Opinion
Civil Action 3:20-cv-2442
06-30-2022
MARC DAMIEN ST. PIERRE, Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY ADMINISTRATION, Defendant.
(BRANN, C.J.)
REPORT AND RECOMMENDATION
PETER E. ORMSBY UNITED STATES MAGISTRATE JUDGE
Plaintiff Marc Damien St. Pierre filed this action pursuant to 42 U.S.C. § 405(g), seeking review of the Commissioner of Social Security's denial of disability benefits. St. Pierre claims he is disabled due to depression, agoraphobia, social anxiety, and rage/anger issues. An Administrative Law Judge (ALJ) found that St. Pierre's mental impairments significantly limit his ability to work but denied benefits because he can perform some types of low-stress jobs. St. Pierre principally contends that the ALJ erred in failing to give more weight to the opinion of a consulting psychologist, Dr. Avi Nires.
A federal court may review the Commissioner's denial of benefits only to determine whether the Commissioner applied the correct legal standards and whether the decision is supported by substantial evidence; a court may not re-weigh the evidence or substitute its judgment for the Commissioner's. See 42 U.S.C. § 405(g); see also Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 359 (3d Cir. 2008). After carefully considering the record in the context of this deferential standard of review, the undersigned concludes that Plaintiff's appeal lacks merit. The ALJ applied the correct standard in weighing the opinion evidence from Dr. Nires and a state agency psychologist. The ALJ's decision to accord less weight to Dr. Nires' opinion is supported by substantial evidence in the record, including St. Pierre's mental health treatment records. Accordingly, for the reasons discussed further below, it is recommended that the Commissioner's decision be affirmed.
This matter has been referred to the undersigned magistrate judge to prepare a report and recommendation to the District Court pursuant to 28 U.S.C. § 636(b) and Rule 72(b) of the Federal Rules of Civil Procedure.
I. BACKGROUND
In February 2018, Plaintiff St. Pierre applied for Disability Insurance Benefits and Supplemental Security Income under Titles II and XVI of the Social Security Act. (See Tr. 127-30.) He alleged he became disabled about six years earlier, on May 1, 2012.
The Commissioner has filed a transcript of the record of the administrative proceedings (Doc. 16), which will be cited as “Tr.” The page numbers refer to the numbers in bold typeface located in the bottom right corner of the transcript pages. Throughout this report, “Doc. ” refers to the docket entry numbers assigned by the Court's electronic filing system (CM/ECF). Page cites included with docket numbers (“at ”) refer to the electronically assigned page numbers found on the top right of each page.
St. Pierre's applications were denied initially on June 20, 2018. He then requested a hearing, which was held on September 25, 2019, before Administrative Law Judge Michele Stolls. She issued a written decision on January 13, 2020, finding that St. Pierre was not disabled. (Tr. 15-28.)
St. Pierre requested the Social Security Administration's Appeals Council to review the ALJ's adverse decision. The Appeals Council denied review, rendering the ALJ's decision the Commissioner's final decision for purposes of judicial review. In considering St. Pierre's challenge to the ALJ's decision, the evidence in the record will be summarized as it relates to the issues raised.
The Court must “scrutinize” the record to determine whether the ALJ's decision is supported by substantial evidence. Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D. Pa. 2003) (citing Smith v. Califano, 637 F.2d 968, 970 (3d Cir.1981)). The undersigned has thoroughly reviewed the medical records and other evidence. In this report, the record will be summarized to the extent it may be helpful in providing context for the specific issues Plaintiff raises.
A. Education, Work Experience, and Activities
St. Pierre was 44 years old when he applied for disability benefits. He is a high school graduate. Up until about 2012, St. Pierre was employed at various jobs, including working for about seven years as a machine helper in a warehouse. (See Tr. 175, 219.) Since 2012, however, he has not been consistently employed. He worked at multiple jobs during that time but states he left them all due to his mental health issues.
In support of his disability applications, St. Pierre submitted a “Function Report” about his conditions and activities. (Tr. 185-92.) He reported being “basically homeless,” although he sometimes stays with his former in-laws. (Tr. 185.) After getting up in the mornings, he goes to public libraries and walks the streets until nighttime, when he goes to a friend's apartment or his former in-laws' home for the evening. (Tr. 186.) He explained that he “cannot work or even go out to crowded grocery stores because [he] become[s] freaked out.” (Id.) He can prepare his own simple meals but going to the laundromat is hard because other people are there. (Tr. 187.) His hobbies are walking, listening to music, and reading, although his depression sometimes limits these activities. (Tr. 189.) He goes to public libraries and local parks to read. (Id.)
St. Pierre reported that his mental health conditions affect his memory, concentration, and understanding, as well as his ability to complete tasks, follow instructions, and get along with others. (Tr. 190.) He cannot complete tasks because his mind wanders, and he does not follow instructions very well because he “mostly block[s] out those who talk to [him].” (Tr. 190.) He further reported “extreme” problems with authority figures (“no one is ‘over' me!”), and he “hate[s] change.” (Tr. 191.)
At the time, St. Pierre was taking two medications. One for sleeping and the other for depression/social anxiety. (Tr. 192.) Both came with side effects, including nightmares, fatigue, memory loss, and depression.
B. The Medical Evidence
St. Pierre's medical records are relatively limited. He did not seek treatment for his mental health conditions until about October 2017. Since that time, he has been treated at a mental health clinic, Community Counseling Services of Northeastern Pennsylvania (CCS). Fortunately, St. Pierre has had no occasion to go to the hospital or visit an emergency room.
St. Pierre's initial visit to CCS was on November 1, 2017. (Tr. 246-60.) The “intake” report notes that St. Pierre said he suffered from “‘social anxiety' (in large crowds)[,] ‘depression' (low mood, helpless/hopeless isolation) and ‘ADD' (poor concentration).” (Tr. 246.) He also stated that he could not keep a job and had a poor work history for the past seven years. (Id.) As to his anxiety, St. Pierre described his “nervousness in large social setting[s].” (Tr. 248.) He denied any current suicidal ideas, plan, or intent. (Tr. 249.) The “psychiatric diagnosis” for this initial visit was “MDD,” which presumably refers to major depression disorder. (Tr. 247.)
St. Pierre's intake evaluation also included a “mental status examination” form, which reflected the following observations about him:
• Appearance: Neatly Groomed
• Hygiene: Clean
• Rapport: Good
• Mood: Euthymic
• Affect: Full Range (not bland, restricted, or inappropriate)
• Behavior: Cooperative
• Speech: Normal
• Orientation: Oriented times 3 (not disoriented as to person, time, or place)
• Estimate of Intellect: Average
• Thought Process: Normal
• Thought Content: Normal
• Memory: Intact
• Insight: Fair
• Judgment: Fair
• Impulse Control: Present.
• Motivation for Treatment: Good.(Tr. 252-53.)
St. Pierre returned to CSS five days later on November 6, 2017, and was seen by Marcy Smith, MSN, CRNP. She prepared a “Psychiatric Evaluation” report about his visit. (Tr. 244-45.) As reflected in the report, St. Pierre described his chief complaint as follows: “I've been battling for about seven years depression, social anxiety, and ADD.” (Tr. 244.) He had recently experienced “panic attacks in social situations,” and he also explained that “a trigger for his anxiety attacks is ruminating about his work history and worry [about the] future.” (Id.)
The credentials listed after Marcy Smith's name reflect that she has a Master's of Science in Nursing and is a Certified Registered Nurse Practitioner.
The “mental status exam” resulted in the following observations:
Marc is pleasant and cooperative through the exam. He has good eye contact. He has no unusual movements. He is alert and oriented x 4. His speech is coherent with normal rate and volume. His mood is eu[]thymic. His affect is full. No delusions or paranoia were elicited. His thought content is relevant. His thought process is linear. His memory is intact for recent and remote. His intellectual functioning is average. His insight and judgment are fair. He denies any thoughts, plan, or intent to harm himself or others.(Tr.245.) St. Pierre was prescribed Zoloft and Doxepin for his depression and sleeping difficulties. (Id.)
St. Pierre's records from CCS reflect that he was seen at the clinic once every month or so over the next two years. Those records will be discussed further later in this report as they relate to St. Pierre's argument about Dr. Nires' opinion.
The state agency retained Dr. Nires to conduct a psychological evaluation and a mental functional capacity assessment. Dr. Nires met with St. Pierre on May 11, 2018, and prepared a “Mental Status Evaluation” report documenting his findings. As background information, Dr. Nires noted that St. Pierre graduated from high school and that his most recent employment was as a warehouse helper. (Tr. 263.) St. Pierre left that work after a few months “due to his social anxiety, depression, rage, and agoraphobia.” (Id.) St. Pierre had been visiting CCS since October 2017, but Dr. Nires did not have any records from CCS in conducting his evaluation. (Id.)
In describing his current symptoms, St. Pierre reported “difficulty falling asleep” and “depressive symptomatology,” which included hopelessness, worthlessness, social withdrawal, irritability, and rage. (Tr. 264.) Dr. Nires made the following observations about St. Pierre:
• Demeanor and responsiveness: cooperative
• Social skill and manner of relating: adequate
• Posture: normal
• Motor behavior: restless
• Eye contact: appropriate
• Speech: clear and adequately expressive
• Thought processes: coherent and goal directed
• Affect: very anxious
• Mood: very anxious
• Sensorium: appeared clear
• Orientation: x3
• Attention and concentration: very mildly impaired (likely due to nervousness)
• Recent and remote memory skills: intact
• Cognitive functioning: average
• Insight: good
• Judgment: good(Tr. 265-66.) Dr. Nires' primary diagnosis was “major depressive disorder, recurrent, severe without psychotic features.” (Tr. 266.) He recommended that St. Pierre continue with his current treatment with CCS and found that his prognosis was guarded, “given the severity of the symptoms despite his treatment.” (Id.)
Dr. Nires also completed a form entitled “Medical Source Statement of Ability to Do Work-Related Activities (Mental).” (Tr. 268-70.) He found that St. Pierre had no limitations in his ability to understand, remember, and carry out instructions (whether simple or complex). (Tr. 268.) However, Dr. Nires indicated that St. Pierre had “marked” limitations in his ability to interact appropriately with the public, supervisors, and co-workers. (Tr. 269.) Dr Nires also opined that St. Pierre had “extreme” limitations in his ability to respond appropriately to usual work situations and changes in a work setting. (Id.) In identifying the factors that supported these findings, Dr. Nires simply noted: “social phobia/anxiety - severe depression [with] isolation.” (Id.)
A state agency psychologist, Michelle R. Santilli, Psy.D., also evaluated St. Pierre's mental residual functional capacity. She reviewed the medical evidence, including Dr. Nires' report. (Tr. 62-70.) Dr. Santilli's assessment agrees with Dr. Nires' opinion to the extent that St. Pierre has no significant limitation in his ability to understand, remember, and carry out instructions. (Tr. 66.) But, unlike Dr. Nires, she found that St. Pierre has only moderate limitations in his ability to interact with others and to respond to changes in a work setting. (Tr. 66-67.) While she considered Dr. Nires' opinion, Dr. Santilli stated that it did not have “substantial support from the other evidence of record.” (Tr. 68.)
C. The Evidentiary Hearing
The hearing was held on September 25, 2019. (Tr. 36-58.) Two witnesses testified: St. Pierre and a vocational expert, Gerald Keating. St. Pierre was represented by counsel.
St. Pierre explained that his current diagnoses were agoraphobia, “extreme social anxiety, bouts of rage, and a very significant amount of depression.” (Tr. 42.) He has no physical symptoms or limitations. (Tr. 43.) His only mental health care provider has been CCS. (Tr. 42-43.)
St. Pierre explained that due to the agoraphobia, he does not like “to be out too much,” and to avoid crowds, he “rarely leave(s) the house.” (Tr. 43.) When the ALJ asked him about the statement in his function report that he was “technically homeless,” St. Pierre responded that he was currently bouncing back and forth between his wife (who he is separated from) and other family members. (Tr. 47.) Although he does not have a car, he does have a driver's license and that is where his problem with rage comes into play; his “road rage” is “getting progressively worse.” (Tr. 48.)
St. Pierre rarely goes out in public. (Tr. 49.) He has a hard time with grocery stores and other stores; when there are more than three or four people there, he just leaves. (Tr. 49-50.) He stated: “the majority of my weeks are spent indoors.” (Tr. 50.) When the ALJ reminded him that his function report indicated he went to public libraries during the day, St. Pierre explained that his symptoms have gotten “progressively worse,” so he no longer goes to libraries or parks as he used to do. (Id.)
St. Pierre last worked in 2017. He was doing maintenance, but it only lasted for one or two days. (Tr. 48-49.) In explaining what happened, he said his “depression takes over” and he “can't even leave the house.” (Tr. 49.) His anxiety
is “just unbearable,” having “kind of snowballed” since 2012. (Id.) He reported no traumatic events from his past, but he had a “bad childhood,” with a father who was an alcoholic and was physically and verbally abusive. (Id.)
The ALJ asked the vocational expert whether there was any work a hypothetical claimant could perform assuming the following:
[A]ssume that we're dealing with a hypothetical claimant who has the same age, education and work experience as this claimant. And assume further that the hypothetical claimant has the residual functional capacity to perform work at all exertional levels, however, his ability to work at those levels is reduced in that he would be limited to occupations requiring no more than simple routine tasks, not performed in a fast-paced production environment, involving only simple work-related decisions, and in general relatively few workplace changes. He would be limited to occupation which require no more than occasional interaction with supervisors and coworkers, and no interaction with members of the general public, and limited to occupations requiring low stress, defined as occasional decision- making required. Could such a hypothetical claimant perform his past work?(Tr. 54-55.)
Mr. Keating responded that the hypothetical claimant would not be capable of performing his past work but could do various jobs, including:
• Floor cleaner or Waxer, with about 35,000 such jobs existing in the national economy;
• Cleaner, with 30,000 jobs nationally; and
• Cleaner, Industrial, with about 50,000 jobs nationally.(Tr. 55.) The ALJ then asked Mr. Keating to assume the same hypothetical with the additional limitation of “no tandem tasks with coworkers.” (Tr. 56.) Mr. Keating responded that the claimant could still perform the listed jobs. (Id.)
D. The ALJ's Decision
The ALJ issued a detailed written decision, consisting of 14 pages of singlespaced type. (Tr. 15-28.) In deciding St. Pierre's applications, the ALJ applied the five-step method for evaluating disability claims. See 20 C.F.R. §§ 404.1520, 416.920.
The five-step process will be explained further in the Standard of Review section of this report, infra Part II.A.
The ALJ first found (at step one) that St. Pierre had not performed substantial gainful activity since the alleged disability onset date, May 1,2012. (Tr. 18.) In considering the severity of his impairments (step two), the ALJ determined that St. Pierre had the following “severe” medical impairments: “major depressive disorder, generalized anxiety disorder, unspecified trauma and stress related disorder and social phobia.” (Id.)
The ALJ next determined (at step three) that St. Pierre's impairments were not severe enough, singly or collectively, to meet or medically equal one of the listed impairments in the regulations. (Tr. 18-21.) In reaching this conclusion, the ALJ analyzed St. Pierre's mental health limitations in the context of the potentially relevant listings. (Id.)
Before proceeding to the next step in the disability analysis, the ALJ assessed St. Pierre's residual functional capacity (RFC) to do physical and mental work activities. The ALJ made the following RFC finding:
After careful consideration of the entire record, the undersigned finds that the claimant has the residual functional capacity to perform a full range of work at all exertional levels but with the following non-exertional limitations. He is limited to occupations requiring no more than simple, routine tasks, not performed in a fast paced production environment, involving only simple, work related decisions, and in general, relatively few work place changes. He is limited to occupations requiring no more than occasional interaction with supervisors and coworkers, and no interaction with members of the general public. He is limited to occupations requiring low stress, defined as occasional decision making required. Further, he is limited to no tandem tasks with coworkers.(Tr. 21.) In making this finding, the ALJ “considered all symptoms and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence.” (Id.)
In considering St. Pierre's symptoms, the ALJ described the evidence in the record, including St. Pierre's treatment records and the medical opinion evidence. (Tr. 22-26.) She summed up her review and assessment of the evidence as follows:
In sum, the above residual functional capacity assessment is supported by the record as a whole, including the claimant's treatment notes, the findings of the state agency assessment and consultative examiner in part, and the reliable portions of the claimant's statements. Overall, the objective evidence does not support the alleged intensity
and persistence of symptoms. Therefore, the undersigned finds that the claimant is capable of performing work in accordance with the residual functional capacity described above.(Tr. 25-26.)
Next, the ALJ found (at step four) that St. Pierre is unable to perform any past relevant work. (Tr. 26.) In considering whether St. Pierre could perform any type of work (step five), the ALJ relied on the testimony of the vocational expert, Mr. Keating, to find that St. Pierre could perform several jobs that exist in significant numbers in the national economy. (Tr. 26-27.) From this, the ALJ concluded that St. Pierre is not disabled.
E. Request for Judicial Review
As noted earlier, Plaintiff sought administrative review of the ALJ's decision. After the Appeals Council denied that request, Plaintiff filed the instant action seeking judicial review of the Commissioner's decision pursuant to 42 U.S.C. § 405(g). (Doc. 1.) The issues raised by Plaintiff have been briefed by the parties and will be analyzed in light of the applicable standard of review. (Doc. 18, 19.)
II. ANALYSIS
A. Standard of Review
To qualify for benefits under the Social Security Act (the “Act”), Plaintiff bears the burden of proving he is disabled. 42 U.S.C. § 423(d)(5)(A) (“An individual shall not be considered to be under a disability unless he furnishes such medical and other evidence of the existence thereof as the Commissioner of Social Security may require.”); see also Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 359 (3d Cir. 2011) (noting the claimant's “burden to produce evidence supporting her disability claim”). The Act defines disability as the “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 twelve months.” 42 U.S.C. §§ 416(i)(1)(A), 423(d)(1)(A), 1382c(a)(3)(A). A “physical or mental impairment” is defined as “an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.” Id. at §§ 423(d)(3), 1382c(a)(3)(D).
To determine whether a claimant is disabled within the meaning of the Act, the Commissioner applies the following five-step inquiry:
(1) whether the claimant is currently working in substantial gainful employment;
(2) whether the claimant suffers from a severe impairment;
(3) whether the claimant's impairment is sufficient under the pertinent regulations (“listings”) to support a finding of disability;
(4) whether the claimant is able to do his or her past relevant work; and, if not,
(5) whether the impairment prevents the claimant from doing any other work.See 20 C.F.R. §§ 404.1520, 416.920.
At steps one through four, the burden of proof rests on the claimant to show that he is disabled. Rutherford v. Barnhart, 399 F.3d 546, 551 (3d Cir. 2005). If the claimant satisfies this responsibility, the burden then shifts to the Commissioner at step five of the process to show that there is other gainful employment the claimant can perform despite his existing impairments. Id.
In this case, the ALJ proceeded to step five. Based on the vocational expert's testimony, the ALJ found that St. Pierre was not disabled because he could perform jobs existing in significant numbers in the national economy. The issues raised by St. Pierre address the ALJ's step-five finding.
A federal court's review of the Commissioner's final decision is limited to determining whether the Commissioner applied the correct legal standards and whether the decision is supported by substantial evidence. See Chandler, 667 F.3d at 359. As the Supreme Court has emphasized, substantial evidence review is deferential:
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). In applying this standard, “[c]ourts are not permitted to re-weigh the evidence or impose their own factual determinations.” Chandler, 667 F.3d at 359 (citing Richardson v. Perales, 402 U.S. 389, 401 (1971)).
The substantial evidence standard is deferential, but this does not mean that a court may accept unsupported or unexplained findings. For meaningful judicial review to occur, the Third Circuit “requires an ALJ to set forth the reasons for his decision.” Burnett v. Comm'r of Soc. Sec., 220 F.3d 112, 119 (3d Cir. 2000) (citing Cotter v. Harris, 642 F.2d 700, 704-06 (3d Cir. 1981)). The “ALJ must consider all evidence before him” and “must give some indication of the evidence which he rejects and his reason(s) for discounting such evidence.” Burnett, 220 F.3d at 12122 (citing Plummer v. Apfel, 186 F.3d 422, (3d Cir. 1999) and Cotter, 642 F.2d at 705) (holding that the ALJ erred in failing to mention and explain contradictory medical and non-medical evidence). Although an ALJ need not “use particular language or adhere to a particular format in conducting his analysis,” the ALJ must ensure “sufficient development of the record and explanation of findings to permit meaningful review.” Jones v. Barnhart, 364 F.3d 501, 505 (3d Cir. 2004).
B. Issues
In seeking review of the Commissioner's denial of benefits, Plaintiff frames the issue as whether he is disabled under the Social Security Act. (Doc. 18 at 3.) But in addressing this broad issue, Plaintiff focuses on the ALJ's assessment of Dr. Nires' opinion and contends that the ALJ erred in failing to give it more weight. (See id. at 4-8; see also Doc. 1 at 3-4.) This report will likewise focus on that argument. The Commissioner contends that the ALJ's decision should be affirmed because it is supported by substantial evidence. (Doc. 21.)
C. Assessment of the Consulting Psychologists' Opinions
Plaintiff contends that the ALJ erred in the relative weight given to Dr. Nires' opinion. As discussed earlier, Dr. Nires found that St. Pierre has “marked” limitations in his ability to appropriately interact with the public, supervisors, and co-workers; he further found that St. Pierre has an “extreme” limitation in his ability to respond appropriately to usual work situations and to changes in work routine. (Tr. 68.) Plaintiff complains that “[t]he ALJ does not address how reducing St. Pierre's work to ‘limited' or ‘occasional' co-worker interaction and ‘occasional' decision-making rather than no interaction or decision-making is supported by the medical evidence.” (Doc. 18 at 8; emphasis in original.)
Because Plaintiff filed his disability claims after March 27, 2017, the ALJ's evaluation of medical opinions is governed by the relatively new regulatory framework found in 20 C.F.R. §§ 404.1520c and 416.920c. See Broaddus v. Kijakazi, No. 3:20-CV-01418, 2022 WL 1096624, at *4-*6 (M.D. Pa. Apr. 12, 2022) (discussing the new regulatory framework for evaluating medical opinion evidence). Under the new regulations, rather than assigning weight to medical opinions, the Commissioner will articulate “how persuasive” he or she finds the medical opinions. 20 C.F.R. §§ 404,1520c(b), 416.920c(b). The Commissioner's consideration of medical opinions is guided by several factors, the most important of which are the “supportability” of the opinion and the “consistency” of the opinion. 20 C.F.R. §§ 404.1520c(b)(2), 416.920c(b)(2). The ALJ must explain how he or she considered the “supportability” and “consistency” of a medical source's opinion. Id.
The introduction for both regulations explains: “For claims filed . . . on or after March 27, 2017, the rules in this section apply.” 20 C.F.R. §§ 404.1520c, 416.920c.
The other factors address the medical source's relationship with the claimant (including the length of the treatment relationship, the frequency of examinations, the purpose of the treatment relationship, the extent of the treatment relationship, and the examining relationship); the specialization of the medical source; and any other factors that tend to support or contradict the opinion. See 20 C.F.R. §§ 404.1520c(c), 416.920c(c). Generally, the ALJ may, but is not required to, explain his or her consideration of these other factors. 20 C.F.R. §§ 404.1520c(b)(2), 416.920c(b)(2). Only if “two or more medical opinions . . . are both equally well-supported . . . and consistent with the record . . . but are not exactly the same, [the ALJ] will articulate how [he or she] considered the other most persuasive factors.” 20 C.F.R. §§ 404.1520c(b)(3), 416.920c(b)(3) (citations omitted).
As to “supportability,” the regulations explain: “The more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion(s) . . ., the more persuasive the medical opinions . . . will be.” 20 C.F.R. §§ 404.1520c(c)(1), 416.920c(c)(1). The regulations describe the “consistency” factor as follows: “The more consistent a medical opinion(s) . . . is with the evidence from other medical sources and nonmedical sources in the claim, the more persuasive the medical opinion(s) . . . will be.” 20 C.F.R. §§ 404.1520c(c)(2), 416.920c(c)(2).
To facilitate judicial review, the ALJ's decision must be accompanied by “a clear and satisfactory explication of the basis on which it rests.” Cotter, 642 F.2d at 704. This means that an “ALJ must explain the weight given to physician opinions.” Chandler, 667 F.3d at 362. The “ALJ is free to accept some medical evidence and reject other evidence, provided that he provides an explanation for discrediting the rejected evidence.” Zirnsak v. Colvin, 777 F.3d 607, 614 (3d Cir. 2014) (citations omitted). In giving such an explanation, an ALJ need not undertake an exhaustive discussion of all the evidence or “use particular language or adhere to a particular format in conducting his analysis.” Jones v. Barnhart, 364 F.3d 501, 505 (3d Cir. 2004); see Hur v. Barnhart, 94 Fed.Appx. 130, 133 (3d Cir. 2004) (“There is no requirement that the ALJ discuss in his opinion every tidbit of evidence included in the record.”). Ultimately, an ALJ need only ensure “sufficient development of the record and explanation of findings to permit meaningful review.” Jones, 364 F.3d at 505 ; see also, Rivera v. Comm'r of Soc. Sec., 164 Fed.Appx. 260, 262 (3d Cir. 2006) (“The only requirement is that, reading the ALJ's decision as a whole, there must be sufficient development of the record and explanation of findings.”).
Here, the ALJ's assessment of the medical opinion evidence is consistent with the regulatory framework and sufficient for meaningful judicial review. The ALJ explained how she viewed the supportability and consistency of Dr. Nires' opinion as follows:
In regards to claimant's mental functioning, the undersigned considered the opinion of Dr. Avi Nires, following his consultative psychological examination, and found it partially persuasive (Exhibit 2F). Dr. Nires opined claimant has no limitations in his ability to understand, remember and carry out instructions, as well as in his ability to concentrate, persist, or maintain pace. He further opined claimant has marked limitations in his ability to interact with the public, supervisors, and co-workers, and an extreme limitation in his ability to respond appropriately to usual work situations and changes in a routine work setting. Dr. Nires opinion is consistent to the extent that is supported by, and consistent with the evidence of record, such as claimant's ability to do simple routine tasks. However, it is not consistent with, or supported by the longitudinal record, in regards to the marked and extreme limitations regarding social interaction and his ability to respond to usual work situations. First, claimant's mental health treatment has been conservative, with no indication that he has been referred for, or required, any group therapy, partial hospitalization program, inpatient hospitalization, or other form of intensive mental health intervention during the relevant time. Second, the marked and severe limitations are based upon claimant's reports, rather than his longitudinal mental status examinations, or even the findings on Dr. Nires' mental status examination. Furthermore, in regards to claimant's ability to concentrate, persist, and maintain pace, the longitudinal record reflects the need for some limitations, as outlined in the above residual functional capacity. For these reasons, the opinion of Dr. Nires is partially persuasive.(Tr. 25.)
The ALJ thus accepted Dr. Nires' opinion to the extent he found that St. Pierre was not significantly limited in his ability to understand, remember, and carry out
instructions. However, she gave little weight to his finding that St. Pierre had “marked” limitations in his ability to interact appropriate with others and “extreme” limitations in his ability to respond to usual work situations and changes in work routine. The ALJ explained that Dr. Nires' assessment of marked and extreme limitations was “not consistent with, or supported by the longitudinal record.” (Id.) This finding is supported by substantial evidence.
The ALJ summarized the medical records from CCS, which spanned a period of almost two years. (Tr. 22-23.) Those records include St. Pierre's statements to mental health providers about his symptoms, as well as their observations about him. For example, the ALJ provided the following description of St. Pierre's CCS medical records dating from about a year after he began treatment there:
In February of 2019, claimant reported that he was feeling better now that he was back on his medication, after missing taking it for a few days, and by March of 2019, he reported that he was only experiencing depressive symptoms once a month for a few days, but that overall he was improving (Exhibits 3F/12-13). Furthermore, at the beginning of May 2019, claimant reported that his mood was stable, and his anxiety had improved with the increase of his Buspar, but that he still had social anxiety and feelings of road rage and aggressive feelings while driving. Even so, by the end of the same month, he was denying irritability and reporting less angry outbursts and mood swings since starting Lamictal, and denied any significant depression, stating it comes and goes, with him feeling depressed 1-2 days out of the month, and then it resolves (Exhibits 3F/14-15).(Tr. 23.) A review of those records shows that the ALJ provided an accurate summary of the health care providers' report. (See, e.g., Tr. 297-301.)
The ALJ also explained why she believed St. Pierre's medical records were not entirely consistent with his statements about the severity of his symptoms:
While the claimant reports some ongoing symptoms and complaints as noted above to his providers, objective findings on mental status examination are within the mild to moderate range, with many findings noted consistently as unremarkable. For instance, the record reflects that claimant has been consistently well groomed, pleasant, and cooperative with good eye contact, and oriented to person, place, and time. Additionally, it reflects normal motor activity, full affect, and relevant thought content, with no hallucinations, delusions, or paranoia. The examinations also reflect an intact memory, normal coherent speech, average intellectual functioning, and linear/normal thought processes. They also indicate a generally euthymic mood, and generally fair judgment and insight, although one examination reflected an anxious mood (Exhibit 3F/12). Lastly, his examinations generally reflect no suicidal or homicidal ideations, however, the undersigned is mindful that there were two examinations which commented on fleeting thoughts of suicide with no plan or intent (Exhibits 1F/9, 12, 19, 3F/6- 17). Based on the forgoing, the objective findings do not suggest mental impairments that would bar functioning as per the above residual functional capacity.(Tr. 23.) Here again, the record supports the ALJ's summary of the mental health care providers' objective findings.
For example, during 15 visits to CCS, St. Pierre complained of anxiety to various extents. Yet in 11 of those visits the provider observed him to be euthymic (i.e., normal or tranquil). (Tr. 242, 245, 252, 294, 296, 297, 299, 304, 305, 307, 308.) The provider noted that St. Pierre appeared anxious during only four visits. (Tr. 300, 301, 303, 306.) As noted in Dr. Nires' report, he did not review any of these records. (Tr. 263 (“No records were submitted by the claimant for review.”).)
In addition to St. Pierre's medical records, the ALJ cited other reasons for discounting Dr. Nires' opinion. To begin with, “the record contains no record of any mental health treatment from the alleged onset date [May 1, 2012] until October of 2017.” (Tr. 24 (citation omitted).) The ALJ also cited “the fact that his providers did not find based on his presentation the need to recommend intensive treatment, and instead, claimant continued to receive conservative outpatient treatment.” (Id.) As to St. Pierre's alleged problem with road rage, the ALJ noted that “he has had no arrests.” (Id.) In addition, the ALJ notes that “the records reflect an improvement in claimant's depressive symptoms, and contrary to his testimony at the hearing, reflects his condition has improved to where he is only experiencing depressive symptoms 1-2 times a month with the medication treatment that has been instituted.” (Tr. 24 (citing Exhibit 3F).) This observation likewise finds support in the medical records.
Based on the record, St. Pierre's alleged road rage is puzzling. In his function report, St. Pierre said he was “basically homeless” and does not own a car. (Tr. 185, 188.) When he wakes up, he “go[es] to public libraries and walk[s] [the] streets until night.” (Tr. 186.) At the hearing, he suggested that he no longer goes out as much and instead stays inside away from people (at a relative's home). (See Tr. 43 (“I rarely leave the house.”); see also Tr. 47, 49-50 (stating “it's rare” that he goes out in public and “the majority of [his] weeks are spent indoors”).) From St. Pierre's descriptions of his activities, it is hard to understand how and when he is driving a car to such an extent that road rage is an issue.
In particular, the record reflects that St. Pierre's depression was improving and manageable in the months leading up to the hearing. For example, during his CCS visit on May 1, 2019, St. Pierre stated that “his anxiety has improved with the increase in Buspar, but [he] still has social anxiety.” (Tr. 284.) During his visit on May 31, 2019, he advised: “he has less anger outbursts and mood swings since starting the Lamictal”; “his depression ‘comes and goes' - feels depressed 1-2 days out the month and then it resolves”; “still reports social anxiety.” (Tr. 284.) For his visit on July 3, 2019, St. Pierre reported: “No specific stress, no rage, feels anxious in social situations.” (Tr. 286.) On September 18, 2019, he reported “his mood as ‘so-so'”; “his depression ‘comes and goes' - feels depressed 1-2 days out of the month and then it resolves”; “still reports chronic social anxiety.” (Tr. 287.) This was one of the many CCS visits in which the provider noted that St. Pierre appeared “euthymic.” (Id.) His hearing was held a week later, on September 25, 2019.
The ALJ thus satisfied the requirement that she give reasons for finding Dr. Nires' opinion unpersuasive to the extent he found that St. Pierre has marked limitations in his work-related social interactions and extreme limitations in his ability to respond to usual work situations. See Burnett, 220 F.3d at 119; Cotter, 642 F.2d at 704. The ALJ's reasons are supported by substantial evidence, including St. Pierre's medical records. Having fulfilled her duty to articulate sufficient reasons and having satisfied the substantial evidence standard, the ALJ did not err in assessing Dr. Nires' opinion. See Zirnsak v. Colvin, 777 F.3d 607, 613-14 (3d Cir. 2014) (holding that the ALJ did not err in discounting the opinion of a consulting psychologist where the ALJ articulated a specific reason for giving the opinion little weight and substantial evidence supported that determination).
One other related issue warrants discussion. Plaintiff's briefing suggests that the ALJ erred in that she also found the state agency psychologist's opinion only “partially persuasive.” (See Doc. 18 at 7; see also Doc 1 at 4-5.) This argument misses the mark in two ways.
First, Dr. Santilli's opinion about St. Pierre's work-related mental limitations was significantly less restrictive than Dr. Nires' opinion. Dr. Santilli's opinion thus provides additional support for the ALJ's decision. See Chandler, 667 F.3d at 361 (noting that the opinions of state agency medical consultants “merit significant consideration”); 20 C.F.R. § 416.913a(b)(1) (ALJs must consider administrative medical findings “because our Federal or State agency medical or psychological consultants are highly qualified and experts in Social Security disability evaluation”). Dr. Santilli opined that St. Pierre is only “moderately limited” in his abilities to work with others and to respond to changes at work. (Tr. 66-67.) The ALJ credited Dr. Santilli's opinion over Dr. Nires' opinion in this regard, finding that her opinion was “consistent with the evidence of record.” (Tr. 25.) In evaluating the conflicting opinions of Dr. Nires and Dr. Santilli, the ALJ was “free to choose the medical opinion of one doctor over that of another,” so long as she considered all the evidence and gave “some reason for discounting the evidence she rejects.” Diaz v. Comm'r of Soc. Sec., 577 F.3d 500, 505-06 (3d Cir. 2009) (citing Cotter, 642 F.2d at 705 and quoting Plummer, 186 F.3d at 429). As discussed above, the ALJ gave several reasons for discounting Dr. Nires' opinion, and Dr. Santilli's differing opinion was yet another reason for the ALJ to do so.
Second, the ALJ determined that St. Pierre was somewhat more limited than suggested by Dr. Santilli's opinion. (Tr. 25.) In fashioning St. Pierre's RFC, the ALJ thus included several work-related restrictions addressing those issues. This was not error; rather, the ALJ was doing the job she is supposed to do-weighing the evidence and resolving conflicts. See Beavers v. Kijakazi, No. 3:20-CV-01415, 2022 WL 989024, at *8 (M.D. Pa. Mar. 31, 2022) (“The ALJ's duty is to weigh the evidence and resolve conflicts.”) (citing Richardson v. Perales, 402 U.S. 389, 410 (1971) and Fargnoli v. Massanari, 247 F.3d 34, 40 (3d Cir. 2001)). If anything, the ALJ's ruling is bolstered in that she did not merely rubber stamp the state agency consultant's opinion; instead, she added limitations that the state agency doctor did not deem necessary. See Chandler, 667 F.3d at 361-62 (holding that the ALJ properly relied on the state agency medical consultant's opinion where the ALJ incorporated additional RFC limitations based on other persuasive evidence in the record). The ALJ acted within her discretion in making a finding that lay somewhere between two conflicting expert opinions. See Zirnsak, 777 F.3d at 614 (an “ALJ is free to accept some medical evidence and reject other evidence, provided that he provides an explanation for discrediting the rejected evidence”); Durden v. Colvin, 191 F.Supp.3d 429, 455 (M.D. Pa. 2016) (“an ALJ can give partial credit to all medical opinions and can formulate an RFC based on different parts from the different medical opinions”) (citations omitted). “The ALJ-not treating or examining physicians or State agency consultants-must make the ultimate disability and RFC determinations.” Chandler, 667 F.3d at 361.
For example, the ALJ's RFC limited St. Pierre to occupations requiring “no more than occasional interaction with supervisors and coworkers,” “no interaction with members of the general public,” “no tandem tasks with coworkers,” and “low stress, defined as occasional decision making required.” (Tr. 21.)
In this case, the record shows that Plaintiff St. Pierre struggles with mental health issues that make it difficult for him to work. The ALJ applied the proper legal standard in determining whether his mental impairments warranted a finding that he is disabled within the meaning of the Social Security Act. She ultimately decided that he is not disabled and explained her reasons for reaching that conclusion. To be sure, other arguments could be made about the evidence and other inferences could be drawn. But it is the ALJ's role to weigh the evidence and resolve conflicts in the evidence. A federal court is “not permitted to re-weigh the evidence or impose their own factual determinations.” Chandler, 667 F.3d at 359. Because the ALJ's decision is supported by substantial evidence, the Commissioner's denial of benefits should be affirmed.
III. RECOMMENDATION
For the foregoing reasons, the undersigned recommends that the Commissioner's decision be AFFIRMED, that final judgment be entered in favor of the Commissioner, and that the Clerk be directed to CLOSE this case.
NOTICE TO THE PARTIES
Any party may obtain review of this Report and Recommendation pursuant to Local Rule 72.3, which provides:
Any party may object to a magistrate judge's proposed findings, recommendations or report addressing a motion or matter described in 28 U.S.C. § 636 (b)(1)(B) . . . 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.