LISA PUPO LENIHAN, Magistrate Judge.
This case is before the Court on appeal from a final decision by the Defendant, the Acting Commissioner of Social Security ("the Commissioner"), denying the claim of Plaintiff Lori A. Stiffey ("Stiffey") for social security disability income ("SSDI") and supplemental security income ("SSI") under Title II and Title XVI, respectively, of the Social Security Act ("SSA"). Stiffey filed her Complaint seeking judicial review pursuant to 42 U.S.C. § 405(g), (ECF No. 3), and the parties have submitted cross-motions for summary judgment with briefs in support.
On September 7, 2012, Stiffey protectively filed an application for SSDI, and on September 10, 2012, she protectively filed an application for SSI. (ECF 13 at 3); R. 25.
Stiffey timely filed for review by the Appeals Council of the ALJ's determination that she was not disabled under the Act. The Appeals Council denied review on July 29, 2015. R. 1. Thus, the ALJ's Decision became the Commissioner's final decision for purposes of this Court's review. Having exhausted her administrative remedies, Stiffey filed the instant action seeking judicial review of the final decision of the Commissioner of Social Security denying her SSI and SSDI applications. With leave granted December 21, 2015, (ECF 2), Stiffey proceeds in forma pauperis.
Stiffey has a high school education, R. 25, 40, 50, and attended online college studying business organization for four years, but did not obtain her bachelor's degree because she did not pay the matriculation fee. R. 50, 51. She was 41 years old on the amended date of her alleged onset of disability, May 10, 2010, R. 49, 72, placing her in the age category of younger person under the regulations. 20 C.F.R. §§ 404.1563(c), 416.963(c). She lives at home with her husband and with her daughter, who attends college. R. 49. Stiffey previously worked as a school bus driver; as a teacher/counselor for a youth emergency shelter, which involved her watching the children, teaching them skills, taking them on outings, and doing paperwork; and on a paper route. R. 51, 52.
Stiffey underwent back surgery in 2006 and 2008 after being diagnosed with herniated nucleus pulposus. R. 353, 354. Surgery was to relieve low back pain that radiated into her right buttock and thigh as steroids and narcotics had only provided moderate pain relief. R. 352, 486. She also has degenerative disc disease, R. 353, 356, that ultimately may require a fusion procedure as indicated by her physician in February of 2008. R. 352-353.
Stiffey sought emergency room treatment for her low back pain in January of 2009, R. 269, and was prescribed analgesics, vicodin and a muscle relaxer. R. 268. At the beginning of February of 2010, a lumbar spine MRI revealed a mild degree of spinal stenosis in the L4-5 level with a bulging disk, recurrent moderate L5/S1 disk protrusion, and degenerative disk disease. R. 295. She was referred to physical therapy. R. 298. She appeared for a physical therapy evaluation on February 23, 2010, R. 297, at which she reported pain at its worse as high as 8 or 9 on a 10 point scale and difficulty sitting or standing for prolonged periods of time. R. 297, 298. The evaluation noted a decreased lumbar range of motion, decreased trunk strength, low back pain with radiculopathy, and gait abnormality. Stiffey only attended the single session of physical therapy. (ECF No. 13 at 6). May 24, 2010 treatment notes from her primary care physician, Dr. Jeffrey Reyer, DO, also indicated that she experienced chronic low back pain. R. 359. On June 16, 2010, Stiffey was treated in the emergency room for pain related to her gall bladder, regarding which she indicated that she was to have it removed but had not done so because of the prior back surgeries. R. 272. Dr. Reyer's treatment notes from November 22, 2010 indicate no back pain. R. 361. On December 22, 2010, Stiffey was treated at an urgent care center by Dr. Laila Avelta for low back pain radiating down her left leg. R. 569-570. Dr. Avelta indicated left sciatica and prescribed steroids, vicodin, toradol and muscle relaxers. R. 570. As indicated in Dr. Reyer's treatment notes from January 17, 2011 and May 4, 2011, she did not present with back pain, R. 369, 373, but he noted in his treatment notes from visits for other issues in May 2011 and August 2011, that her issue with chronic low back pain continued, R. 377, 385, and also noted some relief with Robaxin. R. 357.
Stiffey was treated at the hospital on March 13, 2012, as a result of a fall, displayed pain on physical exam, and was diagnosed with low back pain, but denied any pain radiating down her legs, shortness of breath or chest pain. R. 304. An x-ray revealed moderate degenerative narrowing of the L5-S1 interspace but no spondylosis. R. 305. MRI on June 12, 2012 showed a minor annular bulge and mild to moderate facet arthrosis with mild bilateral recess narrowing at L4-5 and moderate L5-S1 disk space narrowing and desiccation with chronic endplate reactive changes, and moderate degenerative disk disease with no recurrent disk protrusion or nerve impingement. R. 306
Stiffey had her thyroid removed in 2005 due to cancer, and must take synthroid (levothyroxine) as a result, but is not fully compliant with taking her medication. R 302-303. She has a two pack a day history as a smoker, but indicated in 2012 and at the hearing that she was trying to decrease and attempt to quit smoking, and also indicated that she smoked a half of a pack a day. R. 69, 397, 606. The records reflect Stiffey treated at the urgent care on January 27, 2010 for chest pain on breathing, and was prescribed steroids and vicodin. R. 572-573. Then in February 2010, Stiffey experienced shortness of breath and chest pain, had diagnostic imaging that was unremarkable, and again was prescribed steroids and vicodin. R. 296. On December 22, 2010, Stiffey treated at the urgent care for cough and chest pain and was prescribed steroids and vicodin. R. 570-571. Stiffey had a cardiac stress test on November 2, 2012 to evaluate her chest pain, R. 511, which revealed no evidence of ischemia, but which was stopped before completion due to Stiffey's shortness of breath. R. 511. Pulmonary function tests were performed March 8, 2013, revealing moderate airflow obstruction with mild restrictive defect and decreased diffusion lung capacity, which was suggestive of emphysema with smoking history and which also could be related to her body habitus (obesity) versus interstitial lung disease. R. 586. Her respiratory findings were normal in the beginning of 2014. R. 558.
Stiffey treated for her mental health at the Family Counseling Center of Armstrong County ("FCC") from June 24, 2010, through January 16, 2014. R. 429, 601. Several therapists and physicians, including Kelly M. Rock, CRNP ("Nurse Rock"), counselor Gayle Richardson, M.A., Kimberly Altmeyer, LCSW, Dr. Mahendra Patil, M.D., and Dr. Mary Galonski, M.D., participated in her mental health care at FCC, which included several medical management appointments and counseling. Nurse Rock in particular treated Stiffey on numerous occasions at the FCC during that time period. Based on Stiffey's initial visit in 2010, Nurse Rock noted Stiffey's affect was constricted and fatigued; she was anxious, irritable and depressed; her short term memory was impaired; she expressed suicidal ideation in thoughts; and she maintained attention and had logical thought process. R. 430-431. Nurse Rock assessed Stiffey to have major depression, agoraphobia with panic disorder, and generalized anxiety, and prescribed her Celexa. R. 431. Her GAF
Nurse Rock's February 24, 2011 notes indicate that Stiffey reported she had not taken her synthroid for a month or more because of the $3.00 co-pay, had dropped out of therapy, and had not gone to MD appointments that she should because of lack of money for gas. R. 440. Stiffey also indicated she had a supportive friend who she helped deliver newspapers. R. 440. At that appointment, Stiffey indicated she had intermittent suicide ideation, was very tearful, rated her depression from 6-8 on a ten point scale, and had broken sleep due to health problems and pain. R. 440. Nurse Rock indicated that Stiffey's affect was constricted, her mood was depressed, but that her memory was intact, she was cooperative, maintained attention, and she had logical thought processes. R. 441. Nurse Rock saw Stiffey on March 17, 2011, and noted that Stiffey had low energy, was tearful, experienced poor sleep and had intermittent suicide ideation. R. 444-445. Nurse Rock next saw Stiffey on April 21, 2011, and Stiffey reported that her depression was well controlled and that she was taking medication consistently. R. 446. On July 28, 2011, Nurse Rock noted that Stiffey reported having good days and bad days, and rated her depression as an 8 and her anxiety as a 5-6 on a ten point scale. R. 450. Nurse Rock observed that Stiffey's mood was depressed, but her affect was appropriate, her memory was intact, her attention was maintained, and she was planning on spending time away in Indiana to reduce stress. R. 450, 451. Her medication was changed from Celexa to Effexor XR. R. 452. On August 18, 2011, Nurse Rock's notes indicate that Stiffey had a relationship with an individual in Indiana and was planning to be in Indiana for three months to "clear her head and `relax,'" R. 454, 456; she had issues with sleep, anxiety, crowds; and she denied suicide ideation but indicated a passive death wish when completely stressed. R. 454.
On March 1, 2012, Nurse Rock indicated that Stiffey had returned from Indiana in November of 2011 after being away for 3 months, had been off all of her psychiatric medications for 4-6 weeks at the time of her appointment, and her symptoms had returned including mood lability. R. 460. Stiffey reported that when she is off of her medications she has intermittent visual hallucinations consisting of intermittently seeing shadows and flashing lights. R. 460. Stiffey was assessed a GAF score of 55. R. 462. On April 24, 2012, Gayle Richardson, M.A., assessed Stiffey with a GAF of 55. On May 17, 2012, Nurse Rock noted Stiffey's GAF was 57, R. 469, noted that Stiffey had not been consistent with taking her synthroid and noted that she had self-reduced her Effexor to half the dose because she felt tired and "zoned out" from the medication, but that Effexor had resulted in her feeling less depressed, less often. R. 467. The treatment notes also reflected that Stiffey's concentration and attention were poor at that time, R. 467, but that Stiffey indicated she does better when she keeps herself busy. R. 467. On August 22, 2012, she was assessed with a GAF of 58. R. 471. On October 25, 2012, Nurse Rock noted that Stiffey indicated that she had started Abilify and that her "visual hallucinations" had "eased off," her mood and paranoia had somewhat improved, and her depression was not as bad. R. 474. Stiffey was still experiencing irritability, R. 474, felt a bit more tired, continued to have problems with concentration, attention and focus, had good days and bad days, R. 474, and occupied her time with Facebook and arts and crafts. R. 474. The treatment notes for this appointment also indicated a diagnosis of bipolar disorder. R. 474. Nurse Rock's treatment notes from October 25, 2012, indicate a GAF of 57, R. 639, constricted affect, distracted attention, visual hallucinations, but logical thought process and no suicide ideation. R. 638. Treatment notes from November 20, 2012, indicated ongoing issues with depression and anxiety, racing thoughts and excessive worry. R. 651. They also reflect that Stiffey enjoys crafts, cooking, walking and computer games. R. 650. Treatment notes from November 29, 2012, indicate that Stiffey had 3-4 good days a week when she did not have anxiety associated with going places and doing things, but on bad days she felt depressed, irritable and edgy. She had a lot of "anticipatory anxiety" and a passive death wish, but no panic attacks or suicide ideation. R. 632. Stiffey was taking her medication, R. 633, and Abilify helped to drastically reduce her visual hallucinations. R. 632. Her GAF then was assessed as a 58. R. 634.
In January 31, 2013, Stiffey denied suicide ideation, but expressed a passive death wish. R. 627. She indicated that since taking Abilify her visual hallucinations were very rare. R. 627. She was prescribed Neurontin for anxiety. R. 621. Her GAF at that time was assessed as a 56. R. 629. On April 4, 2013, her GAF was assessed as a 55, R. 623, her Effexor was increased, R. 624, and her Neurontin was discontinued as she reported no effect from the medication. R. 624. She denied suicide ideation at that time, but felt overwhelmed and was "scattered and disorganized." R. 621. Gayle Richardson, MA, assessed Stiffey with a GAF of 56 in March of 2013 and notes indicate continuing issues with panic, anxiety and depression. R. 649. Her GAF on June 6, 2013, as indicated by Nurse Rock, was a 59. R. 618. Her affect was appropriate and her thought process was logical. R. 617. Stiffey was planning at that time to host graduation party and baby shower. R. 616. Her anxiety was better overall, R. 616, but her inattention and concentration remained unchanged. R. 616. She experienced anxiety triggered by crowds, R. 616, and had experienced the previous visual hallucinations. R. 617. Again, in July of 2013, Gayle Richardson, MA, indicated Stiffey's continuing issues with panic, anxiety and depression and then assessed her with a GAF of 57. R. 645. On August 15, 2013, Nurse Rock indicated Stiffey's GAF was assessed as a 56. R. 613. Stiffey's affect was appropriate and her thought processes were logical. R. 612-613. She noted improved depression and anxiety and decrease in visual hallucinations, and denied suicide ideation. R-613. 612. She indicated that she enjoyed cooking and crafts but concentration and focus remained a problem R. 611. Gayle Richardson, M.A., assessed Stiffey with a GAF of 57 on October 9, 2013. R. 642. On November 14, 2013, Stiffey reported to Nurse Rock that she does not like to go into stores, large groups make her uncomfortable, and she had suicide ideation. R. 606-607. Her affect was constricted, her attention was gained and distracted, but her visual hallucinations were rare and her thought process was logical. R. 606-607. Stiffey indicated she did not take her Effexor as prescribed because it made her tired, R. 606, and her Effexor prescription was decreased. R. 609.
On January 16, 2014, Nurse Rock noted that Stiffey had quit on her own taking the Effexor because it made her tired. R. 601. She was then prescribed Wellbutrin, R. 604, which also could help Stiffey with her efforts to stop smoking. R. 604. Stiffey's affect was constricted, but her attention was maintained and her thought process was logical. R. 602. She did not express suicide ideation, her visual hallucinations were rare, but she expressed having trouble finishing projects and experiencing panic in public, was avoiding large crowds and expressed a passive death wish. R. 601-602. Her GAF was assessed at 57 at that time. R. 603.
The record includes opinion evidence from treating, examining consultative and non-examining consultative sources.
The December 26, 2013 assessment was similar to the September 20, 2012 assessment, but then indicated a
Finally, the February 27, 2014 assessment was similar to the December 26, 2013 assessment, but indicated an
Stiffey testified at the hearing before the ALJ regarding her condition and daily activities. She also explained that she did not have insurance from February 2014 until just before the June 26, 2014 hearing because she "didn't send in the right paperwork." R. 50. She testified that she drives daily, but does not drive on extended trips, just going to the store and back. R. 50. In the months prior to the hearing, Stiffey also occasionally rode in the car with a friend on the friend's paper route to keep them company. R. 53.
Stiffey explained that she cannot function on a day-to-day basis because her family has to sometimes help her get her shoes and pants on, she has her shoes pre-tied so she can slip them on, she cannot wash dishes or do laundry because standing too long or sitting too long bother her and causes her excruciating pain. R. 53. She indicated that too long meant 10 to 15 minutes. R. 54. She walks but has to take breaks after a half of a block. R. 64. She goes grocery shopping or to the mall, but added that she needs to have a bench close by or a wheelchair. R. 54. She sometimes has trouble sitting, requiring her to get up and down, unless she takes medication such as hydrocodone that makes her tired. R. 54-55. She described the pain as in her back, legs, knees and feet, radiating up and down her back into her hips, down her legs and into her toes. R. 54. She treats her pain with pain medicine, muscle relaxers, heat, ice and exercise. R. 55.
Stiffey described her day as: "consist[ing] of getting up, sitting down, laying down, getting up, moving—[trying] to move around as much as [she] can. But [finding herself] laying around a lot, now more than ever." R. 55. She is frustrated by having to rely on everyone else. R. 55. She also testified that on a typical day, she will go the bathroom, walk outside to see what's going on, then come inside and sit down and maybe turn on the TV or the computer, check her email, shift around trying to do "a little bit of this and a little bit of that" as much as she can, trying to "get a few dishes washed, or straighten up a little bit, or dust, or wipe off the counter, or something; anything to help [her] husband." R. 59-60. She tries to help but her husband does most of the chores, including cooking. R. 60. She cooks simple limited things, unless she can sit, R. 60, and she tries to straighten things up because they are all on different schedules. R. 61. She shops for groceries, but quickly, R. 61, and when she shops by herself she has the store put the bags in her car. R. 61. She goes out to eat at restaurants and has friends and family visit. R. 61-62. She babysits her grandson but has someone to help lift and carry him because he weighs 20 pounds. R. 62. She also sits outside and talks on the phone. R. 65.
She was supposed to host a baby shower, but her daughter-in-law went into labor and was delivering the baby during the shower and Stiffey was at the hospital for the labor and delivery. R. 62-63. A year before the hearing, she hosted a high school graduation party for her daughter. R. 63. She planned the party, assigned jobs, and called and made the arrangements for it. R. 63. She likes to do crafts, but indicated that she does not complete them as she gets frustrated and can't focus to finish them because of her issues with attention. R. 63-64, 71.
Responding to questions by her counsel, she testified that she regularly and usually takes naps in the afternoon from three to five hours a day because the medication makes her tired and because she does not sleep more than three to five hours at a time. R. 65-66. She also testified that she needs to recline or lie down for an hour to two hours at a time due to pain every day for four to five hours. R. 67. She testified that she has a lot of days a month, at least 20 or 25, where her pain is so great it limits her ability to wash dishes, do laundry, vacuum, cook a nice dinner, or "chase after" her grandson. R. 68.
According to her testimony, she had back surgery in 2006 and 2008, which helped for a while but then the pain came back and she was told at one point that her next option was to have a fusion surgery. R. 55, 56, 71. Since 2010 her pain has gotten worse because she has more pain down her legs. R. 70. She tried physical therapy but thought it made her pain worse. R. 70. She testified that sometimes the pain is bad, as her legs were hurting really bad at the hearing, but sometimes "it's not as bad as other times . . . [but it] never goes away." R. 56. She has a hard time falling asleep because of the pain unless she takes medication. R. 59.
She sometimes has trouble breathing when she walks a lot or is in the real hot heat. R. 56. Fumes and odors, however, do not bother her or affect her breathing. R. 56. She used to smoke over two packs of cigarettes a day, but is trying to quit and indicated at the time of the hearing that she was down to less than half a pack a day, which helped her breathing. R. 69. She previously took Chantix and now uses Wellbutrin to help with smoking cessation. R. 69.
Stiffey testified that she takes thyroid medicine because of thyroid cancer and removal, but it does not affect her ability to function. R. 57. Regarding gastrointestinal issues, she mostly has had problems with her stomach when she eats and has gone through periods where everything she eats make her run to the bathroom, so that she stays near a bathroom. R. 57. She takes Bentyl, which is helping her but she still has "flare ups" when her nerves are on edge or she "eats something [she] shouldn't eat." R. 57-58. She testified that it "really bothers [her] being around a bunch of people," resulting in her being unable to function, and that she has panic attacks, and sees and hears things not there," R. 58, but that her condition has improved as long as she is on the medication, although it makes her tired. R. 59. Stiffey did not feel that she could work a full time job even if it was sitting at a table and working with paper because she would need to be up and down, moving around, would need to be in the bathroom, and because her attention would not be constantly on the work like it should be. R. 66-67.
The ALJ determined that Stiffey was not disabled under § 1614(a)(3)(A) of the Social Security Act from November 19, 2006 through September 5, 2014. R. 39. The ALJ concluded that Stiffey had the following
As to Stiffey's RFC, the ALJ found that she has the RFC to perform sedentary work with the following restrictions:
R. 29.
In ruling, the ALJ also made the following credibility determination:
R. 30.
The ALJ determined that Stiffey did not have the RFC to perform her past relevant work, R. 27, and ultimately determined that Stiffey "has not been under a disability, as defined in the Social Security Act, from May 10, 2010, through the date of this decision." R. 39. Regarding his ultimate ruling that Stiffey is not disabled under the Act, ALJ Wood further stated:
R. at 30.
The Congress of the United States provides for judicial review of the Commissioner's denial of a claim for benefits. 42 U.S.C. § 405(g). This Court's review is plenary with respect to all questions of law.
Under the SSA, the term "disability" is defined as the:
42 U.S.C. § 423. A person is unable to engage in substantial activity when she:
42 U.S.C. § 423(d)(1)(A) & (d)(2)(A).
In determining whether a claimant is disabled under the SSA, a sequential evaluation process is applied. 20 C.F.R. § 416.920(a).
Stiffey seeks to have the agency decision vacated and the matter remanded for further administrative proceedings, arguing that: 1) the ALJ's RFC finding was unsupported by substantial evidence and was the product of legal error, namely that the ALJ erred in the weight given to certain opinion evidence; and 2) the ALJ's credibility determination was not supported by substantial evidence and was the product of legal error. (ECF No. 13 at 1).
In according little weight to Dr. Singh's opinion, the ALJ specifically indicated that the objective medical evidence did not establish an impairment that would preclude Stiffey from sitting or walking for more than 10 to 15 minutes, the documented observations of her pain behaviors did not support the 15 minute sitting limitation, and the treatment history did not reflect a severity or frequency of pain complaints that would prevent Stiffey from showing up for work four or more days a month. R. 36. Nonetheless, the ALJ's RFC limited Stiffey to sedentary work, lifting and carrying only occasionally 10 pounds, permitting a sit/stand option every 30 minutes, requiring her only to stand or walk for two hours and sit for six hours of an eight-hour workday, and requiring access to a bathroom. R. 29.
Citing
Great or controlling weight may be given to a treating physician's opinion where the opinion is based on ongoing observation over a prolonged period of time, provides a sufficient explanation to support the opinion, is well-supported by clinical and laboratory evidence, and is not inconsistent with other substantial evidence of record.
Stiffey's challenge generally ignores that Dr. Singh's opinion was based on a single visit, rather than any continuing observation of Stiffey, and that Dr. Singh provided only a check the box form with no accompanying report. Moreover, the ALJ explained that Dr. Singh's own examination of Stiffey and treatment notes from her single visit with him on January 24, 2014, revealed that she complained of low back pain and intermittent diarrhea, but that she had normal gait and station, no acute distress, no abdominal tenderness and normal bowel sounds. R. 31, 32, 557, 558. Stiffey claims that the ALJ only provided a single conclusory reason for affording little weight to Dr. Singh's opinion—that the evidence does not support the opinion. (ECF 13 at 17). To the contrary, the ALJ explained that the treatment records and treatment history did not support the opinion that Stiffey could only sit for 15 minutes and could not walk for more than 15 minutes, and the treatment history did not reflect pain complaints of a severity or frequency preventing her from showing up for work more than four times a month. R. 36. Nevertheless, the ALJ's RFC finding provided her a sit/stand option every 30 minutes, limited her to lifting and carrying 10 lbs., and limited her to standing and walking only 2 hours in an 8 hour workday.
As urged by the Commissioner, (ECF 19 at 23), an ALJ may choose whom to credit.
Stiffey also argues that where the ALJ relies solely upon a consultative examiner's report that did not benefit from a review of the claimant's records, he commits reversible error. (ECF 13 at 21) (citing
The regulations do provide regarding consultative examination, that "[w]e will also give the examiner any necessary background information about your condition." 20 C.F.R. § 404.1517. The regulations do not, however prohibit the ALJ from relying on state agency opinions issued prior to subsequently generated medical records as "there is always some time lapse between the consultant's report and the ALJ hearing and decision. Only where additional medical evidence is received that in the opinion of the [ALJ] . . . may change the State agency medical consultant's finding. . . is an update to the report required."
In sum, the ALJ's decision to afford little weight to Dr. Singh's check the box form provided without explanation and based on a single visit is not error,
Stiffey challenges as error that the ALJ gave little weight to Nurse Rock's opinions, and argues that the ALJ did not assess her opinion evidence in accordance with regulations. (ECF 13 at 19). First and foremost, as pointed out by the ALJ and acknowledged by Stiffey, Nurse Rock is not considered an acceptable medical source under the regulations and her opinion does not constitute a medical opinion. 20 C.F.R. § 404.1513(a); R. 37. Instead, she is classified under "other sources," "whose opinions the ALJ
Stiffey erroneously refers to Social Security Ruling 06-03p as a regulation; however it is a ruling. Nevertheless, the policy interpretation ruling addresses how the Social Security Administration "consider[s] sources who are not "acceptable medical sources." SSR 06-03p (Purpose). That ruling specifies that the regulations do not address factors that must be applied to opinion evidence from "other sources," such as Nurse Rock, but also indicates that the factors that explicitly apply to assessing medical opinions from acceptable medical sources "
SSR 06-03p.
Stiffey claims the ALJ simply brushed aside appropriate analysis of Nurse Rock's opinion and merely offered the conclusory statement that he considered her opinion in accordance with those regulations. (ECF 13 at 20). The ALJ did state specifically that he evaluated Nurse Rock's opinions, as opinion from a non-acceptable medical source that does not constitute a medical opinion, "in accordance with those regulations, under guidance set forth for weighing opinions from treatment providers who are not acceptable medical sources." R. 37. The ALJ, however, also specifically noted Nurse Rock's relationship with Stiffey and her knowledge and experience in the mental health field. R. 37. The ALJ's decision further detailed Nurse Rock's involvement in Stiffey's care, when discussing medical management, treatment notes, mental status findings, and GAF scores assessed with her treatment at the FCC. R. 33-36.
Stiffey argues that in giving Nurse Rock's opinion little weight, the ALJ failed to consider the treatment notes regarding Stiffey's limitations with concentration. (ECF 13 at 20). Rather than ignoring the issue of concentration as suggested by Stiffey, the ALJ in reviewing the record specifically noted Stiffey's complaints of poor concentration, including at her initial visit at the FCC, but also indicated that her mental status exam findings indicated on several occasions that she maintained attention. R. 33. Likewise, the ALJ considered that the mental status examination findings in the treatment records from February 2011 revealed that she maintained attention, R. 34, from April 2011 revealed distracted attention, R. 34, from August 2011 revealed improvement and otherwise normal mental exam findings, R. 34, from November 2012 revealed she maintained attention, R. 35, from June of 2013 revealed distracted attention, R. 35, from August 2013 revealed distracted attention and that she continued to report problems with concentration and focus, R. 35, from November 2013 revealed distracted attention, R. 36, and from January 2014 revealed reported difficulty finishing projects, R. 36. The ALJ noted as well her medical management and improvement with medicine compliance throughout that time period. R. 33. Moreover, the ALJ's RFC finding limited Stiffy to simple, routine, repetitive tasks, with low stress with occasional simple decision making, only occasional changes in the work setting and no fast-paced production environment, occasional interaction with co-workers and supervisors. The Court of Appeals for the Third Circuit has held that an RFC limited to "simple, routine, repetitive work" or "simple, routine tasks" accounts for
As with Dr. Singh's opinion, that the ALJ gave little weight to Nurse Rock's check the box opinions is not error. The ALJ based his decision on the treatment notes from the FCC, including Nurse Rock's treatment notes, the mental status exam findings, Stiffey's treatment history, GAF scores, and Stiffey's activities of daily living, including her self-report. R. 37. For example, Nurse Rock's treatment records and the records from the FCC indicated that Stiffey's mental status examination findings were mostly normal, R. 33-37 (noting Euthymic mood, appropriate behavior, logical and unremarkable though content on multiple occasions), except for the construction in affect at times and depressed mood, R. 36-37, and her GAF scores remained at 55 and above, ranging from 55 to 65 from 2010 to 2014. The ALJ considered and evaluated Nurse Rock in accordance with the requirements of SSR 06-03p, and considered Dr. Kennedy's opinion, as well as the GAF scores throughout in assessing her RFC.
In sum, the Court concludes that the ALJ's decision to afford little weight to the "other source" opinions of Nurse Rock in the check the box forms is supported by substantial evidence.
Stiffey argues that the ALJ's credibility analysis fails and his finding that Stiffey was not fully credible, R. 30, is not supported by substantial evidence because he did not properly assess her complaints of pain and psychological symptoms. (ECF 13 at 23-24). Specifically, she asserts that he failed to explain his finding, "did not offer an explicit analysis of the regulatory factors for assessing such subjective complaints," and did not explain how they were "inconsistent with any treatment notes." ([ECF 13 at 21-22). Admitting, however, that the ALJ "carefully examin[ed] each of Plaintiff's complaints of disabling limitations, and examining the support for them in the record," Stiffey nevertheless argues that the ALJ improperly engaged in only a cursory analysis of Stiffey's credibility and failed "to identify those treatment records inconsistent with her subjective complaints." (ECF 13 at 23).
"An ALJ must explain the degree to which a claimant's testimony is credited."
"Although any statements of the individual concerning his or her symptoms must be carefully considered, SSR 96-7pm (July 2, 1996), the ALJ is not required to credit them." 667 F.3d at 363 (citing 20 C.F.R. §404.1529(a)). "In concluding that some or all of a claimant's testimony is not credible, the ALJ may rely on discrepant medical evidence and the claimant's inconsistent statements."
In
The ALJ thus detailed legitimate and appropriate considerations in assessing Stiffey's credibility and did not simply provide a cursory or conclusory statement finding her not fully credible. "After stating that [Stiffey's] statements were not entirely credible, the ALJ discussed the opinion evidence and explained how the objective medical evidence of record did not support Plaintiff's claims."
Other than the challenges to the credit given to the opinion of Dr. Singh, Dr. Malik, and Nurse Rock, the issue of concentration, and the credibility assessment, Stiffey makes no further specific challenge to the RFC. Based on the Court's review of the record as a whole, and there being no error on the part of the ALJ concerning the treatment of the acceptable medical and "other" source opinions and concerning his credibility determination, the Court finds that ALJ's RFC finding is supported by substantial evidence.
The Third Circuit in
The ALJ's review of the case record was thorough and detailed and the bridge well-constructed. The ALJ determined in his RFC finding that Stiffey was able to perform unskilled sedentary work with certain restrictions. The SSA defines sedentary work as involving:
20 C.F.R. § 404.1567(a). The physical RFC fully accounted for Stiffey's credited back pain with requirements that Stiffey was limited to sedentary work with a sit/stand option every 30 minutes, a stand/walk limit of two hours in an eight hour day, a lifting and carrying limit of 10 lbs. occasionally, and occasional posturals of balancing, stooping, kneeling, crouching and crawling.
Stiffey's credited limitations in mental functioning, also supported by her GAF scores reflecting moderate difficulties, as well as her marked difficulty in dealing with the public, were accommodated by limiting her to simple, routine, repetitive tasks in a low stress environment with occasional simple decision making and occasional changes in work setting, accounting for moderate limitation in concentration, persistence and pace, with no public interaction and with occasional interaction with co-workers and supervisor. By limiting Stiffey to no interaction with the public contact and occasional interaction with coworkers and supervisors, the ALJ's RFC addresses the medical record, and Stiffey's difficulty interacting with people. The ALJ also cites Stiffey's activities of daily living, mental status exam findings and her GAF scores as a basis for his determination that her mental impairments do not prevent her from working jobs with the restrictions as he found. R. 36, 38. Thus, the ALJ addressed Stiffey's credited reports of pain and mental health difficulties and accounted for them in his physical and mental RFC. Review of the record as a whole indicates that the RFC findings are supported by substantial evidence.
For the foregoing reasons and based upon review of the record as a whole, the decision of the Commissioner that Stiffey was not disabled is supported by substantial evidence. Accordingly, the Commissioner's decision will be affirmed. An appropriate order will be entered granting the Commissioner's motion for summary judgment, denying Ms. Stiffey's motion for summary judgment, and affirming the decision of the Commissioner.
