Opinion
CIVIL 3:22-CV-1923
02-23-2024
CHRISTINA BILLINGS, Plaintiff, v. MARTIN O'MALLEY,[1] Commissioner of Social Security Defendant.
Judge Mariani
REPORT AND RECOMMENDATION
MARTIN C. CARLSON, UNITED STATES MAGISTRATE JUDGE
I. Introduction
The Supreme Court has underscored for us the limited scope of our substantive review when considering Social Security appeals, noting that:
The phrase “substantial evidence” is a “term of art” used throughout administrative law to describe how courts are to review agency factfinding. T-Mobile South, LLC v. Roswell, 574 U.S.__,__, 135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-evidence standard, a court looks to an existing administrative record and asks whether it contains “sufficien[t] evidence” to support the agency's factual determinations. Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis deleted). And whatever the meaning of “substantial” in other contexts, the threshold for such evidentiary sufficiency is not high. Substantial
evidence, this Court has said, is “more than a mere scintilla.” Ibid.; see, e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks omitted). It means-and means only-“such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v. Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999) (comparing the substantial-evidence standard to the deferential clearly-erroneous standard).Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019).
In the instant case, Christina Billings filed an application for Social Security benefits in 2020 asserting that the lingering effects of injuries suffered four years earlier in an auto accident rendered her unable to work. Billings' medical treatment records were mixed and equivocal; they confirmed her injuries but also indicated that she retained some residual functional capacity despite these impairments. Likewise, five out of six medical experts who considered her case opined that Billings retained the residual functional capacity to perform some work. Upon consideration of this evidence, an ALJ concluded that Billings could perform light work confined to simple, routine, repetitive tasks. (Tr. 22).
Billings now appeals this decision, contending that the ALJ's decision is not supported by substantial evidence and arguing that the ALJ erred in assessing one medical source opinion; failed to adequately consider Billings' headaches in assessing her disability claim; and erred in evaluating the severity of her symptoms. However, after a review of the record, and mindful of the fact that substantial evidence “means only-‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion,'” Biestek, 139 S.Ct. at 1154, we find that substantial evidence supported the ALJ's findings in this case. Therefore, for the reasons set forth below, we recommend that the district court affirm the decision of the Commissioner denying this claim.
II. Statement of Facts and of the Case
A. Background
The administrative record in this case reveals the following essential facts: In September of 2020, Christina Billings applied for disability and supplemental security income benefits pursuant to Titles II and XVI of the Social Security Act. (Tr. 16). In these applications, Billings alleged an onset of disability in July of 2020 and indicated that her physical and emotional impairments stemmed in part from a 2016 auto accident. (Id.) According to Billings, she was completely disabled due to the combined effects of a series of physical and emotional impairments, including obesity, cervical fracture, headaches, adjustment disorder with mixed anxiety and depression, and mild neurocognitive disorder due to traumatic brain injury. (Tr. 1819).
Billings was born on March 28, 1971, and was 49 years old on the alleged disability onset date, making her a younger worker under the Commissioner's regulations. During the course of these proceedings, Billings' age category under these regulations changed due to the passage of time to the status of a worker who was closely approaching advanced age. (Tr. 28). She had a high school education, (id.), and had earned an associate degree. (Tr. 41, 344). Prior to the alleged onset of her disability, Billings had work in various childcare fields as a preschool teacher, special needs child caregiver, and served part time as a children's ministry director at her church. (Tr. 53, 344, 373).
B. Clinical Record, Billings' Physical Impairments
Billings' principal complaints on appeal relate to her physical impairments. With respect to these physical impairments, the clinical record was aptly summarized by the ALJ, in the following terms:
The record reveals the claimant was involved in a motor vehicle accident in 2016, several years prior to the alleged disability onset date, resulting in an injury to the head causing short and long-term memory loss, a cervical fracture, and headaches (Exhibits B8E; B10F). The claimant had an anterior fusion of the cervical spine (Exhibit B10F).
The claimant has been prescribed amitriptyline that reportedly dulls the pain (Exhibits B8E; B4F). At the September 2020 neurology visit, the neurologist noted the claimant has photophobia and that she will get headaches when driving at night (Exhibit B4F).
On December 23, 2020, the claimant attended a consultative internal medicine examination unaccompanied (Exhibit B10F). At that time, the consultative examiner noted the claimant, who is 5 feet 2 inches tall, weighed 167 pounds, indicating a body mass index in excess of 30 (Exhibit B10F). The consultative physical examination indicated the claimant, who was in no acute distress, had normal gait and stance and was able to perform 70% of a full squat and had no problems walking on heels and toes, getting on and off the exam table, and rising from a chair (Exhibit B10F). The physical examination further indicated tenderness at ¶ 5 to C6, but a supple neck with no masses, JVD, thyromegaly or bruits, 5/5 strength in the upper and lower extremities, no joint deformity, stable joints, and a negative bilateral straight leg raise test in both seated and supine positions (Exhibit B10F). The consultative neurologic examination indicated hypoesthesia along the medial and ulnar radial nerve distribution of the left hand to light touch, but otherwise normal sensory and equal and physiologic deep tendon reflexes in the upper and lower extremities (Exhibit B10F). The consultative examiner noted the claimant has intact hand and finger dexterity and that she is able to zip, button, and tie laces (Exhibit B10F).
At the March 2021 telemedicine neurology visit, the neurologist noted the claimant reported experiencing two (2) to three (3) headaches per week that are mild to moderate (Exhibit B13F). While the neurologist noted the claimant takes amitriptyline at bedtime for headache prevention that reportedly works well, the claimant does not take any medication for headache treatment (Exhibit B13F). The neurologist further indicated the claimant reported that her headaches are relieved by closing her eyes and taking a nap (Exhibit B13F). There is no documentation indicating any additional medical treatment since March 2021. Moreover, there is no documentation indicating any significant treatment for obesity, such as treatment with a nutritionist or dietitian or that the claimant regularly engaged in a formal dietary program or exercise regimen or that the claimant was referred for bariatric surgery. The consultative examination findings indicating 5/5 strength in the upper and lower extremities, the lack of documentation indicating except for limited neurology treatment, any significant and ongoing treatment for neck pain status post cervical fusion such as
physical therapy, additional surgery, injections, pain medication management, and treatment with a pain management specialist, the lack of documentation indicating any significant treatment for obesity, and the neurologist notes that the claimant treats her headaches with conservative treatment such as closing her eyes and napping along with preventative medication management shows the claimant is not as limited as alleged.(Tr. 24-25).
Thus, with respect to Billings' physical impairments, the clinical record revealed that she experienced some neurological deficits but retained 5/5 strength in her extremities; had intact hand and finger dexterity and was able to zip, button, and tie laces; and successfully addressed her headaches though a conservative course of treatment.
C. Clinical Record, Billings' Emotional Impairments .
As for Billings' emotional impairments, the clinical record supported the medical consensus that her emotional conditions were not wholly disabling. As the ALJ explained:
The claimant suffers from adjustment disorder with mixed anxiety and depression, and mild neurocognitive disorder due to traumatic brain injury. The record reveals the claimant has been prescribed fluoxetine and bupropion (Exhibit B10F). The record reveals the claimant has a history of behavioral healthcare treatment, including mental health therapy (Exhibits B6F; B9F; Hearing Testimony). While the record reveals the claimant attended speech therapy and physical therapy prior to the alleged disability onset date (Exhibit B8F), there is no documentation indicating such treatment since the alleged disability
onset date. The mental health therapy progress notes typically indicated the claimant's frustration relating to cognitive problems and memory issues resulting from the 2016 motor vehicle accident. However, the mental status examinations typically indicated normal thought process, appropriate behavior, no suicidal or homicidal risk with mental health treatment including medication management with adjustments (Exhibit B9F/11, 16-17, 20-21). Further, the therapy progress notes generally indicated the claimant's mental health symptoms were exacerbated, at times, when dealing with psychosocial stressors, including the adoption of her daughter (Exhibit B9F/22).
On December 23, 2020, the claimant attended a consultative mental status examination (Exhibit B11F). The consultative mental status examination indicated coherent and goal directed thought processes with no evidence of hallucinations, delusions or paranoia, clear sensorium, intact orientation, intact attention and concentration, fair insight and judgment and average cognitive functioning with a general fund of information appropriate to experience (Exhibit B11F). The consultative examiner noted the claimant's recent and remote memory skills were mildly impaired due to anxiety or nervousness in the evaluation setting, but the claimant was able to specify 3 out of 3 objects and 2 out of 3 objects after a short delay, and she was able to do 6 digits forward and 4 digits backward (Exhibit B11F). The consultative examiner further noted the claimant was able to do simple counting by 2's, simple calculations of addition, subtraction, multiplication, and division, and to do 5 serial 7's and 5 serial 3's (Exhibit B11F). Except for the December 2020 consultative mental status examination, there is no documentation indicating any significant and ongoing mental health treatment since November 2020.
The claimant's limited mental health treatment history since the alleged disability onset date, primarily consisting of mental health therapy, the therapy notes indicating the claimant's mental health symptoms are exacerbated, at times, when dealing with psychosocial stressors, and the consultative mental status examination findings indicating mildly impaired memory, but coherent and goal directed thought processes with no evidence of hallucinations, delusions or paranoia, clear
sensorium, intact orientation, intact attention and concentration, fair insight and judgment and average cognitive functioning with a general fund of information appropriate to experience shows the claimant is not as limited as alleged.(Tr. 25).
D. Billings' Self-Reported Activities of Daily Living
In evaluating this disability claim, the ALJ also took into account Billings' self-described activities, of daily living, explaining that:
The claimant's activities of daily living similarly suggest that the claimant's symptoms are not as limiting as alleged. The claimant, who lives in a house with her husband and children, reported that she is able to watch television, read, and use the computer (Exhibits B8E; B13F). The claimant is able to take care of her children, including playing Legos and driving her daughter to school, and she can take care of three (3) dogs with assistance (Exhibit B8E; Hearing Testimony). The claimant reported that she spends time with others in person, on the phone, by email and text, by video chat, and by mail (Exhibit B8E). The claimant reported that she attends church on a regular basis (Exhibit B8E). The claimant reported that she is able to go shopping accompanied by her husband and to shop by computer (Exhibit B8E). The claimant is able to prepare simple meals, do laundry, and do light household cleaning with encouragement (Exhibit B8E). The claimant is able to drive a car and the claimant's husband reported that the claimant is able to go out alone (Exhibits B8E; B9E). The claimant reported no problems managing finances (Exhibit B8E). These activities of daily living are not consistent with a disabling level of impairment.(Tr. 26).
E. The Expert Opinion Evidence
In Billings' case, it appears that no treating source has opined that she was disabled. Instead, given her clinical picture, and Billings' self-reported activities of daily living, six consulting and examining medical experts opined on the severity of her impairments. The medical consensus of five of these experts was that Billings suffered physical and emotional impairments but retained the ability to perform some work; there was, however, one outlier opinion which indicated that Billings' physical impairments were totally disabling.
At the outset, with respect to Billings' emotional impairments, the plaintiff underwent a consultative examination on December 23, 2020, by Dr. John Kajic. (Tr. 1165-73). Dr. Kajic found that Billings' recent and remote memory was mildly impaired due to anxiety, but observed that Billings was able to specify 3 out of 3 objects and 2 out of 3 objects after a short delay; was able to do 6 digits forward and 4 digits backward; could perform simple counting by 2's, simple calculations of addition, subtraction, multiplication, and division, and could calculate 5 serial 7's and 5 serial 3's. (Tr 1168). He assessed her intellectual functioning to be average, and her judgment and insight to be fair. (Id.) Dr. Kajic concluded that Billings was mildly impaired when it came to interacting with others and following complex work instructions, and suffered from a moderate degree of impairment when making complex wok decisions, but was not otherwise disabled. (Tr. 1170-71).
Two state agency experts agreed with this assessment that Billings' emotional impairments were not disabling. On January 6, 2021, Dr. Richard Williams reviewed Billings' medical records, including the results of her December 2020 consultative examination, and opined that she was mildly impaired when it came to understanding, remembering, and applying detailed instructions and interacting with others and experienced moderate impairment in the realms of concentration and adaptation, but was not wholly disabled as a result of these conditions. (Tr. 101, 10609). These findings were echoed upon reconsideration by a second state agency expert, Dr. Peter Garito, who conducted an independent evaluation of Billings' case on May 25, 2021. (Tr. 116-136).
Likewise, Dr. Joanna Deleo and Dr. David Clark, two state agency experts who examined the clinical records relating to Billings' physical impairments, including the report of a consultative examination of Billings' undertaken in December of 2020, opined that she retained the capacity to perform light work. (Tr. 91-136). The sole outlier opinion was expressed by Dr. Ahmed Kneifati, who conducted a consultative examination of Billings in December of 2020. (Tr. 114762). Despite finding that Billings had 5/5 strength in all extremities, Dr. Kneifati
limited her to only occasionally lifting or carrying up to twenty pounds and never lifting or carrying more than twenty pounds. (Id.)
F. The ALJ Decision
It was against this medical backdrop that a disability hearing was conducted in Billings' case on October 28, 2021, (Tr. 36-58), at which Billings and a vocational expert testified. Following this hearing, on November 10, 2021, the ALJ issued a decision denying Billings' application for benefits. (Tr. 13-30).
In that decision, the ALJ first concluded that Billings met the insured requirements of the Act through December 31, 2024, and had not engaged in substantial gainful activity since her alleged onset date. (Tr. 18). At Step 2 of the sequential analysis that governs Social Security cases, the ALJ found that Billings had the following severe impairments: obesity, cervical fracture, headaches, adjustment disorder with mixed anxiety and depression, and mild neurocognitive disorder due to traumatic brain injury. (Tr. 18-19).
At Step 3, the ALJ determined that Billings did not have an impairment or combination of impairments that met or medically equaled the severity of one of the disability listing impairments. (Tr. 20-22). Between Steps 3 and 4, the ALJ then fashioned a residual functional capacity (“RFC”) for the plaintiff which considered her impairments as reflected in the medical record, and found that:
After careful consideration of the entire record, the undersigned finds that the claimant has the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) except the claimant should avoid exposure to excessive noise and bright lights. The claimant has retained the mental capacity to perform work that is limited to simple, routine, repetitive tasks with occasional interaction with co-workers and supervisors.(Tr. 22).
In fashioning this RFC, the ALJ considered the medical evidence and Billings' testimony regarding her impairments. The ALJ first engaged in a two-step process to evaluate Billings' alleged symptoms, finding that, although the claimant's medically determinable impairments could reasonably be expected to cause her alleged symptoms, Billings' statements concerning the intensity, persistence and limiting effects of those symptoms were not entirely consistent with the medical evidence and other evidence in the record. (Tr. 23). In making this determination, the ALJ considered Billings' statements and testimony regarding her impairments and limitations, but contrasted these statements against the medical records, medical opinion evidence, and Billings' self-described activities of daily living, all of which suggested that Billings retained a greater capacity for work. (Tr. 23-26).
Further, in fashioning this RFC, the ALJ considered the various medical opinions and prior administrative medical findings. On this score, the ALJ found that the medical consensus of five medical experts that Billings retained the physical and emotional capacity to perform some work was generally persuasive. (Tr. 26-28). In contrast, the ALJ afforded less persuasive power to the one outlier opinion expressed by Dr. Kneifati, stating that:
The undersigned considered the opinion of Ahmed Kneifati, M.D., the consultative examiner, who indicated on December 23, 2020 following an internal medicine examination that the claimant is capable of lifting and/or carrying twenty (20) pounds occasionally, but never twentyone (21) to one hundred (100) pounds, sitting, standing and/or walking in an eight (8) hour work day at one time, sitting, standing and/or walking in an eight (8) hour work day total in an eight (8) hour work day, frequent bilateral reaching, including overhead, handling, fingering, pushing and/or pulling, frequent feeling with the right hand, occasional feeling with the left hand, frequent kneeling, crouching or crawling, and occasional climbing of stairs and ramps, climbing of ladders and scaffolds, balancing or stooping (Exhibit B10F). The consultative examiner opined the claimant can tolerate occasional exposure to unprotected heights, moving mechanical parts, operating a motor vehicle, humidity and wetness, extreme cold and extreme heat, but never dust, odors, fumes, and pulmonary irritants, and moderate noise (Exhibit B10F). He further indicated the claimant does not require the use of a cane to ambulate (Exhibit B10F). These findings are not entirely consistent with the consultative examiner's own physical examination findings indicating tenderness at ¶ 5 to C6, but a supple neck with no masses, JVD, thyromegaly or bruits, 5/5 strength in the upper and lower extremities, no joint deformity, stable joints, and a negative bilateral straight leg raise test in both seated and supine positions. Further, the consultative neurologic examination indicated hypoesthesia along the medial and ulnar radial nerve distribution of the left hand to light touch, but otherwise normal sensory and equal and physiologic deep tendon reflexes in the upper and lower extremities. In addition, the consultative examiner noted the claimant has intact hand and finger dexterity and that she is able to zip, button, and tie laces. Moreover, there is no documentation indicating the claimant attended physical therapy or had treatment with a pain management specialist
for neck pain or sought or underwent treatment with a nutritionist or dietitian for obesity. Further, the claimant reported that she is able to drive, go shopping in stores with her husband, do light household cleaning, prepare simple meals, and take care of her children and pets with assistance. Accordingly, the undersigned finds this opinion to be not persuasive.(Tr. 27).
Having arrived at this RFC assessment, the ALJ concluded that there were jobs that existed in the significant numbers in the national economy that Billings could perform. (Tr. 29-30). Based upon these findings, the ALJ determined that Billings did not meet the stringent standard for disability set by the Act and denied this claim. (Id.)
This appeal followed. (Doc. 1). On appeal, Billings advances a threefold argument, contending that the ALJ erred in: (1) assessing one medical source opinion; (2) failing to adequately consider Billings' headaches in assessing her disability claim; and (3) evaluating the severity of her symptoms. However, given the deferential standard of review which applies here, as discussed below we recommend that the court affirm the decision of the Commissioner.
III. Discussion
A. Substantial Evidence Review - the Role of this Court
When reviewing the Commissioner's final decision denying a claimant's application for benefits, this Court's review is limited to the question of whether the findings of the final decision-maker are supported by substantial evidence in the record. See 42 U.S.C. §405(g); Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D. Pa. 2012). Substantial evidence “does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial evidence is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). But in an adequately developed factual record, substantial evidence may be “something less than the weight of the evidence, and the possibility of drawing two inconsistent conclusions from the evidence does not prevent [the ALJ's decision] from being supported by substantial evidence.” Consolo v. Fed. Maritime Comm'n, 383 U.S. 607, 620 (1966). “In determining if the Commissioner's decision is supported by substantial evidence the court must scrutinize the record as a whole.” Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D. Pa. 2003).
The Supreme Court has recently underscored for us the limited scope of our review in this field, noting that:
The phrase “substantial evidence” is a “term of art” used throughout administrative law to describe how courts are to review agency factfinding. T-Mobile South, LLC v. Roswell, 574 U.S.__,__, 135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-evidence standard, a court looks to an existing administrative record and asks whether it contains “sufficien[t] evidence” to support the agency's factual determinations. Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis deleted). And whatever the meaning of “substantial” in other contexts, the threshold for such evidentiary sufficiency is not high. Substantial evidence, this Court has said, is “more than a mere scintilla.” Ibid.; see, e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks omitted). It means-and means only-“such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v. Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999) (comparing the substantial-evidence standard to the deferential clearly-erroneous standard).Biestek, 139 S.Ct. at 1154.
The question before this Court, therefore, is not whether the claimant is disabled, but rather whether the Commissioner's finding that 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 which 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, 931 F.3d at 211. On this score, the appellate court indicated that an ALJ offers a valid explanation on 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, . . . . ” Id. at 214.
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); see also 20 C.F.R. §404.1505(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); 20 C.F.R. §404.1505(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). 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).
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). In making this assessment, the ALJ considers all of the claimant's medically determinable impairments, including any non-severe impairments identified by the ALJ at step two of his or her analysis. 20 C.F.R. §404.1545(a)(2).
There is an undeniable medical aspect to an RFC determination, since that determination entails an assessment of what work the claimant can do given the physical limitations that the claimant experiences. Yet, when considering the role and necessity of medical opinion evidence in making this determination, courts have followed several different paths. Some courts emphasize the importance of medical opinion support for an RFC determination and have suggested that “[r]arely can a decision be made regarding a claimant's residual functional capacity without an assessment from a physician regarding the functional abilities of the claimant.” Biller v. Acting Comm'r of Soc. Sec., 962 F.Supp.2d 761, 778-79 (W.D. Pa. 2013) (quoting Gormont v. Astrue, Civ. No. 11-2145, 2013 WL 791455 at *7 (M.D. Pa. Mar. 4, 2013)). In other instances, it has been held that: “There is no legal requirement that a physician have made the particular findings that an ALJ adopts in the course of determining an RFC.” Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006). Further, courts have held in cases where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability that “the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided.” Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015).
These seemingly discordant legal propositions can be reconciled by evaluation of the factual context of these decisions. Those cases which emphasize the importance of medical opinion support for an RFC assessment typically arise in the factual setting where a well-supported medical source has identified limitations that would support a disability claim, but an ALJ has rejected the medical opinion which supported a disability determination based upon a lay assessment of other evidence. 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 an ALJ is relying upon other evidence, such as contrasting clinical or opinion evidence or testimony regarding the claimant's activities of daily living, to fashion an RFC courts have adopted a more pragmatic view and have sustained the ALJ's exercise of independent judgment based upon all of the facts and evidence. See Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006); Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015). In either event, once the ALJ has made this determination, our review of the ALJ's assessment of the plaintiff's RFC is deferential, and that RFC assessment will not be set aside if it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d Cir. 2002); see also Metzger v. Berryhill, No. 3:16-CV-1929, 2017 WL 1483328, at *5 (M.D. Pa. Mar. 29, 2017), report and recommendation adopted sub nom. Metzgar v. Colvin, No. 3:16-CV-1929, 2017 WL 1479426 (M.D. Pa. Apr. 21, 2017); Rathbun v. Berryhill, No. 3:17-CV-00301, 2018 WL 1514383, at *6 (M.D. Pa. Mar. 12, 2018), report and recommendation adopted, No. 3:17-CV-301, 2018 WL 1479366 (M.D. Pa. Mar. 27, 2018).
At Steps 1 through 4, the claimant bears the initial burden of demonstrating the existence of a medically determinable impairment that prevents him or her in 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); Mason, 994 F.2d at 1064.
The ALJ's disability determination must also meet certain basic substantive requisites. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, the ALJ's decision must be accompanied by “a clear and satisfactory explication of the basis on which it rests.” Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-07. In addition, “[t]he ALJ must indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding.” Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999).
C. Legal Benchmarks for the ALJ's Assessment of Medical Opinion Evidence
The plaintiff filed this disability application after a paradigm shift in the manner in which medical opinions were evaluated when assessing Social Security claims. Prior to March 2017, ALJs were required to follow regulations which defined medical opinions narrowly and created a hierarchy of medical source opinions with treating sources at the apex of this hierarchy. However, in March of 2017, the Commissioner's regulations governing medical opinions changed in a number of fundamental ways. The range of opinions that ALJs were enjoined to consider were broadened substantially, and the approach to evaluating opinions was changed from a hierarchical form of review to a more holistic analysis. As one court as aptly observed:
The regulations regarding the evaluation of medical evidence have been amended for claims filed after March 27, 2017, and several of the prior Social Security Rulings, including SSR 96-2p, have been rescinded. According to the new regulations, the Commissioner “will no longer give any specific evidentiary weight to medical opinions; this includes giving controlling weight to any medical opinion.” Revisions to Rules Regarding the Evaluation of Medical Evidence (“Revisions to Rules”), 2017 WL 168819, 82 Fed.Reg. 5844, at 5867-68 (Jan. 18, 2017), see 20 C.F.R. §§ 404.1520c(a), 416.920c(a). Instead, the Commissioner must consider all medical opinions and “evaluate their persuasiveness” based on the following five factors: supportability; consistency; relationship with the claimant; specialization; and “other factors.” 20 C.F.R. §§ 404.1520c(a)-(c), 416.920c(a)-(c).
Although the new regulations eliminate the perceived hierarchy of medical sources, deference to specific medical opinions, and assigning “weight” to a medical opinion, the ALJ must still “articulate how [he or she] considered the medical opinions” and “how persuasive [he or she] find[s] all of the medical opinions.” Id. at §§ 404.1520c(a) and (b)(1), 416.920c(a) and (b)(1). The two “most important factors for determining the persuasiveness of medical opinions are consistency and supportability,” which are the “same factors” that formed the foundation of the treating source rule. Revisions to Rules, 82 Fed.Reg. 5844-01 at 5853.
An ALJ is specifically required to “explain how [he or she] considered the supportability and consistency factors” for a medical opinion. 20 C.F.R. §§ 404.1520c (b)(2), 416.920c(b)(2). With respect to “supportability,” the new regulations provide that “[t]he more relevant
the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion(s) or prior administrative medical finding(s), the more persuasive the medical opinions or prior administrative medical finding(s) will be.” Id. at §§ 404.1520c(c)(1), 416.920c(c)(1). The regulations provide that with respect to “consistency,” “[t]he more consistent a medical opinion(s) or prior administrative medical finding(s) is with the evidence from other medical sources and nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical finding(s) will be.” Id. at §§ 404.1520c(c)(2), 416.920c(c)(2).
Under the new regulations an ALJ must consider, but need not explicitly discuss, the three remaining factors in determining the persuasiveness of a medical source's opinion. Id. at §§ 404.1520c(b)(2), 416.920c(b)(2). However, where the ALJ has found two or more medical opinions to be equally well supported and consistent with the record, but not exactly the same, the ALJ must articulate how he or she considered those factors contained in paragraphs (c)(3) through (c)(5). Id. at §§ 404.1520c(b)(3), 416.920c(b)(3).Andrew G. v. Comm'r of Soc. Sec., No. 3:19-CV-0942 (ML), 2020 WL 5848776, at *5 (N.D.N.Y. Oct. 1, 2020).
Oftentimes, as in this case, an ALJ must evaluate various medical opinions. Judicial review of this aspect of ALJ decision-making is still guided by several settled legal tenets. First, when presented with a disputed factual record, it is well-established that “[t]he ALJ - not treating or examining physicians or State agency consultants - must make the ultimate disability and RFC determinations.” Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 361 (3d Cir. 2011). Thus, when evaluating medical opinions “the ALJ may choose whom to credit but ‘cannot reject evidence for no reason or for the wrong reason.'” Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (quoting Mason, 994 F.2d at 1066). Therefore, provided that the decision is accompanied by an adequate, articulated rationale, it is the province and the duty of the ALJ to choose which medical opinions and evidence deserve greater weight.
Further, in making this assessment of medical evidence:
An ALJ is [also] entitled generally to credit parts of an opinion without crediting the entire opinion. See Thackara v. Colvin, No. 1:14-CV-00158-GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015); Turner v. Colvin, 964 F.Supp.2d 21, 29 (D.D.C. 2013) (agreeing that “SSR 96-2p does not prohibit the ALJ from crediting some parts of a treating source's opinion and rejecting other portions”); Connors v. Astrue, No. 10-CV-197-PB, 2011 WL 2359055, at *9 (D.N.H. June 10, 2011). It follows that an ALJ can give partial credit to all medical opinions and can formulate an RFC based on different parts from the different medical opinions. See e.g., Thackara v. Colvin, No. 1:14-CV-00158-GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015).Durden v. Colvin, 191 F.Supp.3d 429, 455 (M.D. Pa. 2016). Finally, where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability “the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided.” Cummings, 129 F.Supp.3d at 214-15.
D. Legal Benchmarks for the ALJ's Assessment of a Claimant's Alleged Symptoms
The interplay between the deferential substantive standard of review that governs Social Security appeals, and the requirement that courts carefully assess whether an ALJ has met the standards of articulation required by law, is also illustrated by those cases which consider analysis of a claimant's reported pain. When evaluating lay testimony regarding a claimant's reported degree of pain and disability, we are reminded that:
[T]he ALJ must necessarily make certain credibility determinations, and this Court defers to the ALJ's assessment of credibility. See Diaz v. Comm'r, 577 F.3d 500, 506 (3d Cir.2009) (“In determining whether there is substantial evidence to support an administrative law judge's decision, we owe deference to his evaluation of the evidence [and] assessment of the credibility of witnesses....”). However, the ALJ must specifically identify and explain what evidence he found not credible and why he found it not credible. Adorno v. Shalala, 40 F.3d 43, 48 (3d Cir. 1994) (citing Stewart v. Sec'y of Health, Education and Welfare, 714 F.2d 287, 290 (3d Cir.1983)); see also Stout v. Comm'r, 454' F.3d 1050, 1054 (9th Cir.2006) (stating that an ALJ is required to provide “specific reasons for rejecting lay testimony”). An ALJ cannot reject evidence for an incorrect or unsupported reason. Ray v. Astrue, 649 F.Supp.2d 391, 402 (E.D.Pa.2009) (quoting Mason v. Shalala, 994 F.2d 1058, 1066 (3d Cir.1993)).Zirnsak 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 163p. 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 this backdrop that we evaluate the decision of the ALJ in this case.
E. The ALJ's Decision is Supported by Substantial Evidence.
In this setting, we are mindful that we are not free to substitute our independent assessment of the evidence for the ALJ's determinations. Rather, we must simply ascertain whether the ALJ's decision is supported by substantial evidence, a quantum of proof which is less than a preponderance of the evidence but more than a mere scintilla, Richardson, 402 U.S. at 401, and “does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Pierce, 487 U.S. at 565. Judged against these deferential standards of review, we find that substantial evidence supported the decision by the ALJ that Billings retained the residual functional capacity to perform light work that is limited to simple, routine, repetitive tasks. Therefore, we recommend that the district court affirm this decision.
The plaintiff first challenges the ALJ's evaluation of the one outlying medical opinion, the opinion of Dr. Kneifati concerning the severity of Billings' physical impairments. As we have noted, after the paradigm shift in in the manner in which medical opinions are evaluated when assessing Social Security claims, “[t]he two ‘most important factors for determining the persuasiveness of medical opinions are consistency and supportability,' [ ] [and] [a]n ALJ is specifically required to ‘explain how [he or she] considered the supportability and consistency factors' for a medical opinion.” Andrew G. v. Comm'r of Soc. Sec. at *5 (citing 20 C.F.R. §§ 404.1520c (b)(2), 416.920c(b)(2)). But ultimately, provided that the decision is accompanied by an adequate, articulated rationale, examining these factors, it is the province and the duty of the ALJ to choose which medical opinions and evidence deserve greater weight.
Thus, our inquiry is not whether evidence existed from which the ALJ could have drawn a contrary conclusion, but rather whether substantial evidence existed in the record to support the ALJ's decision to credit or discredit each medical opinion, and whether the ALJ appropriately articulated his decision under the regulations. Here, these requirements have been met. On this score, although the plaintiff suggests that there was evidence from which the ALJ could have drawn a contrary conclusion, we are cognizant that “[t]he presence of evidence in the record that supports a contrary conclusion does not undermine the Commissioner's decision so long as the record provides substantial support for that decision.” Malloy v. Comm'r of Soc. Sec., 306 Fed.Appx. 761, 764 (3d Cir. 2009).
So it is here. As the ALJ aptly noted, Dr. Kneifati's extremely limited medical opinion was not entirely consistent with his objective medical findings which revealed a lesser degree of physical impairment on Billings' part. In this regard, it is well settled that an ALJ may conclude that discrepancies between a source's medical opinion, and the doctor's actual examination notes, justifies giving the medical source opinion little weight in a disability analysis. Torres v. Barnhart, 139 Fed.Appx. 411, 415 (3d Cir. 2005). Likewise, the ALJ observed that this extreme medical opinion seemed inconsistent with Billings' self-reported activities of daily living. This finding, which is also supported by substantial evidence, warranted giving Dr. Kneifati's opinion less persuasive power, since “an opinion from a . . . source about what a claimant can still do . . . 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). In contrast to this extreme outlier opinion, the ALJ cited substantial evidence which supported the medical consensus of five other health care providers, who agreed that Billings could perform some work. These opinions were generally consistent with one another and were congruent with the clinical record. Thus, the ALJ correctly concluded that these opinions met the benchmarks for persuasiveness defined by the Commissioner's regulations-consistency and supportability.
The plaintiff also argues that the ALJ committed multiple errors with symptom evaluation. On this score, it is clear that “[a]llegations of pain and other subjective symptoms must be supported by objective medical evidence.” Hantraft at 362. Further, the ALJ is to consider certain factors in symptom evaluation, 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's symptom evaluation complied with the requirements of the law, and was supported by substantial evidence since Billings' activities of daily living, the clinical record, and the broad medical consensus all agreed that the plaintiff retained the ability to perform some work. There was no error here.
Finally, while Billings alleges that the ALJ failed to fully consider her headaches in making this RFC determination, the administrative record rebuts this assertion. Quite the contrary, it is clear that the ALJ fully considered these headaches when making this disability determination. Thus, the ALJ listed headaches among Billings' severe impairments. (Tr. 18). The ALJ then accounted for these headaches at Step 3 of this evaluation stating that:
The severity of the claimant's headaches does not meet or medically equal the criteria of Listing 11.02, as there is no evidence establishing
that the claimant experiences generalized tonic-clonic or dyscognitive seizures as required by that Listing.(Tr. 20).
The ALJ then continued to examine Billings' headaches throughout the disability evaluation process, noting that:
At the March 2021 telemedicine neurology visit, the neurologist noted the claimant reported experiencing two (2) to three (3) headaches per week that are mild to moderate (Exhibit B13F). While the neurologist noted the claimant takes amitriptyline at bedtime for headache prevention that reportedly works well, the claimant does not take any medication for headache treatment (Exhibit B13F). The neurologist further indicated the claimant reported that her headaches are relieved by closing her eyes and taking a nap (Exhibit B13F). There is no documentation indicating any additional medical treatment since March 2021.(Tr. 24). This examination of the clinical evidence, in turn, led the ALJ to conclude that, “the claimant treats her headaches with conservative treatment such as closing her eyes and napping along with preventative medication management shows the claimant is not as limited as alleged.” (Tr. 25).
Thus, far from ignoring this medical condition, the ALJ's decision shows that Billings' headaches were fully considered but were not deemed to be so severe that they rendered her wholly disabled. Substantial evidence cited by the ALJ supported these findings. Therefore, the ALJ's decision regarding the severity of Billings' headaches may not now be disturbed on appeal.
At bottom, it seems that Billings simply invites us to re-weigh this evidence. This we may not do. See, e.g., Rutherford, 399 F.3d at 552 (quoting Williams v. Sullivan, 970 F.2d 1178, 1182 (3d Cir. 1992) (“In the process of reviewing the record for substantial evidence, we may not ‘weigh the evidence or substitute our own conclusions for those of the fact-finder”')). 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 recommend that the court find that substantial evidence supported the ALJ's evaluation of this case and affirm the decision of the Commissioner.
IV. Recommendation
For the foregoing reasons, IT IS RECOMMENDED that the decision of the Commissioner in this case should be affirmed, and the plaintiff's appeal denied.
The parties are further placed on notice that pursuant to Local Rule 72.3:
Any party may object to a magistrate judge's proposed findings, recommendations or report addressing a motion or matter described in 28 U.S.C. § 636 (b)(1)(B) or making a recommendation for the disposition of a prisoner case or a habeas corpus petition within fourteen (14) days after being served with a copy thereof. Such party shall file with the clerk of court, and serve on the magistrate judge and all parties, written objections which shall specifically identify the portions of the proposed findings, recommendations or report to which objection is made and the basis for such objections. The briefing requirements set forth in Local Rule 72.2 shall apply. A judge shall make a de novo determination of those portions of the report or specified proposed findings or recommendations to which objection is made and may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge. The judge, however, need conduct a new hearing only in his or her discretion or where required by law, and may consider the record developed before the magistrate judge, making his or her own determination on the basis of that record. The judge may also receive further evidence, recall witnesses, or recommit the matter to the magistrate judge with instructions.