Opinion
CIVIL 1:20-CV-1818
02-25-2022
JUDY NOTZ, 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
In Judy Notz's case we most assuredly do not write upon a blank slate. Quite the contrary, Notz's case had been pending in administrative and legal proceedings over the past seven years and this is Notz's second Social Security appeal. Notz initially filed for disability insurance benefits and Supplemental Security Income benefits in April of 2013, alleging that she was disabled and could not work due to premature ventricular contractions, restless leg syndrome, depression, anxiety and panic disorders, along with agoraphobia. Following a hearing, her application for benefits was denied by an Administrative Law Judge (ALJ) in May of 2015. Some two- and one-half years later in 2018, this decision was vacated by the district court and remanded for further consideration by the ALJ. Specifically, the court found that the ALJ had erred in assessing Notz's emotional impairments. In particular, the court concluded that the ALJ failed to adequately explain the weight assigned to the treating source opinions of Notz's psychiatric provider, Dr. Wehman, and the judgment of the state agency psychiatric consultant, Dr. Hite, as well as failing to address the multiple Global Assessment of Functioning (GAF) scores found within the treatment notes.
On remand, the ALJ held a second hearing and, in 2019, determined that Notz's was not disabled and could perform a range of medium work confined to simple tasks with limited interaction with others. In reaching this conclusion, the ALJ provided a much more fulsome and complete discussion of the psychiatric evidence, including an analysis of the pertinent GAF scores as well as all of the expert opinions. Notz now appeals this decision, arguing that the ALJ has continued to err in the evaluation of the medical evidence and the plaintiff's subjective complaints. Mindful of the fact that substantial evidence “means only-‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion, '” Biestek, 139 S.Ct. at 1154, we find that substantial evidence supported the ALJ's findings in this case. Therefore, for the reasons set forth below, we recommend that the court affirm the decision of the Commissioner denying this claim.
II. Statement of Facts and of the Case
A. Procedural History
On April 17, 2013, Judy Notz applied for disability benefits under Title II of the Social Security Act, alleging an onset of disability in November of 2009. (Tr. 16). Notz was born in 1959, was in her mid-50's at the time of her date last insured, and was defined as an individual approaching advanced age under the Commissioner's regulations. (Tr. 25). She had prior employment in clerical fields. (Id.)
In her disability application, Notz alleged that she was disabled due to depression, anxiety and panic disorders, along with a cardiac arrhythmia. (Tr. 18). Notz's last insured for purposes of the Social Security Act was December 13. 2014. (Id.) Thus, the analysis of the ALJ focused upon the evidence of disability between the date of alleged onset-November of 2009-and Notz's date last insured, December 13, 2014.
Following a hearing conducted on May 13, 2015, (Tr. 32-48), the ALJ issued a decision on May 21, 2015, denying Notz's disability claim. (Tr. 13-31). Notz appealed this adverse decision, (Tr. 489-93), and in December of 2018, the district court adopted a Report and Recommendation which recommended that this case be remanded for further consideration by the Commissioner. (Tr. 494-518).
This prior ruling focused upon the ALJ's consideration of Notz's emotional impairments and found three errors in this analysis which compelled a remand. Specifically, the court concluded that the ALJ failed to adequately explain the weight assigned to the treating source opinions of Notz's psychiatric provider, Dr. Wehrman; erred in failing to fully address the judgment of the state agency psychiatric consultant, Dr. Hite; and neglected to completely evaluate the multiple Global Assessment of Functioning (GAF) scores found within the treatment notes. (Id.)
With the issues on remand framed in this fashion, a second administrative hearing was held on June 3, 2019. (Tr. 436-63). On September 26, 2019, the ALJ issued a decision denying Notz's disability application. (Tr. 405-35). This appeal followed. (Doc. 1).
B. Pertinent Clinical and Medical Opinion Evidence
On remand, one of the principal issues previously identified by the court related to the evaluation and assessment of the psychiatric medical opinion evidence. On this score, the administrative record contained at least five sets of medical opinions evaluating Notz's emotional impairments between 2009 and 2014.
At the outset, there were a number of treating source records which assigned Notz various Global Assessment of Functioning, or GAF scores. These GAF scores, which represent a series of snapshots reflecting Notz's mental state on specific dates, were incorporated in the treatment notes of Notz's treating psychiatrist, Dr. Wehman. In the course of his treatment of Notz between 2014 and 2015, Dr. Wehman made the following clinical observations and assessed the following GAF scores for the plaintiff.
A GAF score was a metric formerly used in the medical profession to measure emotional functioning. In summary:
A GAF score is a numerical summary of a clinician's judgment of an individual's psychological, social, and occupational functioning on a hypothetical continuum of mental health on a scale of one hundred. See Diagnostic and Statistical Manual of Mental Disorders, 32-34 (4th ed. text rev. 2000) (hereinafter ‘DSM-IV'). A score is placed in a particular decile if either symptom severity or the level of functioning falls with that range. Id.Markoch v. Colvin, No. 3:14-CV-00780, 2015 WL 2374260, at *10 (M.D. Pa. May 18, 2015). Moreover, under the GAF score system:
GAF scores in the 51-60 range indicate moderate impairment in social or occupational functioning.” Cherry v. Barnhart, 29 Fed.Appx. 898, 900 (3d Cir. 2002). DaVinci v. Astrue, 1:11-CV-1470, 2012 WL 6137324 (M.D. Pa. Sept. 21, 2012) report and recommendation adopted, Davinci v. Astrue, 1:11-CV-1470, 2012 WL 6136846 (M.D. Pa. Dec. 11, 2012). “A GAF score of 41-50 indicates ‘serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) [or] any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).' DSM-IV at 34. A score of 50 is on the borderline between serious and moderate symptoms.” Colon v. Barnhart, 424 F.Supp.2d 805, 809 (E.D. Pa. 2006). See Shufelt v. Colvin, No. 1:15-CV-1026, 2016 WL 8613936, at *2 (M.D. Pa. Sept. 15, 2016), report and recommendation adopted sub nom. Shulfelt v. Colvin, No. 1:15-CV-1026, 2017 WL 1162767 (M.D. Pa. Mar. 29, 2017).Jones v. Colvin, No. 1:16-CV-1535, 2017 WL 4277289, at *2 (M.D. Pa. Sept. 25, 2017), report and recommendation adopted sub nom. Jones v. Berryhill, No. 1:16-CV-1535, 2017 WL 4314572 (M.D. Pa. Sept. 27, 2017). It should be noted that, by the time of the ALJ's decision in this case “the GAF score was abandoned as an assessment tool by mental health clinicians.” Long v. Colvin, No. 1:14-CV-2192, 2016 WL 1320921, at *8 (M.D. Pa. Apr. 5, 2016).
On June 11, 2014, Dr. Wehman stated that Ms. Notz “appears tense and downcast, ” and that “[h]er mood is depressed.” (Tr. 380). He diagnosed Notz with agoraphobia with panic disorder and major depressive disorder and gave Notz a GAF score of 50. (Tr. 381). Two weeks later, on June 30, 2014, Dr. Wehman found that Notz's GAF score was 50, and concluded that she exhibited agoraphobia with panic disorder and a major recurrent depressive disorder. (Tr. 376).
On August 18, 2014, Dr. Wehman noted that Notz was showing signs of “progress, ” and assigned her a GAF score of 65, stating that she had a major depressive disorder which was recurrent but mild. (Tr. 375). One month later, on September 30, 2014, Dr. Wehman described Notz as “very anxious at home” and stated that she was “beginning to relapse [into] depression in spite of [increased] Paxil.” (Tr. 374). Dr. Wehman diagnosed her with major depressive disorder that was recurrent and mild, agoraphobia with panic disorder, and assessed a GAF score of 60 for Notz. (Id.) On October 27, 2014, Dr. Wehman repeated these clinical observations and once again assessed her with a GAF score of 60. (Tr. 373).
On November 24, 2014, Dr. Wehman stated that Ms. Notz “continues to be anxious and depressed, ” and had a “tense” general appearance. (Tr. 372). Dr. Wehman assigned Notz a GAF score of 60. (Id.) The following month, on December 19, 2014, Dr. Wehman noted that Notz had regressed somewhat and diagnosed her with a GAF score of 50. (Tr. 371). Two months after this December clinical encounter, on February 4, 2015, Dr. Wehman noted improvement in Notz's condition, stating that she was making progress since her last visit. (Tr. 370). On this occasion, he assigned a GAF score of 60 to Notz. (Id.) Three weeks later, however, on February 24, 2015, Dr. Wehman observed signs of regression in her condition and concluded that her GAF score of was 50. (Id.)
Yet one month later, Dr. Wehman's treatment notes contained a GAF score entry which showed significant improvement in Notz's mental state. On March 24, 2015 Dr. Wehman noted that Notz was making progress since her last visit. (Tr. 368). He found that her major depressive disorder was in full remission and gave her a GAF score of 80. (Id.)
Thus, the pertinent GAF score evidence revealed that Notz suffered from depression and related emotional impairments, but characterized the severity of her symptoms as fluctuating from mild, to moderate, to the borderline between moderate and severe, and included six GAF scores in the mild to moderate range.
In contrast to his treatment notes and GAF scores, which frequently documented only mild to moderate symptoms, on April 21, 2015, Dr. Wehman completed a mental impairment questionnaire which cast Notz's condition in far starker terms. (Tr. 389-94). According to this report, Notz had no useful ability to function in multiple spheres of work-related activity, (Tr. 391-92), and had extreme and marked impairments in social functioning and maintaining concentration, persistence and pace. (Tr. 393).
Dr. Wehman's report was only one of four expert reports discussing Notz's mental state. Many of these other expert reports found that Notz retained a greater capacity to work than the extreme views voiced by Dr. Wehman. For example, in September of 2013, Dr. Mark Hite, a state agency expert, reviewed Notz's medical records and determined that she was not fully disabled. (Tr. 50-59). With respect to Notz's emotional impairments, Dr. Hite concluded that she faced moderate limitations in interacting with supervisors, coworkers and the public, but did not find that she suffered from severe limitations in other mental spheres of workplace functioning. (Id.)
Likewise, on August 14, 2013, Dr. Christopher Royer conducted a consultative examination of Notz. (Tr. 351-56). Dr. Royer found Notz to be pleasant and cooperative in the evaluation, (Tr. 352), and noted that she was fully oriented and displayed an adequate fund of information, but was clearly anxious. (Tr. 353). Dr. Royer diagnosed Notz as experiencing PTSD and assessed her GAF score at 50. (Tr. 353-54). As for her ability to function in the workplace, Dr. Royer concluded that Notz had no more than mild impairments in carrying out instructions and making work-related judgments. (Tr. 355). He found that she was moderately impaired when it came to interacting with supervisors and responding to changes in work routine, but determined that she suffered from marked impairments with respect to interacting with the public and coworkers due to her anxiety. (Tr. 356).
Finally, on remand, Dr. Rita Clark conducted a review of Notz's impairments and issued a report on June 30, 2019. (Tr. 748-57). This report, issued nearly five years after Notz's date last insured, had limited value since Dr. Clark candidly acknowledged that she lacked sufficient information to reach fully-informed decisions regarding the severity of Notz's impairments. (Tr. 753). Nonetheless based upon the limited and dated information that was available, Dr. Clark opined that Notz experienced only moderate impairments in interacting with others, concentration, and adaptation at work. (Tr. 754). Dr. Clark further found that Notz's ability to perform simple work functions was unimpaired and her capacity to execute more complex instructions was only moderately impaired. (Tr. 749).
Thus, on remand the ALJ was called upon to evaluate and assess this array of medical opinion evidence.
C. Other Evidence and Notz's Activities of Daily Living
On remand, the ALJ was also obliged to consider the clinical evidence and Notz's activities of daily living in order to assess the degree to which she was totally disabled. This evidence also presented a mixed and equivocal picture regarding the severity of her impairments but contained evidence which was consistent with a conclusion that she retained the capacity to perform some work. In particular, Notz's activities of daily living were indicative of some capacity to work. On this score, the evidence indicated that Notz could perform household chores including preparing meals, washing dishes, vacuuming, laundering clothes, taking out the trash, taking care of her dogs, and mowing with a riding mower. (Tr. 421). Notz also reported being able to vacation in Florida in July of 2011 and reported that she had been working on construction in her attic during December of 2011. (Id.) On September 12, 2012, Notz reported getting ready to leave on a cruise, and in August of 2014, she stated that she planned to go camping at Knoebel's over Labor Day weekend, although she later testified that she did not go camping at that time. (Id.)
D. Agency Proceedings on Remand and the ALJ's Decision
It is against this factual backdrop that the ALJ conducted a second hearing in this case on June 3, 2019. (Tr. 436-63). Notz and a Vocational Expert testified at this hearing. (Id.) Following this hearing on September 26, 2019, the ALJ issued a decision denying Notz's application for benefits. (Tr. 405-28). Mindful of the instructions on remand to more fully discuss the medical opinion evidence, this decision contained an extensive analysis of all medical opinions, along with a detailed symptom evaluation assessing the severity of Notz's reported impairments.
In that decision, the ALJ first concluded that the plaintiff met the insured status requirements of the Act through December 31, 2014, thus defining the relevant time frame for this claim. (Tr. 410). At Step 2 of the sequential analysis that governs Social Security cases, the ALJ found that Notz's premature ventricular contractions, familial tremors, restless legs syndrome, bipolar disorder, major depressive disorder, anxiety disorder and panic disorder with agoraphobia were all severe impairments. (Tr. 411). 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. 412-14).
The ALJ then concluded that:
[T]hrough the date last insured, the claimant had the residual functional capacity to perform medium work as defined in 20 CFR 404.1567(c) except the claimant retained the mental capacity to understand, remember and carry out simple instructions, to make judgments on simple work related decisions and to tolerate occasional interaction with supervisors, coworkers and the public in a routine work setting.(Tr. 415).
In reaching this RFC assessment, the ALJ engaged in an extensive, individualized analysis of each medical opinion, as well as a thorough review of Notz's reported symptoms. (Tr. 415-26). At the outset, with respect to the medical opinion evidence, the ALJ considered the various GAF scores reported by treating and examining sources noting that:
[T]he record contains GAF assessment scores of 50 to 80 rendered between August 14, 2013 and April 21, 2015 (Exhibit 6F, 9F, 11F). While the undersigned recognizes that nearly all of the GAF assessment scores were rendered by the claimant's psychiatric provider, the undersigned recognizes that the GAF assessment scores represent a subjective assessment of an area of the claimant's functioning at a specific time based upon information provided by the claimant and/or third parties, not an objective representation of the claimant's overall functioning over a longitudinal period of time. However, to the extent that the scores of 60 and higher are suggestive that mental health symptoms pose no more than moderate functional limitations, they are supported by the absence of any documentation indicating that the claimant has sought or undergone inpatient psychiatric hospitalization
or participation in a partial hospitalization program since the alleged disability onset date, the management of the claimant's mental health symptoms since the alleged disability onset date with medications prescribed by the claimant's primary care provider through June 11, 2014 with therapy starting on March 20, 2014, the commencement of psychiatric medication management starting on June 11, 2014 after the claimant's daughter moved out of the home and the claimant was at home alone at night due to her husband's work schedule, the claimant's experience of worsening symptoms during the fall of 2014 and winter of 2015 with medication adjustments with the claimant's psychiatric provider apparently attempting to undertake cardiology and neurology care of the claimant that was not recommended by the claimant's primary care provider, the notation in March of 2015 following medication adjustments with her psychiatric provider that the claimant is good and stable, the claimant's reports in June and October of 2018 of experiencing improvement in functioning and mood despite attending minimal therapy, situational stressors including her mother's health issues and desire to leave her marriage with medication management with a new psychiatric provider, the discontinuance of specialized mental health treatment as of January 25, 2019, the claimant's ability to go on vacation to Florida with family in July of 2011, a cruise in September of 2012, to do things with her daughter in June of 2014 and regularly to donate blood plasma in September of 2018 and the record reflecting no significant cognitive deficits throughout. For these reasons, the GAF assessment scores are given partial weight.(Tr. 422).
The ALJ then went on to evaluate the opinion of the state agency expert, Dr. Hite. On this score, the ALJ made the following findings:
The undersigned considered the opinion of Mark Hite, Ed.D., the State Agency psychological consultant, who indicated on September 5, 2013 that the claimant has no limitation in her activities of daily living, moderate limitation in social functioning, mild limitation in concentration, persistence or pace, no episodes of decompensation and
is able to perform the basic mental demands of simple, routine work in a stable environment (Exhibit 2A). While the undersigned finds that the claimant has moderate limitation in concentrating, persisting or maintaining pace, the undersigned recognizes that this opinion was rendered by a professional who never met with the claimant and this opinion was rendered prior to the claimant undergoing medication management with Dr. Wehman starting on June 11, 2014, to the extent that the opinion is suggestive that mental health symptoms posed no more than moderate functional limitations since the alleged disability onset date through the expiration of the date last insured, it is supported by the absence of any documentation indicating that the claimant has sought or undergone inpatient psychiatric hospitalization or participation in a partial hospitalization program since the alleged disability onset date, the management of the claimant's mental health symptoms since the alleged disability onset date with medications prescribed by the claimant's primary care provider through June 11, 2014 with therapy starting on March 20, 2014, the commencement of psychiatric medication management starting on June 11, 2014 after the claimant's daughter moved out of the home and the claimant was at home alone at night due to her husband's work schedule, the claimant's experience of worsening symptoms during the fall of 2014 and winter of 2015 with medication adjustments with the claimant's psychiatric provider apparently attempting to undertake cardiology and neurology care of the claimant that was not recommended by the claimant's primary care provider, the notation in March of 2015 following medication adjustments with her psychiatric provider that the claimant is good and stable, the claimant's reports in June and October of 2018 of experiencing improvement in functioning and mood despite attending minimal therapy, situational stressors including her mother's health issues and desire to leave her marriage with medication management with a new psychiatric provider, the discontinuance of specialized mental health treatment as of January 25, 2019, the claimant's ability to go on vacation to Florida with family in July of 2011, a cruise in September of 2012, to do things with her daughter in June of 2014 and regularly to donate blood plasma in September of 2018 and the record reflecting no significant cognitive deficits throughout. For these reasons, this opinion is given partial weight.(Tr. 422-23).
After conducting this individualized assessment of Dr. Hite's opinion and affording partial weight to that opinion, the ALJ assessed the opinion of the consulting examining expert, Dr. Royer and also gave that opinion partial weight, stating that:
The undersigned considered the opinion of Christopher Royer, Psy.D., the consultative examiner, who indicated on August 14, 2013 that the claimant has marked limitation in interacting appropriately with coworkers and the public, moderate limitation in interacting appropriately with the public and responding appropriately to usual work situations and to changes in a routine work setting, mild limitation in making judgments on simple and complex work related decisions and understanding, remembering and carrying out complex instructions and no limitation in understanding, remembering and carrying out simple instructions (Exhibit 6F). The undersigned recognizes that this opinion was rendered before the claimant began treatment with Dr. Wehman on June 11, 2014. While the undersigned agrees with the findings of moderate and lesser limitations noted in this opinion, the marked limitations stated in this opinion are not consistent with the absence of any documentation indicating that the claimant has sought or undergone inpatient psychiatric hospitalization or participation in a partial hospitalization program since the alleged disability onset date, the management of the claimant's mental health symptoms since the alleged disability onset date with medications prescribed by the claimant's primary care provider through June 11, 2014 with therapy starting on March 20, 2014, the commencement of psychiatric medication management starting on June 11, 2014 after the claimant's daughter moved out of the home and the claimant was at home alone at night due to her husband's work schedule, the claimant's experience of worsening symptoms during the fall of 2014 and winter of 2015 with medication adjustments with the claimant's psychiatric provider apparently attempting to undertake cardiology and neurology care of the claimant that was not recommended by the claimant's primary care
provider, the notation in March of 2015 following medication adjustments with her psychiatric provider that the claimant is good and stable, the claimant's reports in June and October of 2018 of experiencing improvement in functioning and mood despite attending minimal therapy, situational stressors including her mother's health issues and desire to leave her marriage with medication management with a new psychiatric provider, the discontinuance of specialized mental health treatment as of January 25, 2019, the claimant's ability to go on vacation to Florida with family in July of 2011, a cruise in September of 2012, to do things with her daughter in June of 2014 and regularly to donate blood plasma in September of 2018 and the record reflecting no significant cognitive deficits throughout. For these reasons, this opinion is given partial weight.(Tr. 423).
Finally, the ALJ carefully scrutinized the treating source opinion of Dr, Wehman. The ALJ credited many aspects of that opinion while finding that it, too, was entitled to only partial weight. As the ALJ explained:
The undersigned considered the opinion of H. Wehman, M.D., the claimant's psychiatric provider, who indicated on April 21, 2015 that the claimant has extreme limitation in social functioning, marked limitation in concentration, persistence and pace and no to mild limitation in her activities of daily living. Specifically, Dr. Wehman indicated that the claimant has no useful ability to function in maintaining attention for two (2) hour segments, sustaining an ordinary routine, making simple work related decisions, completing a normal workday and week, accepting instructions and criticism from supervisors, getting along with coworkers without distraction, responding appropriately to changes in a routine work setting, dealing with normal work stress, understanding, remembering and carrying out detailed instructions, setting realistic goals, dealing with the stress of semiskilled work, interacting appropriately with the public, traveling in unfamiliar places and using public transportation; is unable to meet competitive standards in remembering work like procedures and
working in coordination with others without distraction; is seriously limited but not precluded in understanding, remembering and carrying out very short, simple instructions; is limited but satisfactory in performing at a consistent pace and maintaining socially appropriate behavior; and is unlimited or very good in maintaining regular attendance, asking simple questions or requesting assistance, being aware of normal hazards and adhering to basic standards of neatness and cleanliness. Dr. Wehman indicated that the claimant has a residual disease process that resulted in such marginal adjustment that even a minimal increase in mental demands or change in environment would cause her to decompensate and the claimant likely would be absent from work due to symptoms more than four (4) times per month (Exhibit 11F). While the undersigned recognizes that this opinion was rendered by the claimant's psychiatric provider who treated the claimant since June 11, 2014 and agrees with the opinion to the extent that the findings of limited but satisfactory and unlimited or very good are suggestive that mental health symptoms posed no more than moderate functional limitations, the remainder of the limitations set forth in this opinion is too extensive in light of the absence of any documentation indicating that the claimant has sought or undergone inpatient psychiatric hospitalization or participation in a partial hospitalization program since the alleged disability onset date, the management of the claimant's mental health symptoms since the alleged disability onset date with medications prescribed by the claimant's primary care provider through June 11, 2014 with therapy starting on March 20, 2014, the commencement of psychiatric medication management starting on June 11, 2014 after the claimant's daughter moved out of the home and the claimant was at home alone at night due to her husband's work schedule, the claimant's experience of worsening symptoms during the fall of 2014 and winter of 2015 with medication adjustments with Dr. Wehman apparently attempting to undertake cardiology and neurology care of the claimant that was not recommended by the claimant's primary care provider, the notation in March of 2015 following medication adjustments with Dr. Wehman that the claimant is good and stable, the claimant's reports in June and October of 2018 of experiencing improvement in functioning and mood despite attending minimal therapy, situational stressors including her mother's health issues and desire to leave her marriage and medication
management with a new psychiatric provider, the discontinuance of specialized mental health treatment as of January 25, 2019, the claimant's ability to go on vacation to Florida with family in July of 2011, a cruise in September of 2012, to do things with her daughter in June of 2014 and regularly to donate blood plasma in September of 2018 and the record reflecting no significant cognitive deficits throughout. For these reasons, Dr. Wehman's opinion is given partial weight.(Tr. 424).
In the same way that the medical opinion evidence had been carefully weighed, the ALJ conducted a thorough evaluation of the severity of Notz's reported mental health symptoms, explaining that:
With regard to the claimant's mental health symptoms, while there is no question that the claimant has undergone medication management with trials of different medications since before the alleged disability onset date in this case, the claimant has not sought or undergone inpatient psychiatric hospitalization or participation in a partial hospitalization program since the alleged disability onset date. In fact, the claimant's mental health symptoms were managed since the alleged disability onset date with medications prescribed by the claimant's primary care provider through June 11, 2014 with therapy starting on March 20, 2014. The claimant began psychiatric medication management starting on June 11, 2014 after her daughter, with whom the claimant had been close and performed activities, had moved out of the household with the claimant expressing ambivalence about her marriage. Thereafter, while the claimant reported experiencing difficulty sleeping and anxiety with her husband working at night and being all alone in the large house, she reported experiencing some improvement with medication adjustments in August of 2014. While the claimant thereafter reported experiencing some worsening of symptoms during the fall of 2014 with medication adjustments, the claimant's psychiatric provider after the expiration of the date last insured apparently attempted to undertake cardiology and neurology care of the claimant in addition to her mental health care,
which was not recommended by the claimant's primary care provider. It was noted in March of 2015 following medication adjustments with the claimant's psychiatric provider that the claimant is good and stable. The claimant stopped attending therapy as of September of 2017 with treatment with a new psychiatric provider starting in May of 2018. The claimant, who returned to therapy intermittently in June of 2018, reported thereafter experiencing improvement in functioning and mood despite attending minimal therapy and situational stressors including her mother's health issues and desire to leave her marriage. In fact, specialized mental health treatment was discontinued completely as of January 25, 2019. This record that does not reflect any significant specialized management of mental health symptoms after the alleged disability onset date until therapy starting on March 20, 2014 and medication management with a psychiatric provider starting on June 11, 2014 with improvement after adjustments of medications thereafter by the psychiatric provider fails to establish a disabling level of impairment after the alleged disability onset date and at, about or after the expiration of the date last insured. While the claimant alleges that she does not leave the house other than to attend doctors' appointments, the claimant was able to go on vacation to Florida with family in July of 2011 and a cruise in September of 2012, as well as reportedly to go and do things with her daughter in June of 2014. Moreover, the claimant has not exhibited any significant cognitive deficits throughout with the claimant's attention, concentration and memory being described as intact, normal and fair. These considerations establish that the allegations are not entirely consistent with the record as a whole in this case prior to, at or even after the expiration of the date last insured. The claimant's activities of daily living similarly suggest that the claimant's symptoms were not as limiting as alleged. As stated above, the claimant lives with her husband (Testimony). The claimant has no problems attending to her personal care needs (Exhibit 4E, 5E). The claimant performs household chores including preparing meals, washing dishes, vacuuming, laundering clothes, taking out the trash, taking care of her dogs and mowing with a riding mower (Exhibit 5E, Testimony). The claimant has her driver's license (Testimony). While the claimant alleges that she does not leave the house other than to attend doctors' appointments, it was noted on July 29, 2011 that the claimant experienced left arm pain after playing with her nieces while on vacation in Florida (Exhibit 5F). On December 29,
2011, the claimant reported that she had been working on construction in her attic over the past two (2) weeks and trying to carry significant debris downstairs (Exhibit 3F). On September 12, 2012, the claimant reported getting ready to leave on a cruise (Exhibit 5F). On June 11, 2014, the claimant reported experiencing sadness when her daughter moved out to live with her boyfriend, as she and her daughter had been close and had done things together (Exhibit 9F). On August 18, 2014, the claimant reported planning to go camping at Knoebel's over Labor Day weekend, although she later testified that she did not go camping at that time (Exhibit 9F). On June 13, 2018, it was noted that the claimant has been away due to her mother's medical issues (Exhibit 13F). The claimant reported on September 13, 2018 donating blood plasma two (2) times per week (Exhibit 14F). On October 23, 2018, it was noted that the claimant had to leave town due to her mother's medical issues (Exhibit 13F). The claimant's daughter indicates that the claimant has no problems with changes in routine (Exhibit 4E). These activities of daily living are not consistent with a disabling level of impairment.(Tr. 420-21).
Given this RFC determination, the ALJ found that Notz could not perform her past work but retained the capacity to perform other jobs that existed in significant numbers in the national economy. (Tr. 426-27). Having reached these conclusions, the ALJ determined that the plaintiff had not met the demanding showing necessary to sustain her claim for benefits and denied this claim. (Id.)
This appeal followed. (Doc. 1). On appeal, Notz advances three principal claims, arguing that the ALJ erred in failing to give controlling weight to Dr. Wehman's opinion; in failing to give more than partial weight to any medical opinion; and in conducting the symptom evaluation in this case. However, given the highly deferential standard of review which applies here, and the carefully detailed findings of the ALJ, 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.
On appeal, the plaintiff also alleges that the ALJ erred in posing a hypothetical question to the Vocational Expert, but we find that this argument is largely dependent upon Notz's claims that the assessment of the medical opinions and her symptom severity led to an erroneous RFC assessment. Since, as we discuss below, these more fundamental objections fail on appeal, it follows that this objection to the ALJ's hypothetical question also fails to provide grounds for remand.
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. Evaluation of Medical Opinions
The Commissioner's regulations in effect at the time of Notz's disability application also set standards for the evaluation of medical evidence and defined medical opinions as “statements from physicians and psychologists or other acceptable medical sources that reflect judgments about the nature and severity of [a claimant's] impairment(s), including [a claimant's] symptoms, diagnosis and prognosis, what [a claimant] can still do despite impairments(s), and [a claimant's] physical or mental restrictions.” 20 C.F.R. §404.1527(a)(2). Regardless of its source, the ALJ is required to evaluate every medical opinion received. 20 C.F.R. §404.1527(c).
Effective March of 2017, the Commissioner has substantially revised the regulations governing evaluation of medical opinion evidence. However, because this case pre-dates the revision of these regulations, it is governed by the Commissioner's rules which pre-dated March of 2017.
In deciding what weight to afford competing medical opinions and evidence, the ALJ was guided by factors outlined in 20 C.F.R. §404.1527(c). “The regulations provide progressively more rigorous tests for weighing opinions as the ties between the source of the opinion and the individual become weaker.” SSR 96-6p, 1996 WL 374180 at *2. Treating sources have the closest ties to the claimant, and therefore their opinions generally entitled to more weight. See 20 C.F.R. §404.1527(c)(2) (“Generally, we give more weight to opinions from your treating sources...”); 20 C.F.R. §404.1502 (defining treating source). Under some circumstances, the medical opinion of a treating source may even be entitled to controlling weight. 20 C.F.R. §§04.1527(c)(2); see also SSR 96-2p, 1996 WL 374188 (explaining that controlling weight may be given to a treating source's medical opinion only where it is well-supported by medically acceptable clinical and laboratory diagnostic techniques, and it is not inconsistent with the other substantial evidence in the case record).
Where no medical source opinion is entitled to controlling weight, the Commissioner's regulations direct the ALJ to consider the following factors, where applicable, in deciding the weight given to any non-controlling medical opinions: length of the treatment relationship and frequency of examination; nature and extent of the treatment relationship; the extent to which the source presented relevant evidence to support his or her medical opinion, and the extent to which the basis for the source's conclusions were explained; the extent to which the source's opinion is consistent with the record as a whole; whether the source is a specialist; and, any other factors brought to the ALJ's attention. 20 C.F.R. §404.1527(c). These benchmarks, which emphasize consideration of the nature of the treating relationship, also call for careful consideration of treating source opinions.
Thus, under the regulations which existed at the time of this disability application an ALJ could not unilaterally reject a treating source's opinion and substitute the judge's own lay judgment for that medical opinion. However, the ALJ could discount such an opinion when it conflicted with other objective tests or examination results. Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 202-03 (3d Cir. 2008). Likewise, an ALJ could conclude that discrepancies between the treating source's medical opinion and the doctor's actual treatment notes justifies giving a treating source opinion little weight in a disability analysis. Torres v. Barnhart, 139 Fed.Appx. 411, 415 (3d Cir. 2005). Finally, “an opinion from a treating source about what a claimant can still do which would seem to be well-supported by the objective findings would not be entitled to controlling weight if there was other substantial evidence that the claimant engaged in activities that were inconsistent with the opinion.” Tilton v. Colvin, 184 F.Supp.3d 135, 145 (M.D. Pa. 2016).
Oftentimes, as in this case, an ALJ must evaluate various medical opinions. Judicial review of this aspect of ALJ decision-making is 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).
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 Notz was not entirely disabled, but rather could perform light work limited to simple, routine and repetitive tasks. On appeal, Notz challenges the sufficiency of the ALJ's analysis of this case, and the mental RFC formulated here, on a number of scores but we find that substantial evidence supported the ALJ's denial of this claim.
At the outset, we note that the plaintiff's argument fails to fully take into account the factual context of this case, where the ALJ was confronted with an array of competing medical opinions, a clinical record which was both dated and equivocal with many reported GAF scores reflecting only mild to moderate impairment, and self-reported activities of daily living that were not entirely congruent with a claim of complete disability. Thus, Notz vacationed, engaged in leisure activities and performed a gamut of household tasks. This evidence, standing alone, was sufficient that “a reasonable mind might accept [it] as adequate to support a conclusion” that Notz could perform work confined to simple, routine and repetitive tasks which entailed limited contact with others. Biestek, 139 S.Ct. at 1154.
In light of this mixed and equivocal medical and opinion evidence relating to Notz's emotional impairments, under the deferential standard of review that controls here, we also find that the ALJ's RFC determination sufficiently addressed the plaintiff's psychological impairments when it restricted her to simple routine and repetitive work with limited contacts with others. 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 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 Notz to simple routine tasks that entailed minimal contacts with others, 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.
We also conclude that the ALJ adequately considered the medical evidence relating to Notz's GAF scores which ranged between 50 and 80 when fashioning this mental RFC. On this score, the ALJ found that these GAF scores often reflected no more than moderate impairments, and that many of Notz's most severe scores were related to episodic stressors in her life. The ALJ also observed that treatment records reflected that she often responded well to medication and therapy. (Tr. 422).
Substantial evidence supported these findings, and we note that the United States Court of Appeals for the Third Circuit has expressly endorsed this type of fact-finding by ALJs in the past, affirming the denial of benefits in cases in which claimants presented similar overall GAF scores. See, e.g., Rios v. Comm'r of Soc. Sec., 444 F.Appx. 532 (3d Cir.2011) (affirming Commissioner where the record indicated that the plaintiff was assessed three GAF scores at different times of 50, 50, and 50-55 respectively); Gilroy v. Astrue, 351 Fed.Appx. 714 (3d Cir.2009) (affirming ALJ decision denying disability benefits despite GAF of 45); Glover v. Astrue, CIV.A. 10-901, 2011 WL 1562267 (E.D. Pa. Mar.31, 2011) report and recommendation adopted, CIV.A. 10-901, 2011 WL 1597692 (E.D. Pa. Apr. 26, 2011) (lowest identified GAF rating was 48). There was no error here.
As for the ALJ's evaluation of the medical opinion evidence in this case, we find this evaluation to have been thorough, careful, dispassionate and supported by substantial evidence in this administrative record. The ALJ examined the opinions of Drs. Hite, Royer, Wehman, and Clark, individually and with attention to detail. While the ALJ's assessment of these various medical opinions led this decision-maker to credit many of these medical findings, upon a consideration of the entire record the ALJ afforded partial weight to these various opinions. The reasons for these determinations were amply explained by the ALJ in this decision and 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, supported each of these partial weight assessments.
Notz suggests on appeal the ALJ nonetheless erred by failing to give no more than partial weight to any medical opinion. We disagree. It is axiomatic that the disability determination is a legal evaluation based upon a comprehensive review of the entire administrative record, and not one which is dictated in some mechanical fashion by some particular medical opinions. Therefore, it is well-settled that:
An ALJ is 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, 191 F.Supp.3d at 455. Accordingly the ALJ did not err in this individualized assessment of the medical opinion evidence which led to ALJ to give partial weight to all of these opinions.
In particular, we find that substantial evidence supported the ALJ's decision to give only partial weight to the opinion of Dr. Wehman. As the ALJ aptly noted, the most severely restrictive aspects of this treating source opinion were inconsistent with the doctor's treatment records, the pertinent GAF scores which often reflected mild to moderate impairment, and Notz's own self-reported activities of daily living. It is clearly recognized that a treating source opinion may be discounted, in part, when it conflicts with other objective tests or examination results, Johnson, 529 F.3d at 202-03, or when there are discrepancies between the treating source's medical opinion and the doctor's actual treatment notes. Torres, 139 Fed.Appx. at 415. Further, “an opinion from a treating source about what a claimant can still do which would seem to be well-supported by the objective findings would not be entitled to controlling weight if there was other substantial evidence that the claimant engaged in activities that were inconsistent with the opinion.” Tilton, 184 F.Supp.3d at 145. In this case, the ALJ found that the evidence revealed the types of inconsistencies which justified giving Dr. Wehman's medical opinion only partial weight, and those findings derive sufficient support from the record. There was no error here.
Finally, on appeal Notz 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 Notz's symptoms in accordance with the regulations, and found that her statements regarding the intensity and persistence of these symptoms were not entirely consistent with the medical evidence and his activities of daily living. These factual determinations regarding Notz's medical treatment and activities of daily living were supported by 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 Notz'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.
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.