Opinion
CIVIL 3:21-CV-100
02-11-2022
JEROMY SAGER, Plaintiff v. KILOLO KIJAKAZI, Acting Commissioner of Social Security [1], Defendant
Brann, Chief Judge
REPORT AND RECOMMENDATION
Martin C. Carlson, United States Magistrate Judge
I. Introduction
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).
On April 24, 2019, Jeromy Sager applied for supplemental security benefits initially alleging an onset of disability on March 16, 2018, the day after a prior disability application was denied by an Administrative Law Judge. According to Sager's April 2019 application, he had become disabled due to the combined effects of depression, anxiety, and panic disorders, along with heart disease, hypertension, obesity, degenerative disc disease, and left shoulder adhesions. (Tr. 14). Notwithstanding these medical conditions, the ALJ denied this claim on June 29, 2020, finding that Sager could perform a limited range of light work, provided that his work was confined to simple, repetitive tasks, with limited contact with co-workers and no public interaction. (Tr. 18).
Sager has appealed this determination. On appeal, Sager advances three principal claims, arguing (1) that the emotional limitations incorporated into this residual functional capacity analysis were inadequate to address his emotional impairments; (2) that the ALJ erred in finding the opinion of a treating source, CRNP Gordon, unpersuasive; and (3) that the ALJ's analysis of the severity of Sager's symptoms was flawed.
As to these issues, the administrative record contains multiple medical opinions which suggest that Sager retained some capacity to work. Moreover, with respect to his emotional and physical impairments, Sager's pertinent treatment records are mixed and equivocal but contain numerous entries documenting normal and unremarkable findings. On this record, 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 the ALJ adequately addressed the evidence in this case when concluding that Sager had not met the exacting standard for demonstrating an entitlement to supplemental security income benefits. Therefore, for the reasons set forth below, we recommend that the court affirm the decision of the Commissioner denying this claim.
II. Statement of Facts and of the Case
On April 24, 2019, Jeromy Sager applied for supplemental security benefits, initially alleging an onset of disability on March 16, 2018. (Tr. 12). This was not Sager's first disability application. Rather, the record revealed that this was the third time that Sager sought Social Security benefits. (Tr. 86). Sager's initial alleged date of onset of disability in this application-March 16, 2018-fell one day after an ALJ entered an adverse decision denying one of Sager's prior disability applications. (Tr. 59-74). Acting on the advice of counsel, Sager later amended the claimed date of onset of disability to the date of his application, April 24, 2019. (Tr. 12).
Sager was born in 1974 and was a younger worker in his mid-40's at the time of this disability application. (Tr. 23). He had a high school education (Tr. 39), and prior employment in farming, as a hand packager, and as a tube bender. (Tr. 51-53, 225). According to Sager, he was now unable to work due to the combined effects of major depressive disorder, generalized anxiety disorder, panic disorder, cardiomyopathy, hypertension, obesity, ischemic heart disease, degenerative disc disease, and adhesive capsulitis of the left shoulder. (Tr. 14).
A. Sager's Medical History
With respect to Sager's physical impairments, the ALJ aptly described his medical treatment history in the following terms:
The claimant's medical records reveal that the claimant has a history of degenerative disc disease of the cervical spine and adhesive capsulitis of the left shoulder; however, the longitudinal evidence suggests that the claimant can perform light work, as the diagnostic studies do not reveal disabling pathology, there are infrequent reports of pain documented, and he shows largely intact physical examination, as will be discussed below (Exhibits C1F, C10F, C12F/15). An x-ray of the cervical spine dated December 20, 2017 was consistent with only minimal narrowing of disc space at ¶ 4-5 with tiny marginal osteophytes at ¶ 5-6 (Exhibit C1F/110). There is no evidence of nerve root compression, bladder or bowel involvement, intractable pain, or significant instability or weakness related to the claimant's pain. While
the claimant reports significant pain and orthopedic problems, his care has been conservative in nature after the amended onset date, consisting of medication prescribed by his primary care physician and home exercises, and he reported to his family practitioner that his shoulder pain does not last long (Exhibits C10F/1, C12F). The evidence also documents a history of coronary artery disease, hypertension, and ischemic heart disease, with reports of chronic angina, episodes of chest pain, and shortness of breath (Exhibit C13F/2). Notably, however, the claimant's family doctor records do not document reports of chest pain or shortness of breath (Exhibit C12F). Likewise, pulmonary function testing was unremarkable, and he reported to his cardiologist that he is able to walk half a mile 2-3 times per week without chest discomfort (Exhibit C13F/2). This evidence is inconsistent with the claimant's testimony that he has significantly decreased capacity for walking.
The claimant is status post angioplasty with stent but has not required cardiac surgery during the period at issue (Exhibit C13F). There is no evidence of myocardial infarction (Exhibit C2F/49). A cardiac catheterization in January 2018 showed 50-60% disease and EKGs remain negative (Exhibit C13F/2). The claimant manages his cardiomyopathy with a beta-blocker, and his blood pressure was noted to be well controlled during the relevant time (Exhibit C13F/11, 22). On physical examination, the claimant has presented with a BMI of over 30 (consistent with obesity) and decreased range of motion with tenderness of the left shoulder, but he typically shows normal range of motion of the other joints, normal gait with no use of assistive devices, no edema, no joint instability, normal breath sounds, no respiratory distress, intact neurologic examination, normal sensation, intact reflexes, and good strength (Exhibits C3F/8, 23, C4F/9, C5F/3, C10F/1, 8, C12F/4, 14, 24, 39, C13F/10, 33). The record reveals that the claimant only used a cane for ambulation after an acute exacerbation of knee pain in February 2020 (Exhibit C12F/27). There is no longitudinal evidence of gross instability, markedly diminished range of motion, absent reflexes, loss of sensation, muscle atrophy or motor deficits. Nonetheless, the record shows some complaints of shortness of breath with exertion, aggravated by changes in temperature.(Tr. 19-20).
Sager's mental health treatment records for the pertinent time frame likewise presented a mixed picture regarding the nature and severity of his emotional impairments. These treatment notes spanning from late 2017 through May 2020 consistently noted diagnoses of anxiety and depression for Sager. (Tr. 312-705). However, reports regarding the severity of these conditions differed and varied over time. In some instances, Sager was described as depressed, anxious and crying (Tr. 329), or displaying a flat affect secondary to chronic illness. (Tr. 447). Yet on numerous other occasions treatment notes documented normal mood, affect, speech, judgment, and cognition on his part. (Tr. 371, 372, 378, 379, 406, 407, 422-23, 443, 538, 558, 562, 594). Further, in some instances clinical records indicated that Sager was both depressed and anxious but still exhibited normal behavior, thoughts, and cognition. (Tr. 548, 705).
Given this clinical picture that emerged from Sager's treatment history, there were an array of medical opinions regarding the severity of his impairments, although the greater weight of medical authority supported the proposition that Sager could perform some work. No. less than four non-examining state agency experts reviewed Sager's medical records and opined on his ability to work. For example, in July of 2019, Dr. Glenda Cardillo found that notwithstanding his physical impairments Sager could lift twenty pounds occasionally, ten pounds frequently, and could stand or sit for up to six hours during the work day. (Tr. 93). Dr. Cardillo also concluded that Sager faced no manipulative, visual, and communicative limitations, and experienced only modest environmental restrictions at work. (Tr. 94). At the same time, Dr. Emmanuel Schnepp determined that Sager's emotional impairments presented only mild limitations on his ability to understand, remember, manage, adapt, and interact in the workplace. (Tr. 91). As to Sager's ability to concentrate at work, according to Dr. Schnepp the plaintiff would only experience a moderate degree of impairment. (Id.)
In October of 2019, two other state agency experts, Dr. Michael Brown and Dr. John Gavazzi, conducted a second assessment of Sager's physical and psychological impairments. (Tr. 103-19). In this second evaluation, Dr. Brown and Dr. Gavazzi reached conclusions regarding the severity of Sager's impairments which were similar to those previously found by state agency experts. Thus, Dr. Brown found that Sager could lift twenty pounds occasionally, ten pounds frequently, could stand or sit for up to six hours during the work day, faced no manipulative, visual, and communicative limitations in the workplace, and experienced only modest environmental restrictions at work. (Tr. 112). Likewise, Dr. Gavazzi found that Sager's emotional impairments imposed no more than moderate limitations upon him in the workplace. (Tr. 114-16).
Sager also underwent a mental status examination with Dr. Stacy Trogner in July of 2019. (Tr. 616-24). This examination confirmed that Sager was mildly anxious and depressed, and found that his emotional conditions mildly impaired his memory, attention, and concentration. (Tr. 619). However, Dr. Trogner also concluded that Sager's thought processes were coherent and goal oriented, his insight and judgment were fair, he displayed average cognitive functioning, and he was fully oriented. (Id.) When assessing his workplace functioning, Dr. Trogner determined that Sager would be mildly impaired in understanding and carrying out simple instructions but would face a moderate degree of impairment when undertaking complex tasks. (Tr. 622). Dr. Trogner also believed that Sager was moderately impaired when it came to interacting with co-workers, supervisors, and the public. (Tr. 624).
In stark contrast to these medical opinions was the report of Sager's treating source, CRNP Pamela Gordon, who submitted a report in August of 2019 assessing the plaintiff's physical and psychological limitations and impairments. (Tr. 625-636). This report opined that Sager faced multiple severe limitations on his ability to life, carry, sit, and stand at work. (Id.) CNRP Gordon also opined that Sager would be subject to numerous postural restrictions, would experience frequent absenteeism, and would be highly restricted in undertaking any of the mental demands of even simple tasks. (Id.)
B. Administrative Proceedings and the ALJ Decision
It is against this factual backdrop that the ALJ conducted a hearing in this case on May 1, 2020. (Tr. 31-57). Sager and a Vocational Expert both testified at this hearing. Following this hearing on June 29, 2020, the ALJ issued a decision denying Sager's application for benefits. (Tr. 9-25). In that decision, the ALJ first concluded that the plaintiff had not engaged in substantial gainful activity prior to his alleged amended date of onset of disability, April 24, 2019. (Tr. 14). At Step 2 of the sequential analysis that governs Social Security cases, the ALJ found that Sager suffered from the following severe impairments: major depressive disorder, generalized anxiety disorder, panic disorder, cardiomyopathy, hypertension, obesity, ischemic heart disease, degenerative disc disease, and adhesive capsulitis of the left shoulder. (Tr. 14). At Step 3, the ALJ determined that the plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments. (Tr. 15-18).
The ALJ then concluded that Sager:
[H]as the residual functional capacity to perform light work as defined in 20 CFR 416.967(b) except can occasionally climb ramps/stairs, balance, stoop, kneel, crouch, and crawl and cannot climb any ladders, ropes or scaffolds or tolerate concentrated exposure to fumes, odors,
dust, gases, poor ventilation or temperature extremes. The claimant is further limited to routine, repetitive tasks involving 1 and 2 step tasks, occasional change in the work setting, no public interaction, and occasional interaction with coworkers and supervisors. The work can involve no reaching above shoulder level with non-dominant left upper extremity and no exposure to hazards, such as heights or hazardous machinery.(Tr. 18).
In reaching this conclusion, the ALJ thoroughly addressed Sager's medical history in terms of his physical limitations (Tr. 19-20), and noted that with respect to his mental health treatment records,
[T]he medical evidence demonstrates a history of major depressive disorder, generalized anxiety disorder and panic disorder, characterized by depressed mood, anxiousness, low motivation, tiredness, sleep disturbance, crying spells, and feelings of guilt (Exhibits C8F, C12F). Nonetheless, the claimant's symptoms are managed with conservative treatment, including use of medication through his primary care physician (Exhibits C12F/40). The claimant does not require inpatient psychiatric hospitalization, a highly supportive living arrangement, intensive medical care, frequent visits to the ER or other significant mental health treatment. The claimant reports appetite disturbance, but there is no evidence of weight loss (Exhibits C8F, C12F). On mental status examination, the claimant has shown mild impairment in attention/concentration and memory (at the consultative examination only), poor to limited eye contact, and abnormal mood and affect, but he generally shows intact attention/concentration, fair insight and judgment, intact memory, average cognitive functioning, normal motor behavior, cooperative behavior, normal speech, and coherent and goal directed thought processes with no evidence of delusions, hallucinations or paranoia in the clinical setting (Exhibits C3F/8, 23, C4F/9, C5F/4, C8F/3-4, C10F/8, C12F/4, 9, 15, 24, 39, C13F/10, 33). The record corroborates his statements of adverse medication side effects such that he does not drive a vehicle and that he reports low
motivation to perform activities of daily living and engage in hobbies previously enjoyed (Exhibits C8F/5, C10F/1). The record also reveals difficulty managing stressors, such as financial constraints and transportation issues, but no need for a higher level of care or psychiatric admission (Exhibit C10F/13). This evidence suggests he would be able to perform routine, repetitive tasks with occasional work changes. Given the records showing some social withdrawal, depressed mood, anxiety and limited eye contact, he would also have limited ability to interact with others in the workplace.(Tr. 20).
The ALJ then went on to address and evaluate the medical opinions in this case. (Tr. 20-23). On this score, the ALJ found that the medical consensus expressed by Drs. Schnepp, Brown, Gavazzi, Cardillo, and Trogner, all of whom found that Sager retained the capacity to perform some work, were generally persuasive in that they were consistent with one another and congruent with Sager's treatment notes and records. (Id.)
The ALJ found CRNP Gordon's highly restrictive opinions less persuasive. As to the physical limitations found by CRNP Gordon, the ALJ explained that:
This opinion is not persuasive, as the suggestion that [Sager] can only stand for 1 hour and walk for 1 hour in an 8-hour day is not supported by the unremarkable findings via pulmonary function testing (Exhibits C10F/1, C12F, C13F/2) and is inconsistent with his reports to his cardiologist that he is able to walk half a mile 2-3 times per week without chest discomfort (Exhibit C13F/2). This finding is not supported by the largely intact physical examination findings related to gait, neurologic examination, respiratory/cardiac examination and motor strength (Exhibits C3F/8, 23, C4F/9, C5F/3, C10F/1, 8, C12F/4, 14, 24, 39, C13F/2, 10, 33).(Tr. 21).
The ALJ also concluded that CRNP Gordon's opinion concerning the disabling impact of Sager's emotional impairments was unpersuasive, noting that:
This opinion is not persuasive, as this level of limitation is not supported by her own records, which reveal few reports of suicidal ideation with no plan and largely intact mental status examinations, including attention, concentration, insight, and cognition (See, e.g., Exhibits C10F/1, C12F/9, 12, 20, 24, 29). In addition, the finding that the claimant has extreme limitation from a mental standpoint is inconsistent with the claimant's ability to manage his symptoms with conservative care.(Tr. 23). The ALJ also considered an statement provided by Sager's spouse, noting that:
The undersigned has considered the statements provided by the claimant's spouse, Candace Sager, dated June 1, 2019 (Exhibit C3E). She reported that the claimant is limited in his ability to work because his medications make him sleepy and he becomes winded easily. She reported that the claimant's conditions affect the claimant's ability to lift, squat, bend, stand, reach, walk, kneel, climb stairs, remember, complete tasks, concentrate, understand, follow instructions and use his hands. She further reported that he walks with a cane and is unable to reach overhead. The undersigned finds that this report is not entirely consistent with the longitudinal treatment records showing no use of an assistive device (other than during an acute episodes of knee pain). However, the allegation that he has difficulty lifting and reaching overhead with the left upper extremity is supported by the records showing a history of adhesive capsulitis and degenerative disc disease of the cervical spine. As such, it appears to be an overestimate of the claimant's limitations.(Id.)
Having canvassed the clinical and opinion evidence in this manner, The ALJ:
[Found] the claimant has the above residual functional capacity assessment, which is supported by mild findings via cervical x-ray, the unremarkable pulmonary function studies and EKGs, the conservative management of his symptoms, the frequency of pain and other symptoms reported to his medical providers, and the claimant's clinical presentation.(Id.)
Given this RFC determination, the ALJ ascertained that Sager could not perform his past work but retained the capacity to perform other jobs that existed in significant numbers in the national economy. (Tr. 24-25). Having reached these conclusions, the ALJ determined that the plaintiff had not met the demanding showing necessary to sustain his claim for benefits and denied this claim.
This appeal followed. (Doc. 1). On appeal, Sager advances three claims, arguing (1) that the emotional limitations incorporated into this residual functional capacity analysis were inadequate to address his emotional impairments; (2) that the ALJ erred in finding the opinion of a treating source CRNP Gordon, unpersuasive; and (3) that the ALJ's analysis of the severity of Sager's symptoms was flawed. However, given the highly deferential standard of review which applies here, we are constrained to conclude that substantial evidence supported the ALJ's findings in this case. Therefore, for the reasons set forth below, we recommend that the Commissioner's decision be affirmed.
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 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 he 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 v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005)). 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.
This principle applies with particular force to legal challenges, like the claim made here, based upon alleged inadequacies in the articulation of a claimant's mental RFC. In Hess v. Comm'r Soc. Sec., 931 F.3d 198, 212 (3d Cir. 2019), the United States Court of Appeals recently addressed the standards of articulation that apply in this setting. In Hess, the court of appeals considered the question of whether an RFC, which limited a claimant to simple tasks, adequately addressed moderate limitations on concentration, persistence, and pace. In addressing the plaintiff's argument that the language used by the ALJ to describe the claimant's mental limitations was legally insufficient, the court of appeals rejected a per se rule which would require the ALJ to adhere to a particular format in conducting this analysis. Instead, framing this issue as a question of adequate articulation of the ALJ's rationale, the court held that, “as long as the ALJ offers a ‘valid explanation,' a ‘simple tasks' limitation is permitted after a finding that a claimant has ‘moderate' difficulties in ‘concentration, persistence, or pace.'” Hess v. Comm'r Soc. Sec., 931 F.3d 198, 211 (3d Cir. 2019). On this score, the appellate court indicated that an ALJ offers a valid explanation a mental RFC when the ALJ highlights factors such as “mental status examinations and reports that revealed that [the claimant] could function effectively; opinion evidence showing that [the claimant] could do simple work; and [the claimant]'s activities of daily living, . . . . ” Hess v. Comm'r Soc. Sec., 931 F.3d 198, 214 (3d Cir. 2019).
In our view, the teachings of the Hess decision are straightforward. In formulating a mental RFC, the ALJ does not need to rely upon any particular form of words. Further, the adequacy of the mental RFC is not gauged in the abstract. Instead, the evaluation of a claimant's ability to undertake the mental demands of the workplace will be viewed in the factual context of the case, and a mental RFC is sufficient if it is supported by a valid explanation grounded in the evidence.
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). To receive benefits under Title II of the Social Security Act, a claimant must show that he or she contributed to the insurance program, is under retirement age, and became disabled prior to the date on which he or she was last insured. 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
In making this determination 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 2 of his or her analysis. 20 C.F.R. §§404.1545(a)(2), 416.945(a)(2).
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 number 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.
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 state 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. Colvin, 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 “[t]here is no legal requirement that a physician have made the particular findings that an ALJ adopts in the course of determining an RFC.” Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006). 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 where well-supported medical sources have identified limitations supporting a disability claim, but an ALJ has rejected such a determination based upon a lay assessment of other evidence. Biller, 962 F.Supp.2d at 778-79. 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 no medical opinion supports a disability finding or 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 the facts and evidence. See Titterington, 174 Fed.Appx. 6; 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; see also Metzger v. Berryhill, 2017 WL 1483328, at *5; Rathbun v. Berryhill, 2018 WL 1514383, at *6.
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 706-07. 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 April of 2019, following 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 v. Colvin, 777 F.3d 607, 612-13 (3d Cir. 2014).
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 16- 3p. This includes, but is not limited to: medical signs and laboratory findings, diagnosis 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 George v. Colvin, No. 4:13-CV-2803, 2014 WL 5449706, at *4 (M.D.Pa. Oct. 24, 2014); 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).
It is against these benchmarks that we assess this appeal.
E. The Commissioner's Decision Should Be Affirmed.
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, 402 U.S. at 401, and “does not mean a large or considerable amount of evidence, ” Pierce, 487 U.S. at 565, 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 find that the evidence supported the ALJ's decision that Sager was not entirely disabled, but rather could perform light work limited to simple, routine, and repetitive tasks. On appeal, Sager challenges the sufficiency of the ALJ's analysis on three scores, contending that the ALJ erred in his symptom evaluation, in the assessment of CRNP Gordon's medical opinion, and when crafting the mental RFC formulated here. However, we find that substantial evidence supported the ALJ's denial of this claim since the evidence was sufficient that “a reasonable mind might accept [it] as adequate to support a conclusion” that Sager could perform light work confined to simple, routine and repetitive tasks. Biestek, 139 S.Ct. at 1154.
1. Substantial Evidence Supported the Mental RFC Fashioned by the ALJ in This Case.
Turning first to Sager's challenges to the mental RFC fashioned in this case, that RFC confined Sager to “routine, repetitive tasks involving 1 and 2 step tasks, occasional change in the work setting, no public interaction, and occasional interaction with coworkers and supervisors.” (Tr. 18). In crafting this mental RFC, the ALJ was required to evaluate conflicting clinical and medical opinion evidence. As for Sager's emotional impairments, that clinical evidence differed and varied over time. Thus, while in some instances Sager was described as depressed, anxious and crying (Tr. 329), or displaying a flat affect secondary to chronic illness (Tr. 447), on other occasions treatment notes frequently documented normal mood, affect, speech, judgment, and cognition on his part. (Tr. 371, 372, 378, 379, 406, 407, 422-23, 443, 538, 558, 562, 594). Further clouding this clinical picture was the fact that on occasion, treatment records indicated that Sager was both depressed and anxious but still exhibited normal behavior, thoughts, and cognition. (Tr. 548, 705).
The cross currents in these treatment records, in turn, led to contrasting medical opinions regarding Sager's ability to meet the mental and emotional requirements of the workplace. Three medical sources, Dr. Gavazzi, Dr. Schnepp, and Dr. Trogner, concluded that Sager faced only mild to moderate emotional impairments at work, impairments which were more pronounced if Sager was required to undertake complex tasks. These opinions were consistent with the RFC fashioned here by the ALJ. In contrast, one source, CRNP Gordon, held a contrary view, asserting that Sager's emotional impairments prevented him from working.
In resolving this evidentiary conflict, the ALJ found that Sager could perform simple repetitive and routine tasks which entailed limited contacts with others. This conclusion was supported by significant clinical evidence and was consistent with the greater number of medical expert opinions in this case. Given the mixed and equivocal medical and opinion evidence relating to Sager's emotional impairments, under the deferential standard of review that controls here, we find that the ALJ's mental RFC determination sufficiently addressed the plaintiff's psychological impairments when it restricted him to simple routine and repetitive work.
On this score, we remain mindful that:
[C]onsistent with this deferential standard of review, when we are called upon to assess whether an ALJ has sufficiently articulated a rationale for the mental and emotional components of an RFC, we have recently been instructed that this aspect of an RFC is sufficient “as long as the ALJ offers a ‘valid explanation' ” for the mental and emotional limitations imposed upon a worker. Hess v. Comm'r Soc. Sec., 931 F.3d 198, 211 (3d Cir. 2019). On this score, it has been held that an ALJ offers a valid explanation for a mental RFC when the ALJ highlights
factors such as “mental status examinations and reports that revealed that [the claimant] could function effectively; opinion evidence showing that [the claimant] could do simple work; and [the claimant]'s activities of daily living, . . . .” Hess v. Comm'r Soc. Sec., 931 F.3d 198, 214 (3d Cir. 2019).Vargas v. Saul, No. 1:19-CV-1858, 2020 WL 2468401, at *1-2 (M.D. Pa. May 13, 2020). Adopting this pragmatic approach and mindful of the substantial clinical and opinion support for the ALJ's simple tasks RFC, we find that the ALJ has provided a valid explanation for this decision to restrict Sager to simple routine tasks, which is all that is required under the law. Therefore, there are no grounds to set aside this decision based upon the ALJ's evaluation of the plaintiff's emotional impairments.
2. Substantial Evidence Supported the Evaluation of CRNP Gordon's Medical Opinion.
We also conclude that 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, supported the ALJ's assessment of the medical opinion provided by Sager's treating source, CRNP Gordon. This opinion was an outlier among the six medical opinions contained within the administrative record in that CRNP Gordon was alone among the medical experts in opining that Sager suffered from multiple, completely disabling physical and emotional impairments.
In discounting this medical opinion, the ALJ found that with respect to Sager's physical impairments:
This opinion is not persuasive, as the suggestion that [Sager] can only stand for 1 hour and walk for 1 hour in an 8-hour day is not supported by the unremarkable findings via pulmonary function testing (Exhibits C10F/1, C12F, C13F/2) and is inconsistent with his reports to his cardiologist that he is able to walk half a mile 2-3 times per week without chest discomfort (Exhibit C13F/2). This finding is not supported by the largely intact physical examination findings related to gait, neurologic examination, respiratory/cardiac examination and motor strength (Exhibits C3F/8, 23, C4F/9, C5F/3, C10F/1, 8, C12F/4, 14, 24, 39, C13F/2, 10, 33).(Tr. 21).
The ALJ also concluded that CRNP Gordon's opinion concerning the disabling impact of Sager's emotional impairments was unpersuasive, noting that:
This opinion is not persuasive, as this level of limitation is not supported by her own records, which reveal few reports of suicidal ideation with no plan and largely intact mental status examinations, including attention, concentration, insight, and cognition (See, e.g., Exhibits C10F/1, C12F/9, 12, 20, 24, 29). In addition, the finding that the claimant has extreme limitation from a mental standpoint is inconsistent with the claimant's ability to manage his symptoms with conservative care.(Tr. 23). Moreover, it is clear from the ALJ's decision that the broader medical consensus reflected in the findings of the five other health care professionals who opined regarding Sager's limitations was found to be more consistent, supported by the clinical record, and persuasive.
Under the analytical paradigm now prescribed by Social Security regulations for evaluation of medical opinion evidence, we are no longer bound by a treating source rule. Instead, it is now clear that persuasiveness is the touchstone for any medical opinion evaluation. Further, it is well settled that “supportability ... and consistency ... are the most important factors [to] consider when [ ] determine[ing] how persuasive [to] find a medical source's medical opinions . . . to be.” 20 C.F.R. § 404.1520c(b)(2). In this context, supportability means 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.” Consistency, in turn, is defined to mean 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.” 20 C.F.R. § 404.1520c(c)(1)-(2).
In this case, the ALJ aptly concluded that CRNP Gordon's highly restrictive medical opinion was not entirely congruent with her own treatment notes. Nor was that opinion consistent with other treatment records and the medical opinions of five other health care providers. Thus, with respect to this medical opinion, the ALJ properly found that the elements of supportability and consistency that are essential to a finding of persuasiveness in a medical opinion were lacking. There was no error here.
3. The ALJ Did Not Err in This Symptom Evaluation.
Finally, Sager argues that the ALJ's symptom evaluation in this case was legally insufficient. We disagree. In our view this evaluation was careful, detailed, and fully comported with the Social Security Regulations governing symptom evaluation, which 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, including: 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. 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3).
In this case, the ALJ assessed the severity of Sager's symptoms in accordance with the regulations, and found that his statements regarding the intensity and persistence of these symptoms were not entirely consistent with the clinical and medical opinion evidence. (Tr. 18-23). These factual determinations regarding Sager's medical treatment were supported by substantial evidence in the administrative record. Moreover, 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 v. Colvin, 777 F.3d 607, 615 (3d Cir. 2014); Durden v. Colvin, 191 F.Supp.3d 429, 442 (M.D. Pa. 2016). Thus, there was no legal error in the ALJ's reliance upon these considerations when addressing the severity of Sager's symptoms.
Moreover, in our view each of these factual findings was supported by substantial evidence; that is, “‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'” Biestek, 139 S.Ct. at 1154. Furthermore, as the ALJ aptly noted, while Sager's longitudinal treatment records confirmed these various diagnoses, those records also indicated that that these physical and emotional impairments were not wholly disabling. This clinical evidence provided substantial evidentiary support for the ALJ's symptom evaluation in this case. Accordingly, under the deferential standard of review which we must apply, this challenge to the ALJ's symptom evaluation fails.
In closing, 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.
IV. Recommendation
Accordingly, for the foregoing reasons, IT IS RECOMMENDED that the final decision of the Commissioner denying these claims be AFFIRMED.
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.