination and the claimant's reports [that] she uses her cell phone to text and to view social; media. While the undersigned does not agree with the carrying, standing, walking, manipulative, visual, foot control and environmental limitations stated in this opinion, some of the postural limitations are supported
by the improvement the claimant reported experiencing in symptoms first appearing in August of 2019 with the use of IV steroid medication and plasmapheresis, the notation on March 18, 2020[,] that the claimant experienced almost complete resolution of symptoms with plasma exchange performed during the fall of 2019, the improvement in intermittent fatigue the claimant reported experiencing with the use of Amantadine and .headaches with use of Aleve and the absence of documentation of treatment with an urology or gastroenterology provider for incontinence Or urgency. They are also supported by imaging in May of 2021 that did not show new lesions to account for reported increased weakness and difficulty with ambulation, the improvement in symptoms the claimant reported experiencing with intravenous steroid medication, notes of treatment apart from the consultative examination that generally reflect the claimant's ability to walk with a normal gait without cane use noted, the absence of documentation indicating that the claimant underwent physical or occupational therapy relating to any extremity weakness, spasticity or functional impairment, the claimant's ability at the consultative examination to use her hands to zip, button and tie without difficult and the absence of documentation indicating that the claimant took steps to lose weight or met with a weight management or nutritional provider for assistance in this regard.(Tr. 24-25.)
The plaintiff has not challenged the ALJ's evaluation of this; medical opinion.
D. Opinion of Treating Family Physician
The ALJ also considered notations in Grove's medical treatment records, recorded by her treating family physician, Paul Orange, M.D.| Grove was seen and examined by Dr. Orange on February 8, 2021, and May 11, 2021. In his treatment notes for these encounters, Dr. Orange recorded Grove's occupation as "[d]isabled secondary to MS" or "disabled MS," without any further explanation. (Tr. 1297; Tr. 1310.)
To the extent these notations reflected Dr. Orange's opinion, rather than merely a transcription of occupational information reported by the!patient, the ALJ correctly noted that these bald statements that Grove was disabled due to multiple sclerosis were "inherently neither valuable nor persuasive" under the applicable regulations, which expressly and exclusively reserve to the Commissioner (or the ALJ as her designee) the ultimate issue of whether a claimant is disabled. See 20 C.F.R. §§ 404.1520b(c)(3), 416.920b(c)(3); see also Knittle, 2021 WL 5918706, at *6. Moreover, as a statement on an issue reserved to the Commissioner, the ALJ was under no obligation to discuss these statements by Dr. Orange at all under the new regulations. See 20 C.F.R. §§ 404.1520b(c), 416.920b(c) ("Because the evidence listed in paragraph[ ]. . . (c)(3) of this section is inherently neither valuable nor persuasive to the issue of! whether you are disabled . . ., we will not provide any analysis about how we considered such evidence in our determination or decision . . . ."). Regardless, the ALJ . further considered the supportability and consistency of these statements, finding them to be unsupported and inconsistent with other medical evidence of record. (Tri 26-27.)
The plaintiff has not challenged the AL J's evaluation of this opinion by a medical source.
E. Opinions of Treating Neurologist
On December 15, 2020, Grove's treating neurologist, Ravi Dukkipati, M.D., completed a "physical assessment" form. Dr. Dukkipati recorded a diagnosis of multiple sclerosis, and he reported that Grove's symptoms, including dizziness, mental slowing, fatigue, and weakness,, were constantly" severe enough to interfere with the attention and concentration necessary to perform simple work-related tasks. Dr. Dukkipati opined that Grove's multiple sclerosis would require her to recline or lie down during an 8-hour workday in excess of typical workplace breaks. Dr. Dukkipati found Grove was capable of walking less than a city block without rest or significant pain. He opined that she was capable of sitting no more than 4 hours total and standing or walking hoi more than 1 hour total during an 8-hour workday, and that she would require unscheduled breaks of 15 to 30 minutes in duration every 1 or 2 hours throughout the workday. Dr. Dukkipati opined that Grove was capable of lifting or carrying 10 pounds only occasionally, and never more. He reported no manipulative limitations. He Opined that Grove's impairments or treatment would require her to be absent from work more • than 4 times per month. (Tr: 792-93.)
That same day, Dr. Dukkipati also completed a "mental capacity assessment" form. Dr. Dukkipati again recorded a diagnosis of multiple sclerosis. He opined that, due to her medical condition, Grove had moderate limitations in her ability to sequence multi-step activities and her ability to use reason and judgment to make work-related decisions, and mild limitations in her ability to follow one- or two-step oral; instructions to carry out a task and her ability to recognize a mistake and correct it, or to identify and solve problems. Dr. Dukkipati found that Grove also had moderate limitations in her ability to work at an; appropriate and consistent pace, her ability to complete tasks in a timely manner, to ignore or avoid distractions while working, and her ability to work a full day Without needing more than the allotted number or length! of rest periods during the day, and he found that Grove had mild limitations in her ability to initiate and perform a task she knows how to do, her ability to work close to or with others without interrupting or distracting them, and her ability to sustain an ordinary routine and regular attendance at work. He found that Grove had mild limitations in her ability to adapt to changes, to manage psychologically based symptoms, to distinguish between acceptable and unacceptable work performance, to set realistic goals, to make plans independently of others, to maintain personal hygiene and attire appropriate to a work setting, and to be aware of normal hazards and take appropriate precautions. Dr. Dukkipati also found that Grove had mild limitations in her ability to cooperate with others or ask for help when needed, her ability to handle conflicts with others, her ability to understand and respond to social cues, her ability to respond to requests, suggestions, criticism, correction, and challenges, and her ability to keep social interactions free from excessive I irritability, sensitivity, argumentativeness, or suspiciousness. (Tr. 794-96.)
On July 6, 2021, Dr. Dukkipati completed a "physical impairment! questionnaire." Dr. Dukkipati noted that Grove had been a patient of his' since February 2020, and he recorded a diagnosis of multiple sclerosis with a fair prognosis. He reported that Grove's symptoms, including dysuria, tremors, paroxysmal vertigo paresthesia, fatigue, and headaches, were "frequently" severe enough to interfere with the attention and concentration necessary to perform simple work-related tasks. Dr. Dukkipati opined once again that Grove's medical condition would require her to recline or lie down during an 8-hour workday in excess of typical workplace breaks. Dr. Dukkipati found Grove was unable to walk any distance at all without rest or significant pain. He opined that she was incapable of sitting, standing, or walking for more than 30 minutes at a time, and that she could sit, stand, or walk for a: total of zero hours in an 8-hour workday. He further opined that Grove would require unscheduled breaks of unspecified duration every 0 to 30 minutes, throughout the workday. Dr. Dukkipati once again opined that Grove was capable of lifting or carrying 10 pounds only occasionally, and never more. He checked a box to indicate that Grove had limitations in her ability for repetitive reaching, handling, and fingering, but he then; failed to record any specific manipulative limitations at all, leaving blank; a section requesting such information. Dr. Dukkipati opined that Grove's impairments or treatment would require her to be absent from work more than 4 times per month, and he opined that she was not physically capable of working an 8-hour day, 5 days per week. (Tr. 1323-25.)
That same day, Dr. Dukkipati also completed a "mental impairment questionnaire." Dr. Dukkipati now opined that Grove had marked limitations in her ability to remember locations and work-like procedures and her ability to understand and remember even very short and simple instructions. He now found that Grove also had marked limitations in her ability to carry out even very short and simple instructions, her ability to maintain attention and concentration for extended periods, her ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances, and her ability to sustain an ordinary routine without special supervision. Dr. Dukkipati opened that, although Grove had only moderate limitations in her ability to work in coordination with or in proximity to others without being distracted by them and her ability to make simple work-related decisions, Grove had marked limitations in her ability to complete a normal workday or workweek without interruptions; from psychologically based symptoms or interruptions, and her ability to'j perform at a consistent pace without a standard number and length of rest periods. He also found that Grove had moderate limitations in her ability to accept instructions and respond appropriately to criticism from supervisors, her ability to get along with coworkers or peers without distracting them or exhibiting behavioral extremes, and her ability to travel in unfamiliar places or use pub He transportation, but no more than slight functional limitations in other areas of adaptation and social interaction. (Tr. 1327-30.)
In evaluating the opinions of Dr. Dukkipati, the ALJ found specified portions the opinions to be persuasive, and the rest not persuasive. In particular, the ALJ found that:
While the undersigned recognizes that these opinions were rendered by the claimant's neurology provider, the undersigned also recognizes that the statements with regard to. the determination of disability are vested in the sole discretion of the Commissioner. While the undersigned agrees with some of the findings of moderate and lesser limitations with regard to mental health symptoms, the marked and some of the moderate limitations stated in the opinion of July 6, 2021 [,] are not supported by the absence of documentation of inpatient psychiatric hospitalization, participation in a partial hospitalization or intensive outpatient program, emergency treatment, medication management with a psychiatric provider or therapy or treatment with a psychological or other specialized mental health provider for mental health symptoms, the record indicating that the claimant realized improvement in mental health symptoms with medications prescribed
by providers not specializing in mental health symptoms without the claimant's need for any more intensive interventions and the record that does not reflect the claimant's exhibition of significant behavioral, cognitive, memory or attentional deficits/The remainder of the hmitations stated in these opinions and the opinions to the extent that they are suggestive of an inability to perform a competitive level of work are not supported by the improvement the claimant reported experiencing in symptoms first appearing in August of 2019 with use of IV steroid medication and plasmapheresis, the notation on March 18, 2020 [,] that the claimant experienced almost complete resolution of symptoms with plasma exchange performed during the fall of 2019, the improvement in intermittent fatigue the claimant reported experiencing with use of Amantadine and headaches with use of Aleve and the absence of documentation of treatment with an urology or gastroenterology provider for incontinence or urgency. They also are not supported by imaging in May of 2021 that did not show new lesions to account for reported increased weakness and difficulty with ambulation, the improvement in symptoms the claimant reported experiencing with intravenous steroid medication, notes of treatment apart from the consultative examination that generally reflect the claimant's ability to walk with a normal gait without cane use noted, the absence of documentation indicating that the claimant underwent physical or occupational therapy relating to any extremity weakness, spasticity or functional impairment, the claimant's ability at the consultative examination to use her hands to zip, button and tie without difficulty and the absence of documentation indicating that the claimant took steps to lose weight or i met with a weight management or nutritional provider for assistance in this regard. For these reasons, while some of the moderate and lesser limitations with respect to mental health symptoms are persuasive, the
remainder of the limitations set forth in these opinion[s] is not persuasive.(Tr. 26.)
Here, the ALJ properly considered the medical evidence of record and the relevant factors of supportability and consistency. He expressly articulated the basis of his evaluation and his findings with respect to the persuasiveness of these opinions as well. Although the plaintiff quibbles with the ultimate outcome of the ALJ's evaluation of the opinions, arguing that various factors support a contrary conclusion, it is clear that the ALJ's findings with respect to Dr. Dukkipati's opinions are supported by substantial evidence.
The plaintiff argues that the ALJ made only selective references to the medical evidence in his decision. She points out several medical findings not expressly discussed by the ALJ that she contends support a: contrary finding with respect to the supportability and consistency of Dr. Dukkapati's opinons. But it is the exclusive province of the ALJ, not this court, to resolve conflicting evidence. "In the process of reviewing the record for substantial evidence, we may not 'weigh the evidence or substitute our own conclusions for that of the fact-finder.'" Rutherford, 399 E.3d at 552 (quoting Williams, 970 F.2d at 1182); see also Stancavage v. Saul, 469 F.Supp.3d 311, 334 (M.D. Pa. 2020). Moreover, it is well settled that an ALJ is not required to discuss every detail of the record evidence cited in his opinion. See Johnson v. Comm'r of Soc. Sec, 529 F.3d 198, 203-04 (3d Cir. 2008). "A written evaluation of every piece of, evidence is not required, as long as the ALJ articulates at some minimum level her analysis of a particular line of evidence. Moreover, the ALJ's mere failure to cite specific evidence does not establish that the ALJ failed to consider it." Philips v. Barnhart, 91 Fed.Appx. 775, 780 n. 7 (3d Cir. 2004) (citation omitted). While the evidence cited by the plaintiff on appeal might reasonably support a different conclusion with respect to the persuasiveness of Dr. Dukkapati's medical opinions, it does not compel it.
Accordingly, we find the ALJ's evaluation of the opinions of treating neurologist Dr. Dukkapati is supported by substantial evidence and was reached based upon a correct application of the relevant law.
III. Recommendation
Based on the foregoing, we conclude that the Commissioner's finding that Grove was not disabled is supported by substantial evidence and was reached based upon a correct application of the relevant law.
Accordingly, it is recommended that the decision of the Commissioner of Social Security be AFFIRMED.
NOTICE
NOTICE IS HEREBY GIVEN that the undersigned has entered the foregoing Report and Recommendation dated August 9, 2023. Any party may obtain a review of the Report and Recommendation pursuant to Local Rule 72.3, which provides:
Any party may object to a magistrate judge's proposed findings, recommendations or report addressing a motion or matter described in 28 U.S.C. § 636(b)(1)(B) or making a recommendation for the disposition of a prisoner case or a habeas corpus petition within fourteen (14) days after being served with a copy thereof. Such party shall file with the clerk of court, and serve j on the magistrate judge, and all parties, written j objections which shall specifically identify the portions j 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.
Failure to file timely objections to the foregoing Report and Recommendation may constitute a waiver of any appellate rights.