Opinion
Civil Action 1:22-CV-1446
07-28-2023
DANIELLE R.,[1] Plaintiff v. KILOLO KIJAKAZI, Acting Commissioner of Social Security Defendant
BRANN, C.J.
REPORT AND RECOMMENDATION
William I. Arbuckle, U.S. Magistrate Judge
I. INTRODUCTION
Danielle R. (“Plaintiff”), an adult who lives in the Middle District of Pennsylvania, seeks judicial review of the final decision of the Acting Commissioner of Social Security (“Commissioner”) denying her application for disability insurance benefits under Title II of the Social Security Act. Jurisdiction is conferred on this Court pursuant to 42 U.S.C. §405(g).
This matter has been referred to the undersigned magistrate judge to issue a report and recommendation. After reviewing the parties' briefs, the Commissioner's final decision, and the relevant portions of the certified administrative transcript, we find the Commissioner's final decision is supported by substantial evidence. Accordingly, it is RECOMMENDED that the Commissioner's final decision be AFFIRMED.
II. BACKGROUND & PROCEDURAL HISTORY
On March 14, 2019, Plaintiff protectively filed an application for disability insurance benefits under Title II of the Social Security Act. (Admin. Tr. 14; Doc. 12-2, p. 15). In this application, Plaintiff alleged she became disabled on July 15, 2016, when she was thirty-eight years old, due to the following conditions: chronic fatigue; joint pain; Lyme disease; difficulty walking-uses a cane to walk; fibromyalgia; and bipolar disorder. (Admin. Tr. 222; Doc. 12-6, p. 6). Plaintiff alleges that the combination of these conditions affects her ability to lift, squat, bend, stand, reach, walk, sit, kneel, talk, climb stairs, complete tasks, concentrate, understand, follow instructions, and use her hands. (Admin. Tr. 253; Doc. 12-6, p. 37). She also alleges these conditions affect her memory. Id. Plaintiff completed high school and two years of college. (Admin. Tr. 223; Doc. 12-6, p. 7). Plaintiff is also a certified travel agent. Id. Before the onset of her impairments, Plaintiff worked as a benefits clerk, payroll clerk, a courier/administrative clerk/receptionist, and a sales laborer/vendor. (Admin. Tr. 26; Doc. 12-2, p. 27).
On June 20, 2019, Plaintiff's application was denied at the initial level of administrative review. (Admin. Tr. 14; Doc. 12-2, p. 15). On October 22, 2019, Plaintiff's application was denied on reconsideration. Id. On November 26, 2019, Plaintiff requested an administrative hearing. Id.
On September 9, 2020, Plaintiff, assisted by her counsel, appeared and testified during a hearing before Administrative Law Judge Scott M. Staller (the “ALJ”). (Admin. Tr. 14, 28; Doc. 12-2, pp. 15, 29). On November 17, 2020, the ALJ issued a decision denying Plaintiff's application for benefits. (Admin. Tr. 28; Doc. 12-2, p. 29). On January 20, 2021, Plaintiff requested that the Appeals Council of the Office of Disability Adjudication and Review (“Appeals Council”) review the ALJ's decision. (Admin. Tr. 202; Doc. 12-4, p. 96). Along with her request, Plaintiff submitted new evidence that was not available to the ALJ when the ALJ's decision was issued. (Admin. Tr. 8; Doc. 12-2, p. 9).
On July 13, 2022, the Appeals Council denied Plaintiff's request for review. (Admin. Tr. 1-7; Doc. 12-2, pp. 2-8).
On September 16, 2022, Plaintiff filed a complaint in the Court. (Doc. 1). In the complaint, Plaintiff alleges that the ALJ's decision denying the application “is not supported by substantial evidence and is based on the incorrect application of legal principles and the application of incorrect legal principles.” (Doc. 1 ¶13). As relief, Plaintiff requests that the court reverse the ALJ's decision and award benefits, or in the alternative remand this case for a new hearing with directions to render a timely decision in accordance with the applicable law. (Doc. 1, ¶ 14).
On November 21, 2022, the Commissioner filed an answer. (Doc. 11). In the answer, the Commissioner maintains that the decision denying Plaintiff's application is correct, was made in accordance with the law, and is supported by substantial evidence. (Doc. 11, ¶ 9). Along with her answer, the Commissioner filed a certified transcript of the administrative record. (Doc. 12).
Plaintiff's Brief (Doc. 13), the Commissioner's Brief (Doc. 14), and Plaintiff's Reply (Doc. 15) have been filed. This matter is now ready to decide.
III. LEGAL STANDARDS
Before looking at the merits of this case, it is helpful to restate the familiar legal principles of substantial evidence review and the sequential evaluation process governing Social Security Appeals. We will also discuss the standards relevant to mental impairments and symptom evaluation, the specific arguments raised in this case.
A. Substantial Evidence Review - the Role of This Court
A district court's review of ALJ decisions in social security cases is limited to the question of whether the findings of the final decision-maker are supported by substantial evidence in the record.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.”Substantial evidence is less than a preponderance of the evidence but more than a mere scintilla. A single piece of evidence is not substantial if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the record.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.” In determining if the Commissioner's decision is supported by substantial evidence under sentence four of 42 U.S.C. § 405(g) the court may consider any evidence that was in the record made before the ALJ.
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).
Pierce v. Underwood, 487 U.S. 552, 565 (1988).
Richardson v. Perales, 402 U.S. 389, 401 (1971).
Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993).
Consolo v. Fed. Maritime Comm 'n, 383 U.S. 607, 620 (1966).
Matthews v. Apfel, 239 F.3d 589, 593 (3d Cir. 2001) (“when the Appeals Council has denied review the district court may affirm, modify, or reverse the Commissioner's decision, with or without a remand based on the record that was made before the ALJ (Sentence Four review).”). The claimant and Commissioner are obligated to support each contention in their arguments with specific reference to that record where appropriate. L.R. 83.40.4; United States v. Claxton, 766 F.3d 280, 307 (3d Cir. 2014) (“parties . . . bear the responsibility to comb the record and point the Court to the facts that support their arguments.”); Ciongoli v. Comm'r of Soc. Sec., No. 15-7449, 2016 WL 6821082 (D.N.J. Nov. 16, 2016) (noting that it is not the Court's role to comb the record hunting for evidence that the ALJ overlooked).
The Supreme Court has underscored the limited scope of district court 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 v. Berryhill, 139 S.Ct. 1148, 1154 (2019).
To determine whether the final decision is supported by substantial evidence, the court must decide not only whether “more than a scintilla” of evidence supports the ALJ's findings, but also whether those findings were made based on a correct application of the law.In doing so, however, the court is enjoined to refrain from trying to re-weigh evidence and “must not substitute [its] own judgment for that of the fact finder.”
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 ....”).
Zirnsak v. Colvin, 777 F.3d 607, 611 (3d Cir. 2014).
Furthermore, meaningful review cannot occur unless the final decision is adequately explained. 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 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).
B. Standards Governing the ALJ's Application of The Five-Step Sequential Evaluation Process
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.” 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. To receive benefits under Title II of the Social Security Act, a claimant must also 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(d)(1)(A); see also 20 C.F.R. § 404.1505(a).
In making this determination at the administrative level, the ALJ follows a five-step sequential evaluation process.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”).
Between steps three and four, the ALJ must also assess a claimant's RFC. RFC is defined as “that which an individual is still able to do despite the limitations caused by his or her impairment(s).” In making this assessment, the ALJ considers all the claimant's medically determinable impairments, including any non-severe impairments identified by the ALJ at step two of his or her analysis.
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); 20 C.F.R. § 404.1545(a)(1).
At steps one through four, 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. Once this burden has been met by the claimant, it shifts to the Commissioner at step five 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.
C. Guidelines for the ALJ's Evaluation of Mental Impairments
The Commissioner's regulations set out a special technique for the evaluation of mental impairments. This “special technique” is sometimes referred to as the Psychiatric Review Technique (“PRT”) or the paragraph B criteria. First, the ALJ is required to evaluate the claimant's “pertinent symptoms, signs, and laboratory findings” to determine whether the claimant has one or more medically determinable mental impairments.” Second, the ALJ is required to rate the degree of functional limitation (none, mild, moderate, marked, or extreme) resulting from the impairment across the following four broad functional areas: understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; and adapting or managing oneself.
SSR 96-8p refers to the “psychiatric review technique” described in 20 C.F.R. § 404.1520a. 1996 WL 374184, at *4. The broad functional areas analyzed as part of this special technique are the same areas that are assessed in “paragraph B” of the mental disorder listings in 20 C.F.R. Pt. 404, Subpt. P. App. 1.
20 C.F.R. § 404.1520a. The points on the rating scale are defined in the listing of impairments. 20 C.F.R. Pt. 404, Subpt. P. App. 1 § 12.00(F)(2). The broad functional areas are also defined in the listing of impairments. 20 C.F.R. Pt. 404, Subpt. P. App. 1 § 12.00(E).
After an ALJ rates the degree of functional limitation across these broad categories, he or she will use those ratings to determine the severity of a claimant's mental impairments. If the claimant has “no” or “mild” limitations across all categories, the impairment will be found non-severe at step two “unless the evidence otherwise indicates that there is more than a minimal limitation in [the claimant's] ability to do basic work activities.” If an impairment is found severe, the ratings will be used to determine whether the claimant's mental impairments meet or medically equal a listed impairment at step three.
Where a claimant has at least one severe impairment, but does not have an impairment that meets or equals a listing, a more detailed functional assessment is required. As explained in SSR 96-8p:
the limitations identified in the “paragraph B” . . . criteria are not an RFC assessment but are used to rate the severity of mental impairment(s) at steps 2 and 3 of the sequential evaluation process. The mental RFC assessment used at steps 4 and 5 of the sequential evaluation process requires a more detailed assessment by itemizing various functions contained in the broad categories found in paragraphs B and C of the adult mental disorders listings in 12.00 of the Listing of Impairments, and summarized on the PRTF.
SSR 96-8p, 1996 WL 374184, at *4.
D. Guidelines For An ALJ's Symptom Evaluation
In social security cases, “symptoms” are defined as the claimant's “own description of [his or her] physical or mental impairments.” The Social Security Regulations and Rulings set out a two-step process to evaluate a claimant's symptoms.
First, the ALJ must consider whether there is an underlying medically determinable impairment that could reasonably be expected to produce the claimant's symptoms. If there is no medically determinable impairment, or if there is a medically determinable impairment but that impairment could not reasonably be expected to produce the claimant's symptoms, an ALJ will not find that those symptoms affect the claimant's ability to perform work-related activities. An ALJ does not consider whether the severity of an individual's symptoms is supported by the objective medical evidence at the first step of this analysis.
SSR 16-3p, 2017 WL 5180304, at *4.
SSR 16-3p, 2017 WL 5180304, at *3.
Second, the ALJ must evaluate the intensity, persistence, and limiting effects of the symptoms caused by the claimant's medically determinable impairments. SSR 16-3p explains:
If an individual's statements about the intensity, persistence, and limiting effects of symptoms are consistent with the objective medical evidence and the other evidence of record, we will determine that the individual's symptoms are more likely to reduce his or her capacities to perform work-related activities for an adult. . . . In contrast, if an individual's statements about the intensity, persistence, and limiting effects of symptoms are inconsistent with the objective medical
evidence and the other evidence, we will determine that the individual's symptoms are less likely to reduce his or her capacities to perform work-related activities or abilities to function independently, appropriately, and effectively in an age-appropriate manner.
We may or may not find an individual's symptoms and related limitations consistent with the evidence in his or her record. We will explain which of an individual's symptoms we found consistent or inconsistent with the evidence in his or her record and how our evaluation of the individual's symptoms led to our conclusions. We will evaluate an individual's symptoms considering all the evidence in his or her record.
SSR 16-3p, 2017 WL 5180304, at *8.
When evaluating a claimant's symptoms, an ALJ considers objective evidence, a claimant's statements about the intensity, persistence and limiting effects of his or her symptoms, statements made by medical sources in opinions and treatment records, and statements about a claimant's symptoms made by nonmedical sources. This evidence is evaluated based on the following factors:
(1) the claimant's daily activities;
(2) the location, duration, frequency, and intensity of the claimant's pain or other symptoms;
(3) any factor that precipitates or aggravates the claimant's pain or other symptoms;
(4) the type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate his or her pain or other symptoms;
(5) any treatment, other than medication, the claimant receives or has received for relief of his or her pain or other symptoms;
(6) any measures the claimant uses or has used to relieve his or her pain or other symptoms (e.g., lying flat on your back, standing for 15 to 20 minutes every hour, sleeping on a board, etc.); and
(7) any other factors concerning functional limitations and restrictions due to pain or other symptoms.
The ALJ is required to discuss the factors pertinent to the evidence of record, but will not discuss a factor where it is not relevant.
SSR 16-3p, 2017 WL 5180304, at *8.
Although the “statements of the individual concerning his or her symptoms must be carefully considered . . . the ALJ is not required to credit them.” The ALJ is, however, required to explain which of an individual's symptoms he or she finds consistent or inconsistent with the evidence in the record.
Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 363 (3d Cir. 2011).
SSR 16-3p, 2017 WL 5180304, at *8.
Some claimants may experience symptoms differently and may be limited by symptoms to a greater or lesser extent than other claimants with the same medical impairments, objective evidence, and non-medical evidence. For this reason, district courts have recognized that an ALJ, as the factfinder, is in a better position to evaluate a claimant's symptoms, and generally afford great deference to an ALJ's symptom evaluation. With this understanding of the relevant legal principles, we now turn to the specifics of this case.
SSR 16-3, 2017 WL 5180304, at *4.
IV. DISCUSSION
Plaintiff raises the following issues in her statement of errors:
(1) “Substantial evidence does not support the ALJ's RFC assessment.” (Doc. 13, p. 1).
(2) “The ALJ's multiple errors with symptom evaluation compel reversal.” Id.
However, based on our review of the briefs, Plaintiff actually raises five arguments:
(1) Whether the ALJ adequately defined Plaintiff's ability to sit, stand, and walk in the RFC assessment;
(2) Whether the record in this case is adequately developed despite the absence of a treating or examining source opinion about Plaintiff's impairments;
(3) Whether substantial evidence supports the ALJ's analysis that Plaintiff's Lyme disease symptoms are inconsistent with the level of treatment she received;
(4) Whether substantial evidence supports the ALJ's analysis that some of Plaintiff's statements about the intensity, persistence, and limiting effects of her impairments are inconsistent with some of Plaintiff's selfreported activities of daily living; and
(5) Whether substantial evidence supports the ALJ's analysis that Plaintiff had “stable” mental health-related symptoms with “modest” treatment.
We will begin our analysis by summarizing the ALJ's findings in his decision, and then will address each of Plaintiff's arguments.
A. The ALJ's Decision Denying Plaintiff's Application
In his November 2020 decision, the ALJ found that Plaintiff met the insured status requirement of Title II of the Social Security Act through September 30, 2017. (Admin. Tr. 16; Doc. 12-2, p. 17). Then, Plaintiff's application was evaluated at steps one through five of the sequential evaluation process.
At step one, the ALJ found that Plaintiff did not engage in substantial gainful activity at any point between July 15, 2016, (Plaintiff's alleged onset date) and September 30, 2017, (Plaintiff's date last insured) (“the relevant period”). (Admin. Tr. 16; Doc. 12-2, p. 17).
At step two, the ALJ found that, during the relevant period, Plaintiff had the following medically determinable severe impairments: chronic Lyme disease, bipolar disorder, and anxiety disorder. (Admin. Tr. 17-19; Doc. 12-2, pp. 18-20). The ALJ found that the following conditions were medically determinable but non-severe: recurrent candidiasis infections, urinary tract infections, and one renal stone requiring acute removal in March 2017. Id. The ALJ found that the following conditions were not medically determinable during the relevant period: intestinal cystitis, temporomandibular joint dysfunction, fall with concussion, osteoarthritis, rheumatoid arthritis, fibromyalgia, hypertension, hepatitis C, cervical spine disorder, carpal tunnel syndrome, ankle fracture, trochanteric bursitis, cubital tunnel syndrome, migraine, sleep disorder, attention deficit hyperactivity disorder, posttraumatic stress disorder, obsessive-compulsive disorder, depressive disorder, and substance use disorder. Id.
At step three, the ALJ found that, during the relevant period, Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Admin. Tr. 19-21; Doc. 12-2, pp. 20-22).
Between steps three and four, the ALJ assessed Plaintiff's RFC. The ALJ found that, during the relevant period, Plaintiff retained the RFC to engage in light work as defined in 20 C.F.R. § 404.1567(b) except:
the claimant can occasionally climb ramps, stairs, ladders, ropes, and scaffolds. She can frequently stoop, kneel, crouch, or crawl. The claimant can tolerate frequent exposure to unprotected heights, moving mechanical parts, dusts, fumes, gases, odors, poor ventilation, and other pulmonary irritants. She can understand, remember, or carry out detailed, but uninvolved written or oral instructions. The claimant can deal with problems involving a few concrete variables on or from standardized situations. The claimant can make judgments on detailed, but uninvolved written or oral instructions. She can only occasionally interact with the public, coworkers, and supervisors in a routine work setting.(Admin. Tr. 21; Doc. 12-2, p. 22).
At step four, the ALJ found that, during the relevant period, Plaintiff could not engage in her past relevant work. (Admin. Tr. 26; Doc. 12-2, p. 27).
At step five, the ALJ found that, considering Plaintiff's age, education and work experience, Plaintiff could engage in other work that existed in the national economy. (Admin. Tr. 27-28; Doc. 12-2, pp. 28-29). To support his conclusion, the ALJ relied on testimony given by a vocational expert during Plaintiff's administrative hearing and cited the following three representative occupations: cleaner-housekeeping, DOT# 323.687-014; small products assembler, DOT# 739.687-030; and electrical accessories assembler, DOT# 729.687-010. Id.
B. The ALJ Adequately Defined Plaintiff's Ability To Sit, Stand, and Walk in the RFC Assessment
In his decision, the ALJ found that Plaintiff was limited to the performance of “light” work. The term, “light work” is an exertional category that is well-defined in the Commissioner's regulations and rulings. The relevant regulation explains that:
Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities.
The amount of standing or walking required in light work is clarified in SSR 83-10. This ruling provides that:
Since frequent lifting or carrying requires being on one's feet up to two-thirds of a workday, the full range of light work requires standing or walking, off and on, for a total of approximately 6 hours of an 8-hour workday. Sitting may occur intermittently during the remaining time. The lifting requirement for the majority of light jobs can be accomplished with occasional, rather than frequent, stooping. Many unskilled light jobs are performed primarily in one location, with the ability to stand being more critical than the ability to walk. They require use of arms and hands to grasp and hold and turn objects, and they generally do not require use of the fingers for fine activities to the extent required in much sedentary work.
SSR 83-10, 1983 WL 31251, at *6.
Plaintiff argues that the ALJ's RFC assessment is deficient as a matter of law because it does not include a function-by-function assessment of Plaintiff's limitations.In particular she argues that, instead of separately setting out the individual limitations to Plaintiff's ability to sit, stand, and walk, the ALJ simply cites to the definition of “light” work. (Doc. 13, pp. 5-6). Plaintiff is correct that neither the RFC assessment itself nor the narrative discussion that follows discusses Plaintiff's ability to sit, stand, or walk individually. We are not, however, persuaded that this issue requires remand.
See SSR 96-8p, 1996 WL 374184.
It is well-established that although an ALJ's RFC assessment “must first identify an individual's functional limitations or restrictions and assess his or her work-related abilities on a function-by-function basis,” an ALJ is not required to use particular language or adhere to a particular format in conducting that analysis. Instead, an ALJ is only required to provide “sufficient development of the record and explanation of [his or her] findings to permit meaningful review.” This principle has been extended to issues like this one, where an ALJ articulated an RFC assessment in terms of an exertional category without discussing sitting, standing, or walking separately.
SSR 96-8p, 1996 WL 374184, at *1; Jones v. Barnhart, 364 F.3d 501, 505 (3d Cir. 2004).
Jones, 364 F.3d at 505.
See e.g., Navas v. Comm'r of Soc. Sec., 289 Fed.Appx. 555, 558 (3d Cir. 2008) (rejecting a claimant's argument that the ALJ failed to define her sitting, standing, and walking limitations, stating “by finding that Navas could perform light work, the ALJ implicitly found that she could work at a job that involves ‘a good deal of walking or standing,' or a job that ‘involves sitting most of the time with some pushing and pulling of arm or leg controls.”); Johnny R. v. Kijakazi, No. 2:20-CV-12818, 2023 WL 4073960, at *6 (D.N.J. June 20, 2023) (finding that an ALJ's RFC assessment limiting a claimant to sedentary work was effectively an assessment that the claimant could sit for up to six hours in an eight-hour workday, stand/walk for up to two hours in and eight-hour workday, and lift/carry up to ten pounds).
C. The ALJ Adequately Developed the Administrative Record
Plaintiff asserts that the record in this case is insufficient because there is no treating or examining medical source opinion about her physical or mental health-related limitations. The record does, however, contain administrative medical findings about Plaintiff's impairments from the initial and reconsideration level of review, treatment records, and Plaintiff's own statements about her symptoms. Thus, we must consider whether this evidence was sufficient to allow an ALJ to reach a reasoned conclusion in this case.
Plaintiff argues that there is “absolutely no support for the ALJ's physical or mental RFC assessment as the record is devoid of any RFC assessments from any physicians (treating or examining).” (Doc. 13, p. 6). She also suggests that the ALJ “should have sent Ms. [R.] to a consultative examiner or scheduled a medical expert at the hearing for an opinion as to the claimant's residual functional capacity.” (Doc. 13, p. 7). To support her argument Plaintiff cites to: Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th Cir. 2001); Rondan v. Halter, 8 Fed.Appx. 724, 725 (9th Cir. 2001); and DeLorme v. Sullivan, 924 F.2d 841 (9th Cir. 1991).
In response, the Commissioner argues that Plaintiff's argument “lacks both a factual and legal basis” because Plaintiff overlooks the prior administrative medical findings. (Doc. 14, pp. 12-15). She also contends that a record can be sufficient without a treating or examining source opinion. and because the decision to order a consultative examination is discretionary. Id.
Plaintiff's argument is not persuasive. Although she cites to three cases where the Ninth Circuit Court of Appeals remanded for further development of the record, the facts of each case are distinguishable from those presented here. None address the scenario where the opinion evidence of record is limited to state agency consultant administrative medical findings. In the Third Circuit, courts have found that substantial evidence can support a decision in the absence of a treating or examining source opinion, and that the absence of a treating or examining source opinion alone does not trigger an ALJ's obligation to further develop the record.
In Tonapetyan, the Ninth Circuit Court of Appeals reversed a district court's decision that substantial evidence supported an ALJ's opinion. The Court concluded that substantial evidence did not support the ALJ's evaluation of a claimant's mental impairments because the ALJ relied heavily on limitations assessed by a nonexamining medical expert, who testified that the claimant's records were “confusing,” and who recommended that a more detailed report be obtained because he found it difficult to say whether the medical record was complete enough to allow the ALJ to reach a conclusion. Tonapetyan, 242 F.3d at 1150-51. In Rondan, the Ninth Circuit reversed and remanded a district court opinion affirming an ALJ's decision. In Rondan, the claimant was proceeding pro se, no treating source submitted an opinion, and the only source that provided a functional assessment was a consultative examiner who did not have access to any of the claimant's records at the time of the examination. Rondan, 8 Fed.Appx. at 725. The Court of Appeals reasoned that the ALJ did not meet his heightened duty to develop the record, and found that the ALJ should have ordered another RFC examination by a doctor who would examine the claimant and consider his medical records. Id. In DeLorme, the Ninth Circuit reversed and remanded a district court opinion affirming an ALJ's decision. In DeLorme, physicians treating the claimant's physical impairments consistently noted he suffered from depression, and one physician noted that the claimant was hospitalized in February 1981 because of depression with dissociative state. Delorme, 924 F.2d at 844. The claimant applied for benefits in 1982, but did not have a comprehensive psychiatric evaluation until 1986 (the same year his administrative hearing took place). Id. at 844, 848. That 1986 report was highly suggestive that the claimant met a listing. The record did not, however, include evidence to establish how continuous or extensive the claimant's mental health symptoms were before 1986. Id. at 847-50. The Court found that substantial evidence did not support the ALJ's decision because the ALJ did not develop the record as to the claimant's onset date as was (at the time) required under SSR 83-20. Id.
When faced with a similar scenario, a magistrate judge from a court in the Ninth Circuit issued a report and recommendation rejecting an argument similar to Plaintiff's argument. In the report, the magistrate judge reasoned that “the mere absence of a report from a treating or examining physician does not give rise to a duty to develop the record.” Tahnee M. v. Kijakazi, No. 22-CV-00257-BEN-JLB, 2023 WL 4624698, at *9-11 (S.D. Cal. Jul. 19, 2023). This report, issued only one week ago, has not been reviewed by the District Judge.
See e.g., Chandler, 667 F.3d 356 (finding that substantial evidence supported an ALJ's RFC assessment where the only functional assessment by an acceptable medical source in the record before the ALJ was from a state agency consultant); Lutz-Stoker v. Saul, No. 3:19-CV-1601, 2020 WL 2306760, at *9 (M.D. Pa. May 8, 2020) (finding that an ALJ has no affirmative obligation to seek out further medical opinions unless the claimant establishes that such an examination is necessary to enable the ALJ to make a disability determination).
Accordingly, we find that the record was adequately developed in this case.
D. Substantial Evidence Supports the ALJ's Symptom Evaluation
Plaintiff asserts several challenges to the ALJ's evaluation of her statements about the intensity, persistence and limiting effects of her symptoms. We will begin our analysis by summarizing those statements. In his decision, the ALJ provided a thorough summary of Plaintiff's testimony. We find that the summary is largely accurate, and therefore have reproduced it below:
The claimant alleges disability due to Lyme disease, fibromyalgia, pinched ulnar and median nerves, thumb arthritis/tendinitis, bulging discs in the neck, a broken ankle, ganglion cyst, psoriasis, hepatitis C,
migraine headaches, interstitial cystitis, concussion, rheumatoid arthritis, bipolar disorder, anxiety disorder, attention deficit hyperactivity disorder, posttraumatic stress disorder, obsessive compulsive disorder, and depressive disorder, symptomatically characterized by chronic fatigue, chronic joint and neck pain, hand/arm pain with weakness and loss of feeling, headaches occurring two to three times per month, difficulty walking, anxiety, depression, limited concentration/focus, impaired memory, hypersomnia, and insomnia (Ex. 2E, 7E, 10E, 13E, 17E, 21E; Testimony). She also reports tiredness, feeling loopy, sleepiness, and grogginess as side effects of her prescription medications (Ex. 13E; Testimony). Secondary to these disorders, symptoms, and side effects, the claimant alleges she has significant difficulty lifting, sitting, standing, walking, squatting, bending, reaching, kneeling, climbing stairs, using her hands, talking, remembering, completing tasks, concentrating, understanding, following instructions, getting along with authority figures, friends, family, or neighbors, handling stress, and handling changes in routine (Ex. 7E; Testimony). The claimant specifically alleges she cannot type, write for long periods, lift or carry anything, walk, stand, or sit for long periods, drive without difficulty, ambulate without the use of a cane, or mentally complete tasks, such that, due to the combination of her impairments, she would be unable to maintain the concentration and/or pace required to sustain any job in the national economy (Ex. 6E, 7E, 9E, 10E, pp. 9; Testimony).(Admin. Tr. 21-22; Doc. 12-2, pp. 23-24).
Ultimately, the ALJ found that, although Plaintiff's medically determinable impairments could reasonably be expected to cause some of the alleged symptoms, the claimant's statements about the intensity, persistence, or limiting effects of those symptoms were not entirely consistent with the medical and other evidence of record. Plaintiff disagrees with some of the reasons the ALJ cited in support of his evaluation of her statements. First she argues that substantial evidence does not support the ALJ's rationale for discounting her statements about the intensity and limiting effects of her Lyme disease symptoms because he did not adequately develop the record before drawing the inference that Plaintiff's “markedly conservative” treatment was inconsistent with her statements. Second she argues that contrary to the ALJ's conclusion, her activities of daily living are consistent with her statements about the severity and limiting effects of her symptoms. Third, she argues that the ALJ incorrectly concluded that her ability to function in a clinical environment was inconsistent with her statements about her mental health-related symptoms. The Commissioner disagrees, and argues that substantial evidence supports the ALJ's evaluation of Plaintiff's statements about the intensity, persistence and limiting effects of her symptoms.
1. Substantial Evidence Supports the Evaluation of Plaintiff's Lyme Disease Symptoms
Plaintiff was originally diagnosed with Lyme disease in 2007. (Admin. Tr. 12-7, p. 22). After her initial diagnosis and treatment Plaintiff reports that she continued to have symptoms and flare-ups. Id. In his decision the ALJ discussed Plaintiff's statements about the intensity and persistence of her Lyme disease symptoms as follows:
Relevant to the period at issue, the record documents extensive subjective symptom complaints attributed to Lyme disease, primarily pain, fatigue, and mental confusion but also including headache, bowel
issues, sleep disturbance and multiple other symptoms ranging from mild to severe in her subjective estimation (Ex. 3F, 4F, 29F, 40F). However, the claimant's treatment for Lyme disease was markedly conservative, as she was primarily managed with homeopathic supplements and some osteopathic manipulation (Ex. 3F, 29F), a lesser course of care than would be expected given the alleged severity of the claimant's symptoms. There is no documentation of persistent side effects associated with this treatment (see Id.). Further, physical examinations from the alleged onset date through the date last insured fail to objectively support the claimant's extensive allegations of exertional and non-exertional physical dysfunction, as these exams documented typical claimant presentation in no acute distress with normal cardiovascular, respiratory, abdominal, musculoskeletal, and neurological presentation - specifically including full motor strength throughout the body, intact sensation throughout the body, normal reflexes and cranial nerves, normal gait, and full range of motion in all joints (Ex. 3F, 27F, 29F, 43F, 46F); this includes the physical examination closest in time to the date last insured, which specifically noted presentation in no distress with normal eyes, ears, throat, oral cavity, neck, lymph nodes, lungs, heart, skin, and abdomen, neurologic exam nonfocal with normal motor strength and full sensation in all extremities, and extremity exam normal for extremity presentation and vascular functioning (Ex. 46F, pp. 34).(Admin. Tr. 23; Doc. 12-2, p. 24) (emphasis added).
Plaintiff argues that the ALJ characterized her treatment for Lyme disease as “conservative” and then improperly discounted her statements about the debilitating limitations this condition causes without developing the record to determine why Plaintiff did not pursue more aggressive treatment. (Doc. 13, p. 7).
In her argument, Plaintiff cites to page 23 of the administrative record. The word “conservative” appears on this page one time, in the ALJ's discussion of Plaintiff's testimony about her Lyme disease symptoms. Therefore, we construe Plaintiff's argument as challenging the ALJ's evaluation of her Lyme symptoms.
In response, the Commissioner argues the consideration of Plaintiff's course of treatment for an impairment is proper under the applicable regulation. (Doc. 14, p. 19).
In reply, Plaintiff does not dispute that an ALJ is required to consider Plaintiff's course of treatment. She argues that in this particular case the ALJ failed to adequately develop evidence about this issue, and failed to explain the basis for his conclusion that this factor weighed against crediting her testimony. (Doc. 15, p. 2).
As the Commissioner notes in her brief, 20 C.F.R. § 404.1529 lists several factors to consider when evaluating a claimant's statements about the intensity and limiting effects of symptoms. Those factors include “[t]he type dosage, effectiveness, and side effects of any medication” the claimant takes or has taken, and “[t]reatment, other than medication” that the claimant receives or has received.SSR 16-3p explains that an ALJ:
will consider an individual's attempts to seek medical treatment for symptoms and to follow treatment once it is prescribed when evaluating whether symptom intensity and persistence affect the ability to perform work-related activities for an adult . . . . Persistent attempts to obtain relief of symptoms, such as increasing dosages and changing medications, trying a variety of treatments, referrals to specialists, or
changing treatment sources may be an indication that an individual's symptoms are a source of distress and may show that they are intense and persistent. []
In contrast, if the frequency or extent of the treatment sought by an individual is not comparable with the degree of the individual's subjective complaints, or if the individual fails to follow prescribed treatment that might improve symptoms, we may find the alleged intensity and persistence of an individual's symptoms are inconsistent with the overall evidence of record.
Plaintiff's argument is based on the following passage from this same ruling:
[An ALJ] will not find an individual's symptoms inconsistent with the evidence in the record on this basis without considering possible reasons he or she may not comply with treatment or seek treatment consistent with the degree of his or her complaints. We may need to contact the individual regarding the lack of treatment or, at an administrative proceeding, ask why he or she has not complied with or sought treatment in a manner consistent with his or her complaints.
SSR 16-3p, 2017 WL 5180304, at *9 (internal footnote omitted).
Id. (emphasis in original).
When an ALJ considers a claimant's treatment history, he or she may consider (but is not limited to) one or more of the following: (1) “An individual may have structured his or her activities to minimize symptoms to a tolerable level by avoiding physical activities or mental stressors that aggravate his or her symptoms”; (2) “An individual may receive periodic treatment or evaluation for refills of medications because his or her symptoms have reached a plateau;” (3) “An individual may not agree to take prescription medications because the side effects are less tolerable than the symptoms;” (4) “An individual may not be able to afford treatment and may not have access to free or low-cost medical services;” (5) “A medical source may have advised the individual that there is no further effective treatment to prescribe or recommend that would benefit the individual;” (6) “An individual's symptoms may not be severe enough to prompt him or her to seek treatment, or the symptoms may be relieved with over the counter medications;” (7) “An individual's religious beliefs may prohibit prescribed treatment;” (8) “Due to various limitations (such as language or mental limitations), an individual may not understand the appropriate treatment for or the need for consistent treatment of his or her impairment;” and (9) “Due to a mental impairment (for example, individuals with mental impairments that affect judgment, reality testing, or orientation), an individual may not be aware that he or she has a disorder that requires treatment.”In conducting this analysis an ALJ will “review the case record to determine whether there are explanations for inconsistencies in the individual's statements about symptoms and their effects, and whether the evidence of record supports any of the individual's statements at the time he or she made them.”
Id. at 9-10.
Id. at 10.
We agree that the ALJ did not adequately explain the basis for his conclusion that, Plaintiff's statements about the intensity of her symptoms are inconsistent with the level of treatment pursued for Lyme disease. Nonetheless we are not persuaded that the ALJ's failure to explain his analysis of one of the 20 C.F.R. § 404.1529(c) factors related to his evaluation of Plaintiff's statements about the limitations caused by one of Plaintiff's impairments warrants remand in this case because substantial evidence supports the ALJ's analysis of the remaining relevant factors.
Lyme disease is a bacterial infection caused by the bite of an infected tick. Lyme Disease, MedlinePlus, https://medlineplus.gov/lymedisease.html (last visited July 23, 2023). Initially, Lyme disease is treated with antibiotics. Id. Some individuals, however, develop post-treatment Lyme disease syndrome and continue to experience symptoms. Id. There is no proven treatment for post-treatment Lyme disease syndrome, but a health care provider may be able to help a patient manage their symptoms. Id. Most people get better with time. Id.
See e.g., Fisher v. Colvin, No. 2:15-CV-215-JLR-DWC, 2015 WL 8104961 at *2-3 (W.D. Wash. Nov. 17, 2015) (finding that an ALJ's credibility finding “is not invalid simply because one reason for discounting Plaintiff's credibility was improper,” but remanding on other grounds) report and recommendation adopted, 2015 WL 8207932 (W.D. Wash. Dec. 7, 2015).
2. Substantial Evidence Supports the ALJ's Evaluation of Plaintiff's Activities of Daily Living
In his decision, the ALJ found that Plaintiff's own reporting of her activities of daily living was not “entirely consistent” with her statements about the intensity, persistence and limiting effects of her impairments. (Admin. Tr. 22-23; Doc. 12-2, p. 23-24). The ALJ provided the following explanation to support his conclusion:
The claimant's own reporting of her activities of daily living is not entirely consistent with these allegations. The claimant offered no written or detailed oral statements specific to her functional capacity as of the date last insured. The written function reporting of record, which documents markedly limited self-reported functional capacity, was completed in 2019, more than a year after the date last insured, such that this claimant reporting is of very little relevance to her functioning as of the date last insured (see Ex. 6E, 7E, 9E, 10E). However, the undersigned notes that, even at that time, the claimant admitted she was functioning as a single parent to her son, caring for herself, her child, and her home with no assistance from anyone other than her child, driving, shopping, and managing household finances, and socializing with her mother and significant other (see Ex. 6E, 7E, 9E), retained abilities that suggest a greater degree of exertional and non-exertional capabilities than alleged by the claimant. Similarly, in hearing testimony, the claimant admitted that she currently remains able to function as a single parent to her now nine-year-old son without assistance from others, to drive as needed, to lift her 45 pound son, to attend to her own personal care, prepare meals, and complete light household chores, shop as needed, craft, color, and paint as leisure activities, and to serve as a landlord to her tenant, attend a prayer group, visit with family, go out to eat, and get along with others without substantial difficulty (Testimony), again suggestive of substantial retained capabilities more consistent with the above residual functional capacity assessment than with total disability, as alleged.(Admin. Tr. 22; Doc. 12-2, pp. 22-23) (emphasis added).
In her second and third symptom evaluation arguments, Plaintiff challenges the ALJ's evaluation of her activities of daily living. Plaintiff argues: (1) that the ALJ improperly cited Plaintiff's ability to care for her child as a basis to discount her statements about her functional limitations, (Doc. 13, p. 8); and (2) that the ALJ was mistaken that her activities of daily living were inconsistent with her statements about her own limitations, (Doc. 13, p. 10).
To support her argument that Plaintiff's ability to care for her child is not inconsistent with her statements, Plaintiff relies on several cases, including Gentle v. Barnhart, 430 F.3d 865 (7th Cir. 2005) and Pen v. Astrue, No. 12-CV-1041 NC, 2013 WL 3990913, at *10 (N.D. Cal. Aug. 2, 2013).
In response, the Commissioner argues that a claimant's daily activities are relevant in evaluating a claimant's symptoms, and that the ALJ reasonably considered those activities (including Plaintiff's ability to care for her family and household) and found that they were inconsistent with her statements alleging debilitating limitations.
When reviewing the applicable regulations, rulings, and caselaw, a few salient points emerge. It is, as the Commissioner says, appropriate for an ALJ to consider whether evidence about a claimant's daily activities is consistent with the claimant's statements about the intensity and limiting effects of his or her symptoms. In this regard, an ALJ considers not only what a claimant does on a day to day basis, but how he or she does it. Further, there is no bright line rule that caring for a child or family member is inconsistent with a finding of total disability. For example, in Gentle v. Barnhart, the Seventh Circuit Court of Appeals found that substantial evidence did not support the ALJ's assessment of the claimant's daily activities because the ALJ did not consider how the claimant was able to care for her four year old and eleven-month old children, or what physical abilities were required for her to care for her children in the manner she described. The same type of analysis is also required when evaluating whether a claimant's other daily activities are inconsistent with a claimant's statements about his or her functional limitations.
20 C.F.R. § 404.1529(c)(3)(i); SSR 16-3p, 2017 WL 5180304, at *7, 9.
Gentle, 430 F.3d at 867 (observing that the ALJ placed great emphasis on the claimant's ability to care for her own personal needs and for those of her two small children, without discussing uncontested evidence that she performs these chores with great difficulty and with the aid of her sister, neighbor, and another woman); see also Penn v. Astrue, No. 12-CV-1041 NS, 2013 WL 3990913, at *9-10 (N.D. Cal. Aug 2, 2013) (finding that substantial evidence did not support ALJ's evaluation that a claimant's statements that she is able to care for her children, drive and shop inconsistent with the limitations alleged where the record was unclear as to exactly which tasks the claimant performed herself and which tasks her sister assister her with).
Although Plaintiff generally argues that substantial evidence does not support the ALJ's conclusion that Plaintiff's ability to care for herself and her nine-year-old is inconsistent with her allegations of disabling limitations, no brief addresses how Plaintiff is able to care for her child or what specific activities she engages in to care for the child. There is also no discussion of why Plaintiff believes her statements do not support the ALJ's findings on this issue.
In this case, Plaintiff testified that: her child is only with her “partially” (Tuesday, Wednesday, and weekends); she could lift her son (who weighs forty-five pounds); she relies on her son to help with some household chores; and she is able to help her son with his homework. As it pertains to Plaintiff's ability to care for herself and her household, during her hearing Plaintiff testified that she can shop in a store for up to two hours (using the shopping cart for support). Plaintiff testified at her hearing that she can dress, bathe, and cook simple meals for herself. These statements, however, are somewhat inconsistent with statements in her function reports, which suggest a more limited ability to do these tasks. She also drives, and attends medical appointments, goes to prayer group twice per month, and visits family three times per week.
Comparing these activities to Plaintiff's statements about her limitations, there is indeed support for the ALJ's conclusion in the record. Plaintiff testified that she has constant pain in all of her joints, has significant memory issues that cause her to get lost while driving and make it difficult to maintain conversations or read books. Plaintiff also reported that she walks with a cane, and cannot walk for more than two or three blocks or ten minutes (even with her cane). During her hearing Plaintiff testified she could lift forty-five pounds, but in her function report forms she reported she could only lift ten pounds. She also reported that she could only stand for ten minutes, sit for two hours, and concentrate for ten minutes.
There is no dispute that Plaintiff's daily activities are limited. Our inquiry here, however, is whether the ALJ reasonably concluded that these activities suggest a greater ability to function than Plaintiff's statements about her limitations. We agree that a reasonable factfinder could determine that some of Plaintiff's daily activities suggest a greater ability to function than Plaintiff's statements about some of her limitations. Therefore, we find that substantial evidence supports the ALJ's evaluation of Plaintiff's daily activities.
3. Substantial Evidence Supports the ALJ's Assessment that Plaintiff's Mental Health-Related Symptoms Were “Stable” with “Modest” Treatment
In his decision the ALJ found that Plaintiff's allegation that she was totally disabled by her mental health-related impairments was not consistent with “the documented course of treatment for mental health disorders through the date last insured and the claimant's presentation upon mental status examinations at the time.” (Admin. Tr. 24). The ALJ provided the following explanation to support his conclusion:
the claimant's treatment for mental health symptoms was routine and conservative, consisting only of outpatient psychiatric medication
management (Ex. 4F), outpatient therapy (Ex. 40F), and some homeopathic treatment for sleep and depressive symptoms associated with Lyme and mental health disorders (Ex. 3F). She typically reported improvement in symptoms and stability with this modest treatment (Ex. 3F, 4F) and did not require inpatient psychiatric hospitalization, partial outpatient hospitalization, or any other more intensive form of treatment that might, by the nature of the treatment itself, have supported a greater degree of mental disorder severity, as alleged. Minor medication side effects were noted, but rapidly addressed with treatment changes (Ex. 4F), such that the record through the date last insured does not support the claimant's allegation of side effects that could be expected to affect her functioning. Finally, objective mental status examinations from the alleged onset date through the date last insured only intermittently documented abnormal mood and, rarely, distracted attention; the claimant more typically presented as alert and fully oriented with normal and appropriate affect, well-groomed appearance, normal/clear thought processes with normal reasoning/thought content, no perceptual abnormalities, normal cognition, normal speech with conversational tone and logical progression, normal psychomotor behavior, normal recent and remote memory, appropriate fund of knowledge, and appropriate insight and judgment (Ex. 3F, 4F, 27F, 29F, 43F, 46F), suggestive of excellent objective mental functioning. This includes the mental status examination closest in time to the date last insured, during which the claimant noted some issues with sleep and stress associated with her physical health/financial status, but reported stable mood, denied depression, denied panic attacks, and presented with mental status examination entirely normal except depressed mood (Ex. 4F, pp. 4-6).(Admin. Tr. 24-25; Doc. 12-2, pp. 25-26) (emphasis added).
Plaintiff argues that the ALJ improperly discounted her statements about the limiting effects of her mental health-related impairments based on his observation that Plaintiff was “stable with treatment.” (Doc. 13, p. 12). To support her argument, Plaintiff relies on Morales v. Apfel, 225 F.3d 310, 319 (3d Cir. 2000) and Nazario v. Comm'r of Soc. Sec., 794 Fed.Appx. 204, 211 & n.5 (3d Cir. 2019).
In response, the Commissioner argues that an ALJ may properly consider the type and effectiveness of any treatments a claimant receives when evaluating his or her symptoms, and that substantial evidence supports the ALJ's assessment of this factor. (Doc. 14, pp. 19-20). She also contends that there is no rule prohibiting an ALJ from characterizing a claimant's condition as “stable” with treatment under appropriate circumstances, and when accompanied by a well-reasoned explanation. Id.
We find that both cases Plaintiff cites are distinguishable from this case. For example, in Nazario, in support of a conclusion that the claimant's depression and anxiety were not disabling the ALJ twice cited a treating source's comment that the claimant “was stable” and “doing well.” Despite those comments, however, the treating source issued an opinion that included mental health-related limitations inconsistent with the ability to engage in any work. The Third Circuit found that substantial evidence did not support the ALJ's conclusion that the claimant was not disabled, and criticized the ALJ's citation to a record that the claimant was “stable.” It observed that “stability does not equate to a specific medical condition,” and that a person “can be stable with a chronic disabling malady on a particular day or in a certain environment.” It explained that relying on a treatment record that says a claimant is “stable” without a supporting analysis did not adequately support the ALJ's conclusion when viewed against a record that included medical opinions and treatment records documenting multiple severe and disabling symptoms and limitations. Unlike Nazario, however, no medical source identified the presence of a potentially disabling mental health-related limitation in this case. The ALJ's summary of Plaintiff's treatment records suggests that, when symptoms were present in a clinical setting, they were relatively mild and were often the result of situational stressors. Viewed in this context, substantial evidence supports the ALJ's evaluation that Plaintiff's report of “stable” symptoms in treatment records is inconsistent with her allegations of disabling mental health-related symptoms. The issue of whether Plaintiff's symptoms are more severe outside the clinical setting has not been developed in the parties' briefs. Absent any evidence to the contrary, we find that substantial evidence supports the ALJ's conclusion.
Nazario, 794 Fed.Appx. at 211.
Id.
In Morales, the Third Circuit Court of Appeals found that substantial evidence did not support an ALJ's decision to reject the opinion of a treating source as inconsistent with the source's own treatment records. Morales, 225 F.3d at 319. In that case, the medical source issued an opinion assessing marked mental health-related limitations caused by an affective or personality disorder marked by anxiety. Id. He did so based on a notation that the claimant was “stable and well controlled with medication” during treatment. Id. The Court found that substantial evidence did not support this conclusion because (1) other information in the treatment records supported the opinion, and (2) a treating source medical opinion otherwise supported by the record should not be supplanted “by an inference gleaned from treatment records reporting on the claimant in an environment based of the stresses that accompany the work setting,” especially when that claimant suffers from an anxiety-related disorder. Id. Unlike Plaintiff's argument in this case, Morales addresses the rejection of a medical opinion, not of a claimant's statements about his or her limitations. Also unlike Morales, Plaintiff has not directed the Court to other evidence in the record that otherwise supports her statements. This issue has not been developed in the briefs. In fact, Plaintiff's testimony suggests that she leads a fairly active social life and would have little difficulty functioning outside a clinical setting in a “routine” environment from a mental health-perspective (aside form her reports of “embarrassment” due to cane use). (Admin. Tr. 54; Doc. 12-2, p. 55) (reporting that she visits family three times per week, and attends a prayer group every other Thursday); (Admin. Tr. 244-245; Doc. 12-6, pp. 28-29) (reporting that although she is shy, and does not handle stress well she has no problems getting along with authority figures and has never been laid off because of problems getting along with others).
We also note that much of the Plaintiff's testimony at the ALJ hearing (November 19, 2019) concerned her current ailments. However, the relevant period for this claim ended on September 30, 2017, two years earlier.
V. RECOMMENDATION
Accordingly, it is RECOMMENDED that:
(1) The final decision of the Commissioner be AFFIRMED.
(2) Final judgment be issued in favor of the Commissioner.
(3) The Clerk of Court be DIRECTED to close this case.
NOTICE OF LOCAL RULE 72.3
NOTICE IS HEREBY GIVEN that any party may obtain a review of the Report and Recommendation pursuant to Local Rule 72.3, which provides:
Any party may object to a magistrate judge's proposed findings, recommendations or report addressing a motion or matter described in 28 U.S.C. § 636 (b)(1)(B) or making a recommendation for the disposition of a prisoner case or a habeas corpus petition within fourteen (14) days after being served with a copy thereof. Such party shall file with the clerk of court, and serve 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.