Opinion
CIVIL 1:22-CV-897
03-31-2023
KARA HOWARD, Plaintiff v. KILOLO KIJAKAZI, Acting Commissioner of Social Security, Defendant
BRANN, CHIEF JUDGE
REPORT AND RECOMMENDATION
MARTIN C. CARLSON, UNITED STATES MAGISTRATE JUDGE
I. Introduction
This case illustrates for us one of the challenges of Social Security litigation, the deferential standard of review that applies in these cases. The Supreme Court has underscored for us the limited scope of our substantive review when considering Social Security appeals, noting that:
The phrase “substantial evidence” is a “term of art” used throughout administrative law to describe how courts are to review agency factfinding. T-Mobile South, LLC v. Roswell, 574 U.S.__, __, 135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-evidence standard, a court looks to an existing administrative record and asks whether it contains “sufficien[t] evidence” to support the agency's factual determinations. Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis deleted). And whatever the meaning of “substantial” in other contexts, the threshold for such evidentiary sufficiency is not high. Substantial evidence, this Court has said, is “more than a mere scintilla.” Ibid.;
see, e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks omitted). It means-and means only-“such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v. Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999) (comparing the substantial-evidence standard to the deferential clearly-erroneous standard).Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019).
Kara Howard filed an application for disability and disability insurance benefits under Title II of the Social Security Act on September 19, 2019. A hearing was held before an Administrative Law Judge (“ALJ”), and the ALJ found that Howard was not disabled as of the onset date of disability of July 1, 2019 and denied her application for benefits.
Howard now appeals this decision, arguing that the ALJ's decision is not supported by substantial evidence. However, 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, 139 S.Ct. at 1154, we find that substantial evidence supported the ALJ's findings in this case. Therefore, for the reasons set forth below, we recommend that the district court affirm the decision of the Commissioner denying this claim.
II. Statement of Facts and of the Case
Kara Howard filed for disability insurance benefits, alleging disability due to fibromyalgia, depression, scleroderma, Raynaud's syndrome, Sjogren's syndrome, lupus, constant sinus infections, and costochondritis. (Tr. 56). She alleged an onset date of disability of July 1, 2019. (Id.) Howard had at least a high school education and past work as a waitress. (Tr. 23-24).
With respect to Howard's impairments, the record revealed the following: Howard was diagnosed with fibromyalgia in 2005. Prior to the relevant period, she treated with her treating physician, Dr. Daniel Mateer, D.O., in May of 2019. On May 30, 2019, Dr. Mateer noted that the medication Howard was taking for her fibromyalgia pain was mostly keeping her discomfort acceptable. (Tr. 373). He also noted that Howard suffered from insomnia, and that she was working at her business in the food industry at that time. (Id.) Howard also complained of finger pain at this visit. (Id.) On examination, Howard exhibited normal musculoskeletal range of motion but had tenderness and swelling in her hands. (Tr. 374). She was prescribed prednisone for her fibromyalgia pain. (Id.)
Howard saw Dr. Mateer in July for a follow up, at which time she reported that she was without pain, had more energy, and denied anxiety or depression. (Tr. 368). On examination, her musculoskeletal range of motion was normal, and she exhibited no tenderness or edema. (Tr. 369). Dr. Mateer noted that her mood, affect, behavior, judgment, and thought content were normal. (Tr. 369-70). Also in July, Howard complained of sinus symptoms, reporting that she had symptoms for the past eight months. (Tr. 365). Her musculoskeletal and psychiatric examinations were normal at this time. (Tr. 365-66).
In October of 2019, Howard followed up with Dr. Mateer for her fibromyalgia and insomnia. (Tr. 357). Howard complained of left sided neck pain radiating to her shoulder, lower back pain, and pain in her bilateral hips. (Id.) However, on examination, she exhibited normal range of motion and no tenderness, edema, or deformity. (Tr. 359-60). Dr. Mateer ordered X-rays of her cervical spine, lumbar spine, and bilateral hips. (Tr. 360-61). These X-rays showed no malalignment or fracture of the cervical or lumbar spine; mild bilateral neural foraminal narrowing in the cervical spine at C3-C4; mild lower lumbar facet arthropathy; and small foci of calcific tendinitis in the hips. (Tr. 393). At a follow up appointment in November, Dr. Mateer noted that Howard was depressed because she had lost her business and broken up with her boyfriend. (Tr. 416). He noted that the medications helped manage Howard's pain, but she still experienced pain at night. (Id.) On examination, she exhibited tenderness over her entire back and extremities. (Tr. 418). Dr. Mateer referred her to rheumatology for her degenerative disc disease, fibromyalgia, and Raynaud's syndrome. (Tr. 419).
Howard underwent a consultative examination with Dr. Ahmed Kneifati, M.D., in January of 2020. (Tr. 425-36). Howard reported that she cooked occasionally, showered twice per week, dressed herself three times per week, and watched television. (Tr. 426). On examination, her gait was normal; she could not stand on her toes or walk on her toes and heels due to pain; she was able to squat 35%; and she needed no help getting on or off the examination table or rising from a chair. (Tr. 427). She had a negative straight leg raise bilaterally both seated and supine; there was no evident joint deformity; she exhibited some tenderness and had 14 trigger points; her hand and finger dexterity were intact; and she had 5/5 strength in the upper and lower extremities. (Tr. 427-28). Dr. Kneifati opined that Howard could occasionally lift and carry up to 10 pounds; could sit for 4 hours, stand for 3 hours, and walk for 2 hours in an 8-hour workday; could reach occasionally but never overhead; and could occasionally climb stairs, ramps, ladders, and scaffolds, balance, stoop, kneel, and crouch. (Tr. 431-36).
Howard also underwent a mental status evaluation with Dr. John Kajic, Psy.D., in January of 2020. (Tr. 445-49). Howard reported difficulty falling asleep, depressed moods, fatigue, loss of energy, and social withdrawal. (Tr. 446). On examination, Howard's speech was fluent; her thought processes were coherent and goal directed; her affect was appropriate; her mood was depressed and irritable; her attention and concentration, as well as her recent and remote memory, were intact; and her insight and judgment were fair. (Tr. 447-48). She reported that she showered twice per week, was able to prepare simple meals for herself, did laundry every two weeks, socialized with her mother, and watched television. (Tr. 448). Dr. Kajic recommended psychological therapy. (Tr. 449).
Around this time, Howard treated at UPMC for joint pain and fibromyalgia. (Tr. 463). She reported worsening fatigue, as well as joint pain in her wrists and feet. (Id.) She also reported anxiety. (Id.) Treatment notes indicate that her medications were alleviating some of her symptoms, and she had no limitation on range of motion in her joints and no lower extremity edema. (Tr. 464). A musculoskeletal examination was normal, and Howard was advised to stay active and continue on her medications. (Tr. 464, 468). At a follow up later in February, Howard reported that she was restricted to bed for a few days due to severe fatigue. (Tr. 471). She further reported achy pain over her entire body, and she exhibited more than 12 tender points consistent with fibromyalgia. (Id.) These treatment records also noted Howard's ongoing depression and anxiety, and she was advised to see a therapist or psychiatrist. (Tr. 472). On examination, Howard exhibited tenderness over her entire paraspinal region, but no tenderness or swelling elsewhere. (Tr. 476). In March of 2020, it was noted that Howard had begun seeing a rheumatologist, and that she was sleeping well on her medications. (Tr. 481-82).
Howard was seen by Dr. Mateer in May of 2020 via a telephone encounter due to the COVID-19 pandemic. (Tr. 587). She complained of ongoing sinus issues, as well as fatigue. (Id.) She further reported experiencing pain everywhere in her extremities and her spine. (Id.) At a visit to Pinnacle Health Urgent Care in July of 2020, where she complained of ongoing sinus symptoms, she denied any musculoskeletal symptoms, and her upper and lower extremities were normal to inspection. (Tr. 537-38). Further, her mood and affect were normal, and her speech and thought processes were clear and appropriate. (Tr. 538).
Howard was seen by Dr. Mateer on September 4, 2020 for a follow up. (Tr. 595). On examination, she had normal musculoskeletal range of motion, no swelling or edema, but tenderness present. (Tr. 599). Her psychiatric examination revealed normal mood, behavior, thought content, and judgment. (Id.) Dr. Mateer continued Howard's medications. (Tr. 600). Later in September, Howard presented to Pinnacle Health Urgent Care in complaining of right knee pain and excessive fatigue. (Tr. 550). On examination, she had no swelling of the bilateral knees but had tenderness to palpation on her right knee. (Tr. 551). Howard was advised to follow up with her primary care physician. (Id.)
Thus, Howard was seen by Dr. Mateer in October of 2020 for her knee pain. (Tr. 619). She also reported that her fibromyalgia pain was increased but she was more worried about her increased depression at that time, which she described as mild but was concerned about the winter months ahead. (Id.) On examination, she exhibited decreased range of motion in both knees but no swelling, effusion, or deformity. (Tr. 623). Dr. Mateer ordered an X-ray of Howard's knees, which showed no acute abnormality of significant degenerative joint disease. (Tr. 632). At a follow up appointment in November, Howard reported that her depression was much better since switching medications, and her neuropathy was stable. (Tr. 655). On examination, she had normal range of motion, tenderness present but no swelling, and no edema in her lower extremities. (Tr. 659). Her psychiatric examination revealed a depressed mood but normal attention, speech, behavior, and thought content. (Id.)
Howard was seen by Dr. Mateer in December of 2020, where it was noted that her “depression seems resolved,” and she was “happier than [she] has been in [a] long time.” (Tr. 572). She reported sleeping better and having more energy, but that her pain continued to interfere with her activities of daily living. (Id.) A physical examination revealed normal musculoskeletal range of motion, no edema in the lower extremities, and diffuse tenderness in her upper and lower spine, as well as tender spots in her upper and lower extremities. (Tr. 576). At this time, Dr. Mateer filled out a physical residual functional capacity questionnaire. (Tr. 567-71). Dr. Mateer opined that Howard's impairments constantly interfered with her attention and concentration, and she was incapable of even low stress work; she could stand and walk less than 2 hours and sit for at least 6 hours in an 8-hour workday; she would need an unidentified amount of unscheduled breaks during the workday; she could occasionally lift and carry up to 10 pounds, could rarely twist and stoop and could never crouch, squat, or climb ladders or stairs; she had handling and fingering limitations, as well as reaching limitations; and she would be absent from work more than 4 days per month. (Id.)
Howard followed up with Dr. Mateer in January of 2021. (Tr. 699). She noted that her medication had improved her fibromyalgia pain, and she was sleeping 10 hours per day. (Id.) She further reported numbness and tingling in her neck radiating down into her left arm. (Id.) On physical examination, Dr. Mateer noted tenderness but no edema and normal range of motion. (Tr. 703). Her psychiatric evaluation was normal. (Id.)
It was against the backdrop of this medical opinion and clinical evidence that an ALJ conducted a hearing on Howard's disability application on January 27, 2021. (Tr. 35-54). Howard and a Vocational Expert both appeared and testified telephonically at this hearing. (Id.) Following this hearing, on March 19, 2021, the ALJ issued a decision denying Howard's application for disability benefits. (Tr. 11-25). In this decision, the ALJ first concluded that Howard met the insured stated requirements of the Act through December 31, 2021. (Tr. 13). The ALJ then found at Step 2 of the sequential analysis which governs disability claims that Howard suffered from the following severe impairments: degenerative disc disease, fibromyalgia, and mixed connective tissue disease. (Tr. 14). The ALJ found Howard's depression and anxiety to be nonsevere impairments. (Id.) At Step 3, the ALJ concluded that these severe impairments did not meet or equal the severity of any listed impairments under the Commissioner's regulations. (Tr. 15-16).
Between Steps 3 and 4, the ALJ then concluded that Howard:
[H]a[d] the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) except she can frequently stoop and kneel; she can occasionally climb ramps and stairs, balance, crouch, and crawl; she is precluded from climbing ladders, ropes, and scaffolds; she can frequently engage in handling and fingering with the bilateral upper extremities; and she must avoid even moderate exposure to extreme cold.(Tr. 16).
In reaching this result, the ALJ considered the medical record as detailed above, as well as medical opinion evidence and Howard's reported symptoms. With respect to the medical opinion evidence, the ALJ considered the opinions of the state agency consulting sources who examined the record during the alleged disability period. On this score, in February of 2020, a consulting source, Dr. Barry Kraynack, M.D., examined the record and opined that Howard could perform light work. (Tr. 62-65). Dr. Kraynack opined that Howard could occasionally climb ramps and stairs but never ladders, ropes, or scaffolds; could occasionally balance, crouch, and crawl and frequently stoop and kneel; and she should avoid even moderate exposure to extreme cold. (Tr. 62-63). Dr. Paul Taren, PhD., also examined the record at this time and found that Howard had only mild limitations in interacting with others; concentrating, persisting, and maintaining pace; and adapting or managing oneself; and had no limitations in understanding, remembering, or applying information. (Tr. 60).
At the reconsideration level in August of 2020, Dr. Richard Williams, Ph.D., examined the record and concluded that Howard had only mild limitations in interacting with others; concentrating, persisting, and maintaining pace; and adapting or managing oneself; and had no limitations in understanding, remembering, or applying information. (Tr. 76). In October of 2020, Dr. David Clark, M.D., opined that Howard was capable of light work, in that she could lift and carry up to 20 pounds occasionally and up to 10 pounds frequently; she could sit, stand, and walk for up to 6 hours in an 8-hour workday; she could frequently stoop and kneel and occasionally balance, crouch, and crawl; she could occasionally climb ramps and stairs but never ladders, ropes, or scaffolds; and she should avoid even moderate exposure to extreme cold. (Tr. 78-79). The ALJ also considered Dr. Kajic's January 2020 mental status evaluation.
The ALJ found these opinions persuasive. (Tr. 21-22). Regarding the mental status opinion evidence, the ALJ found that these opinions were consistent with the relatively benign clinical findings regarding Howard's mental status, as well as the conservative nature of her treatment. (Id.) The ALJ noted that her treatment consisted mainly of medication management by her primary care doctor, and her mental status findings consistently showed fluent speech, intact thought processes, appropriate affect, intact attention and concentration, and intact recent and remote memory. (Id.) Regarding Howard's physical limitations, the ALJ found these state agency opinions mostly persuasive, but accounted for further limitations in handling and fingering as supported by the record evidence. (Tr. 22).
The ALJ also considered the opinions of Dr. Kneifati from January of 2020 and Dr. Mateer's December 2020 residual functional capacity assessment. With respect to Dr. Kneifati's opinion, the ALJ found that this opinion was not supported by the doctor's own benign clinical findings or by X-rays taken at the time of his evaluation. (Id.) With respect to Dr. Mateer's December 2020 opinion, the ALJ found this restrictive opinion not persuasive, as it was inconsistent with Dr. Mateer's own treatment records at that time. (Tr. 23).
Further the ALJ considered Howard's testimony regarding the severity of her symptoms but ultimately determined that Howard's symptoms were not supported by the evidence of record. On this score, Howard testified that she could no longer work due to her pain and depression. (Tr. 40). She stated that she was in constant pain all day, and that her pain worsened if she was standing too long. (Tr. 40-41). She testified that she could only walk for a few minutes before needing to rest. (Tr. 42). She further stated that she could only lift up to 2 pounds, as her hands would give out. (Tr. 43). Howard reported that her mother helped her do things like laundry, cooking, and shopping, and that it was difficult for her to do things like dress, shower, and perform personal care. (Tr. 44). She further stated that she experienced anxiety attacks. (Tr. 45-46). She testified that she used to make jewelry, but she could no longer do that because she lacked concentration and because of her hand pain. (Tr. 47-48).
The ALJ ultimately found that Howard's testimony was inconsistent with the treatment records from the relevant time. On this score, the ALJ noted that the treatment records showed relatively benign clinical findings, such as normal range of motion, no sensory deficits, normal gait and reflexes, and normal psychiatric findings. (Tr. 18-19). The ALJ further noted Howard's conservative treatment, which largely consisted of medication management with her primary care physician. (Id.)
Having made these findings, the ALJ found that Howard could perform her past work as a waitress, and further concluded at Step 5 that there were a significant number of jobs in the national economy that Howard could perform, such as garment housekeeping cleaner, officer helper, and cashier II. (Tr. 23-24). Accordingly, the ALJ found that Howard had not met the stringent standard prescribed for disability insurance benefits and denied her claim. (Tr. 25).
This appeal followed. On appeal, Howard challenges the ALJ erred in his treatment of the opinion of Dr. Mateer, Howard's treating doctor. Further, she challenges the ALJ's assessment of her subjective symptoms This case is fully briefed and is therefore ripe for resolution. For the reasons set forth below, under the deferential standard of review that applies here, we recommend that the court affirm the decision of the Commissioner.
III. Discussion
A. Substantial Evidence Review - the Role of this Court
When reviewing the Commissioner's final decision denying a claimant's application for benefits, this Court's review is limited to the question of whether the findings of the final decision-maker 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 is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). But in an adequately developed factual record, substantial evidence may be “something less than the weight of the evidence, and the possibility of drawing two inconsistent conclusions from the evidence does not prevent [the ALJ's decision] from being supported by substantial evidence.” Consolo v. Fed. Maritime Comm'n, 383 U.S. 607, 620 (1966). “In determining if the Commissioner's decision is supported by substantial evidence the court must scrutinize the record as a whole.” Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D. Pa. 2003).
The Supreme Court has recently underscored for us the limited scope of our review in this field, noting that:
The phrase “substantial evidence” is a “term of art” used throughout administrative law to describe how courts are to review agency factfinding. T-Mobile South, LLC v. Roswell, 574 U.S.__, __, 135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-evidence standard, a court looks to an existing administrative record and asks whether it contains “sufficien[t] evidence” to support the agency's factual determinations. Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis deleted). And whatever the meaning of “substantial” in other contexts, the threshold for such evidentiary sufficiency is not high. Substantial evidence, this Court has said, is “more than a mere scintilla.” Ibid.; see, e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks omitted). It means-and means only-“such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v. Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999) (comparing the substantial-evidence standard to the deferential clearly-erroneous standard).Biestek, 139 S.Ct. at 1154.
The question before this Court, therefore, is not whether the claimant is disabled, but rather whether the Commissioner's finding that she is not disabled is supported by substantial evidence and was reached based upon a correct application of the relevant law. See Arnold v. Colvin, No. 3:12-CV-02417, 2014 WL 940205, at *1 (M.D. Pa. Mar. 11, 2014) (“[I]t has been held that an ALJ's errors of law denote a lack of substantial evidence”) (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 ....”).
Several fundamental legal propositions flow from this deferential standard of review. First, when conducting this review, “we are 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, 399 F.3d at 552). Thus, we are enjoined to refrain from trying to re-weigh the evidence. Rather, our task is to simply determine whether substantial evidence supported the ALJ's findings. However, we must also ascertain whether the ALJ's decision meets the burden of articulation demanded by the courts to enable informed judicial review. Simply put, “this Court requires the ALJ to set forth the reasons for his decision.” Burnett v. Comm'r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000). As the Court of Appeals has noted on this score:
In Burnett, we held that an ALJ must clearly set forth the reasons for his decision. 220 F.3d at 119. Conclusory statements ... are insufficient. The ALJ must provide a “discussion of the evidence” and an “explanation of reasoning” for his conclusion sufficient to enable
meaningful judicial review. Id. at 120; see Jones v. Barnhart, 364 F.3d 501, 505 & n. 3 (3d Cir. 2004). The ALJ, of course, need not employ particular “magic” words: “Burnett does not require the ALJ to use particular language or adhere to a particular format in conducting his analysis.” Jones, 364 F.3d at 505.Diaz v. Comm'r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009).
Thus, in practice, ours is a twofold task. We must evaluate the substance of the ALJ's decision under a deferential standard of review, but we must also give that decision careful scrutiny to ensure that the rationale for the ALJ's actions is sufficiently articulated to permit meaningful judicial review.
B. Initial Burdens of Proof, Persuasion, and Articulation for the ALJ
To receive benefits under the Social Security Act by reason of disability, a claimant must demonstrate an inability to “engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. §423(d)(1)(A); 42 U.S.C. §1382c(a)(3)(A); see also 20 C.F.R. §§404.1505(a), 416.905(a). To satisfy this requirement, a claimant must have a severe physical or mental impairment that makes it impossible to do his or her previous work or any other substantial gainful activity that 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). The definition of a disability for a child age 18 or older is the same definition used to determine a disability for purposes of SSI or disability insurance benefits. See 42 U.S.C. § 402(d)(1)(B); 42 U.S.C. § 423(d).
In making this determination at the administrative level, the ALJ follows a five-step sequential evaluation process. 20 C.F.R. §§404.1520(a), 416.920(a). Under this process, the ALJ must sequentially determine: (1) whether the claimant is engaged in substantial gainful activity; (2) whether the claimant has a severe impairment; (3) whether the claimant's impairment meets or equals a listed impairment; (4) whether the claimant is able to do his or her past relevant work; and (5) whether the claimant 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 assess a 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 v. Comm'r of Soc. Sec., 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted); see also 20 C.F.R. §§404.1520(e), 404.1545(a)(1), 416.920(e), 416.945(a)(1). In making this assessment, the ALJ considers all of 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).
There is an undeniable medical aspect to an RFC determination, since that determination entails an assessment of what work the claimant can do given the physical limitations that the claimant experiences. Yet, when considering the role and necessity of medical opinion evidence in making this determination, courts have followed several different paths. Some courts emphasize the importance of medical opinion support for an RFC determination and have suggested that “[r]arely can a decision be made regarding a claimant's residual functional capacity without an assessment from a physician regarding the functional abilities of the claimant.” Biller v. Acting Comm'r of Soc. Sec., 962 F.Supp.2d 761, 778-79 (W.D. Pa. 2013) (quoting Gormont v. Astrue, Civ. No. 11-2145, 2013 WL 791455 at *7 (M.D. Pa. Mar. 4, 2013)). In other instances, it has been held that: “There is no legal requirement that a physician have made the particular findings that an ALJ adopts in the course of determining an RFC.” Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006). Further, courts have held in cases where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability 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).
These seemingly discordant legal propositions can be reconciled by evaluation of the factual context of these decisions. Those cases which emphasize the importance of medical opinion support for an RFC assessment typically arise in the factual setting where a well-supported medical source has opined regarding limitations which would support a disability claim, but an ALJ has rejected the medical opinion which supported a disability determination based upon a lay assessment of other evidence. In this setting, these cases simply restate the commonplace idea that medical opinions are entitled to careful consideration when making a disability determination, particularly when those opinions support a finding of disability. In contrast, when an ALJ is relying upon other evidence, such as contrasting clinical or opinion evidence or testimony regarding the claimant's activities of daily living to fashion an RFC, courts have adopted a more pragmatic view and have sustained the ALJ's exercise of independent judgment based upon all of the facts and evidence. See Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006); Cummings, 129 F.Supp.3d at 214-15. In either event, once the ALJ has made this determination, our review of the ALJ's assessment of the plaintiff's RFC is deferential, and that RFC assessment will not be set aside if it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d Cir. 2002); see also Metzger v. Berryhill, No. 3:16-CV-1929, 2017 WL 1483328, at *5 (M.D. Pa. Mar. 29, 2017), report and recommendation adopted sub nom. Metzgar v. Colvin, No. 3:16-CV-1929, 2017 WL 1479426 (M.D. Pa. Apr. 21, 2017); Rathbun v. Berryhill, No. 3:17-CV-00301, 2018 WL 1514383, at *6 (M.D. Pa. Mar. 12, 2018), report and recommendation adopted, No. 3:17-CV-301, 2018 WL 1479366 (M.D. Pa. Mar. 27, 2018).
At Steps 1 through 4, the claimant bears the initial burden of demonstrating the existence of a medically determinable impairment that prevents him or her from engaging in any of his or her past relevant work. Mason, 994 F.2d at 1064. Once this burden has been met by the claimant, it shifts to the Commissioner at Step 5 to show that jobs exist in significant numbers in the national economy that the claimant could perform that are consistent with the claimant's age, education, work, experience, and RFC. 20 C.F.R. §§404.1512(f), 416.912(f); Mason, 994 F.2d at 1064.
The ALJ's disability determination must also meet certain basic substantive requisites. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, 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). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-707. In addition, “[t]he ALJ must indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding.” Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999).
C. Legal Benchmarks for the ALJ's Assessment of Medical Opinions
The plaintiff filed this disability application in September of 2019 after a paradigm shift in the manner in which medical opinions were evaluated when assessing Social Security claims. 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. However, in March of 2017, the Commissioner's regulations governing medical opinions changed in a number of fundamental ways. 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. As one court as aptly observed:
The regulations regarding the evaluation of medical evidence have been amended for claims filed after March 27, 2017, and several of the prior
Social Security Rulings, including SSR 96-2p, have been rescinded. According to the new regulations, the Commissioner “will no longer give any specific evidentiary weight to medical opinions; this includes giving controlling weight to any medical opinion.” Revisions to Rules Regarding the Evaluation of Medical Evidence (“Revisions to Rules”), 2017 WL 168819, 82 Fed.Reg. 5844, at 5867-68 (Jan. 18, 2017), see 20 C.F.R. §§ 404.1520c(a), 416.920c(a). Instead, the Commissioner must consider all medical opinions and “evaluate their persuasiveness” based on the following five factors: supportability; consistency; relationship with the claimant; specialization; and “other factors.” 20 C.F.R. §§ 404.1520c(a)-(c), 416.920c(a)-(c).
Although the new regulations eliminate the perceived hierarchy of medical sources, deference to specific medical opinions, and assigning “weight” to a medical opinion, the ALJ must still “articulate how [he or she] considered the medical opinions” and “how persuasive [he or she] find[s] all of the medical opinions.” Id. at §§ 404.1520c(a) and (b)(1), 416.920c(a) and (b)(1). The 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. Revisions to Rules, 82 Fed.Reg. 5844-01 at 5853.
An ALJ is specifically required to “explain how [he or she] considered the supportability and consistency factors” for a medical opinion. 20 C.F.R. §§ 404.1520c (b)(2), 416.920c(b)(2). 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.” Id. at §§ 404.1520c(c)(1), 416.920c(c)(1). The regulations provide that with respect to “consistency,” “[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. at §§ 404.1520c(c)(2), 416.920c(c)(2).
Under the new regulations an ALJ must consider, but need not explicitly discuss, the three remaining factors in determining the persuasiveness of a medical source's opinion. Id. at §§ 404.1520c(b)(2), 416.920c(b)(2). However, where 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 those factors contained in paragraphs (c)(3) through (c)(5). Id. at §§ 404.1520c(b)(3), 416.920c(b)(3).Andrew G. v. Comm'r of Soc. Sec., No. 3:19-CV-0942 (ML), 2020 WL 5848776, at *5 (N.D.N.Y. Oct. 1, 2020).
Oftentimes, as in this case, an ALJ must evaluate various medical opinions. Judicial review of this aspect of ALJ decision-making is still guided by several settled legal tenets. First, when presented with a disputed factual record, it is well-established 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). Thus, when evaluating medical opinions “the ALJ may choose whom to credit but ‘cannot reject evidence for no reason or for the wrong reason.'” Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (quoting Mason, 994 F.2d at 1066). Therefore, provided that the decision is accompanied by an adequate, articulated rationale, it is the province and the duty of the ALJ to choose which medical opinions and evidence deserve greater weight.
Further, in making this assessment of medical evidence:
An ALJ is [also] entitled generally to credit parts of an opinion without crediting the entire opinion. See Thackara v. Colvin, No. 1:14-CV-00158-GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015); Turner v. Colvin, 964 F.Supp.2d 21, 29 (D.D.C. 2013) (agreeing that “SSR 96-2p does not prohibit the ALJ from crediting some parts of a treating source's opinion and rejecting other portions”); Connors v. Astrue, No. 10-CV-197-PB, 2011 WL 2359055, at *9 (D.N.H. June 10, 2011). It follows that an ALJ can give partial credit to all medical opinions and can formulate an RFC based on different parts from the different medical opinions. See e.g., Thackara v. Colvin, No. 1:14-CV-00158-GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015).Durden v. Colvin, 191 F.Supp.3d 429, 455 (M.D. Pa. 2016). Finally, where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability “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
The interplay between the deferential substantive standard of review that governs Social Security appeals, and the requirement that courts carefully assess whether an ALJ has met the standards of articulation required by law, is also illustrated by those cases which consider analysis of a claimant's reported pain. When evaluating lay testimony regarding a claimant's reported degree of pain and disability, we are reminded that:
[T]he ALJ must necessarily make certain credibility determinations, and this Court defers to the ALJ's assessment of credibility. See Diaz v. Comm'r, 577 F.3d 500, 506 (3d Cir.2009) (“In determining whether
there is substantial evidence to support an administrative law judge's decision, we owe deference to his evaluation of the evidence [and] assessment of the credibility of witnesses....”). However, the ALJ must specifically identify and explain what evidence he found not credible and why he found it not credible. Adorno v. Shalala, 40 F.3d 43, 48 (3d Cir.1994) (citing Stewart v. Sec'y of Health, Education and Welfare, 714 F.2d 287, 290 (3d Cir.1983)); see also Stout v. Comm'r, 454 F.3d 1050, 1054 (9th Cir.2006) (stating that an ALJ is required to provide “specific reasons for rejecting lay testimony”). An ALJ cannot reject evidence for an incorrect or unsupported reason. Ray v. Astrue, 649 F.Supp.2d 391, 402 (E.D.Pa.2009) (quoting Mason v. Shalala, 994 F.2d 1058, 1066 (3d Cir.1993)).Zirnsak, 777 F.3d at 612-13.
Yet, it is also clear that:
Great weight is given to a claimant's subjective testimony only when it is supported by competent medical evidence. Dobrowolsky v. Califano, 606 F.2d 403, 409 (3d Cir. 1979); accord Snedeker v. Comm'r of Soc. Sec., 244 Fed.Appx. 470, 474 (3d Cir. 2007). An ALJ may reject a claimant's subjective testimony that is not found credible so long as there is an explanation for the rejection of the testimony. Social Security Ruling (“SSR”) 96-7p; Schaudeck v. Comm'r of Social Security, 181 F.3d 429, 433 (3d Cir. 1999). Where an ALJ finds that there is an underlying medically determinable physical or mental impairment that could reasonably be expected to produce the individual's pain or other symptoms, however, the severity of which is not substantiated by objective medical evidence, the ALJ must make a finding on the credibility of the individual's statements based on a consideration of the entire case record.McKean v. Colvin, 150 F.Supp.3d 406, 415-16 (M.D. Pa. 2015) (footnotes omitted). Thus, we are instructed to review an ALJ's evaluation of a claimant's subjective reports of pain under a standard of review which is deferential with respect to the ALJ's well-articulated findings but imposes a duty of clear articulation upon the ALJ so that we may conduct meaningful review of the ALJ's conclusions.
In the same fashion that medical opinion evidence is evaluated, the Social Security Rulings and Regulations provide a framework under which the severity of a claimant's reported symptoms are to be considered. 20 C.F.R. §§ 404.1529, 416.929; SSR 16-3p. It is important to note that though the “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”). It is well settled in the Third Circuit that “[a]llegations of pain and other subjective symptoms must be supported by objective medical evidence.” Hantraft v. Apfel, 181 F.3d 358, 362 (3d Cir. 1999) (referring to 20 C.F.R. § 404.1529). When evaluating a claimant's symptoms, the ALJ must follow a two-step process in which the ALJ resolves whether a medically determinable impairment could be the cause of the symptoms alleged by the claimant, and subsequently must evaluate the alleged symptoms in consideration of the record as a whole. SSR 16-3p.
First, symptoms, such as pain or fatigue, will only be considered to affect a claimant's ability to perform work activities if such symptoms result from an underlying physical or mental impairment that has been demonstrated to exist by medical signs or laboratory findings. 20 C.F.R. §§ 404.1529(b), 416.929(b); SSR 16-3p. During the second step of this credibility assessment, the ALJ must determine whether the claimant's statements about the intensity, persistence, or functionally limiting effects of his or her symptoms are substantiated based on the ALJ's evaluation of the entire case record. 20 C.F.R. § 404.1529(c), 416.929(c); SSR 163p. This includes but is not limited to medical signs and laboratory findings, diagnoses, and other medical opinions provided by treating or examining sources, and other medical sources, as well as information concerning the claimant's symptoms and how they affect his or her ability to work. Id. The Social Security Administration has recognized that individuals may experience their symptoms differently and 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 identify seven factors which may be relevant to the assessment of the severity or limiting effects of a claimant's impairment based on a claimant's symptoms. 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3). These factors include: activities of daily living; the location, duration, frequency, and intensity of the claimant's symptoms; precipitating and aggravating factors; the type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate his or her symptoms; treatment, other than medication that a claimant has received for relief; any measures the claimant has used to relieve his or her symptoms; and, any other factors concerning the claimant's functional limitations and restrictions. Id.; see Koppenaver v. Berryhill, No. 3:18-CV-1525, 2019 WL 1995999, at *9 (M.D. Pa. Apr. 8, 2019), report and recommendation adopted sub nom. Koppenhaver v. Berryhill, No. 3:18-CV-1525, 2019 WL 1992130 (M.D. Pa. May 6, 2019); Martinez v. Colvin, No. 3:14-CV-1090, 2015 WL 5781202, at *8-9 (M.D. Pa. Sept. 30, 2015); George v. Colvin, No. 4:13-CV-2803, 2014 WL 5449706, at *4 (M.D. Pa. Oct. 24, 2014).
E. The ALJ's Decision in this Case is Supported by Substantial Evidence.
In this setting, we are mindful that we are not free to substitute our independent assessment of the evidence for the ALJ's determinations. Rather, we must simply ascertain whether the ALJ's decision is supported by substantial evidence, a quantum of proof which is less than a preponderance of the evidence but more than a mere scintilla, Richardson v. Perales, 402 U.S. 389, 401 (1971), and “does not mean a large or considerable amount of evidence,” Pierce v. Underwood, 487 U.S. 552, 565 (1988), but rather “means-and means only-‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.' ” Biestek, 139 S.Ct. at 1154. Judged against these deferential standards of review, we conclude that substantial evidence supported the ALJ's decision that Howard was not entirely disabled.
First, Howard contends that the ALJ erred when he did not find Dr. Mateer's opinion persuasive. At the outset, we note that “[t]he ALJ-not treating or examining physicians or State agency consultants-must make the ultimate disability and RFC determinations.” Chandler, 667 F.3d at 361. Further, in making this assessment of medical opinion evidence, “[a]n ALJ is [also] entitled generally to credit parts of an opinion without crediting the entire opinion.” Durden, 191 F.Supp.3d at 455. Finally, when there is no evidence of any credible medical opinion supporting a claimant's allegations of disability it is also well settled that “the proposition that an ALJ must always base his RFCona medical opinion from a physician is misguided.” Cummings, 129 F.Supp.3d at 214-15.
Here, the ALJ considered the opinion of Dr. Mateer and found this opinion unpersuasive. The ALJ reasoned that this opinion, which found extreme and work-preclusive limitations, was not supported by or consistent with the claimant's medical records, including Dr. Mateer's own treatment notes from the relevant time. The ALJ noted that the medical records contained relatively benign findings with respect to her pain and depression, and that Howard's treatment consisted mostly of medication management. The ALJ pointed to consistent findings of no focal neurological deficits, normal psychiatric evaluations, normal range of motion, and indications that Howard's medications were helping her manage her symptoms. The ALJ further noted that no alternative treatment was recommended during the relevant period.
In this case, the ALJ was presented with a host of medical opinions, including consulting sources, during the relevant time period. The consensus of these consulting sources was that Howard was limited to light work with some additional limitations, and that she only experienced, at most, mild impairments in areas of social functioning. The ALJ found these opinions persuasive, as they were consistent with the medical evidence from the relevant period which showed relatively benign findings as to Howard's physical and mental limitations. Thus, we conclude that the ALJ did not err in finding these opinions more persuasive than Dr. Mateer's opinion, which the ALJ found was inconsistent with the overall record, including the doctor's own treatment notes.
We further conclude that the ALJ did not err in his assessment of Howard's subjective symptoms. On this score, the ALJ found that Howard's reported symptoms were not consistent with the overall medical evidence of record. While Howard testified that she was unable to work due to her pain and depression, the ALJ noted that treatment notes indicated her pain was managed with medication, and that by December of 2020, she reported that her depression seemed to have resolved. Indeed, the medical records consistently reported normal psychiatric findings on examination, as well as findings of normal range of motion, no edema, and no deformity in her extremities, despite findings of tenderness. The ALJ further noted that Howard reported that she was able to perform activities of daily living, such as personal care several times per week, shopping, driving, and preparing meals. While the plaintiff contends that the ALJ erred when he relied on her reported activities of daily living, it is well settled that an ALJ can, and often must, rely upon such factors when conducting a symptom evaluation analysis. See e.g., Zirnsak, 777 F.3d at 615; Durden, 191 F.Supp.3d at 442. Accordingly, we conclude that the ALJ's assessment of Howard's subjective symptoms is supported by substantial evidence.
At bottom, it appears that the plaintiff is requesting that this court re-weigh the medical and opinion evidence. This we may not do. See Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 359 (3d Cir. 2011) (citing Richardson v. Perales, 402 U.S. 389, 401 (1971) (“Courts are not permitted to re-weigh the evidence or impose their own factual determinations.”); see also Gonzalez v. Astrue, 537 F.Supp.2d 644, 657 (D. Del. 2008) (“In determining whether substantial evidence supports the Commissioner's findings, the Court may not undertake a de novo review of the Commissioner's decision and may not re-weigh the evidence of the record.”) (internal citations omitted)). Rather, our task is simply to determine whether the ALJ's decision is supported by substantial evidence, a quantum of proof which is less than a preponderance of the evidence but more than a mere scintilla, Richardson, 402 U.S. at 401, and “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, 487 U.S. at 565. Finding that this deferential standard of review is met here, we conclude that a remand is not appropriate for the purpose of further assessing this opinion evidence.
In sum, on its merits the ALJ's assessment of the evidence in this case complied with the dictates of the law and was supported by substantial evidence. This is all that the law requires, and all that a claimant can demand in a disability proceeding. Thus, notwithstanding the argument that this evidence might have been viewed in a way which would have also supported a different finding, we are obliged to affirm this ruling once we find that it is “supported by substantial evidence, ‘even [where] this court acting de novo might have reached a different conclusion.' ” Monsour Med. Ctr. v. Heckler, 806 F.2d 1185, 1190-91 (3d Cir. 1986) (quoting Hunter Douglas, Inc. v. NLRB, 804 F.2d 808, 812 (3d Cir. 1986)). Accordingly, under the deferential standard of review that applies to appeals of Social Security disability determinations, we find 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.