LYNNE A. SITARSKI, Magistrate Judge.
Plaintiff, Steven Kremsner, brought this counseled action pursuant to 42 U.S.C. § 405(g), seeking review the Commissioner of the Social Security Administration's decision denying his claim for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") under Titles II and XVI of the Social Security Act, 42 U.S.C. §§ 401-433, 1382-1383 (the "Act"). Defendant has filed a response and the matter is before me for a Report and Recommendation. For the reasons set forth below, I respectfully
Plaintiff was born on August 27, 1978 and was thirty-three years old as of his alleged disability onset date. (R. 198, 204). Plaintiff protectively filed for DIB and SSI on October 18, 2012, alleging disability since July 22, 2012, due major depressive disorder and anxiety.
Plaintiff's SSI and DIB applications were initially denied by the Bureau of Disability Determination on January 24, 2013. (R. 118-25). Plaintiff filed a request for a hearing before an administrative law judge ("ALJ") on April 1, 2013. (R. 126-27). A hearing was held before ALJ Deborah Mande on November 7, 2013, at which Plaintiff, represented by an attorney, and a vocational expert ("VE"), appeared and testified. (R. 35-55). On November 25, 2013, the ALJ issued a decision finding Plaintiff not disabled and not entitled to benefits under the Act. (R. 18-28). Plaintiff filed a request for review with the Appeals Council, (R. 14), which was denied April 2, 2014, (R. 11-13), making the ALJ's decision the final decision of the Commissioner. On July 16, 2014, Plaintiff filed the filed the above-captioned action to appeal the Commissioner's decision. (ECF No. 1).
The matter has been assigned to the Honorable Jan E. DuBois, who has referred to it to the undersigned for preparation of a Report and Recommendation. (Order, ECF No. 10).
In his DIB and SSI applications, Plaintiff alleges inability to work due to major depressive disorder. (R. 60, 64, 245). In his Function Report, he further alleged anxiety, including racing thoughts, a racing heartbeat, sweatiness, nervousness, and shakiness in social settings. (R. 262, 265, 267). The following summarizes the relevant medical evidence.
On July 23, 2012, Plaintiff presented at St. Luke's Hospital ("St. Luke's") in Allentown, Pennsylvania. (R. 403, 461). Upon admission, Dr. Stephen A. Prayson, D.O., the attending physician, observed that Plaintiff appeared anxious and extremely depressed with a tearful affect. (R. 405-06). Plaintiff explained that he felt overwhelmed by his situation, as he had recently received his second DUI citation, was unemployed, and was homeless. (R. 472-73). Dr. Prayson diagnosed Plaintiff with recurrent Major Depressive Disorder ("MDD") with suicidal tendencies and moderate to severe alcohol dependence, and gave him a Global Assessment of Functioning ("GAF") score of 21. (R. 405-06). On July 24, 2012, Dr. David Daley, D.O., who also treated Plaintiff at St. Luke's, completed a state welfare employability form in which he indicated that Plaintiff was temporarily disabled from July 22, 2012, to August 1, 2013, due to MDD. (R. 331).
During his course of treatment at St. Luke's, Plaintiff began to take antidepressants and medication for alcohol withdrawal, and attend group therapy. (R. 406, 417-18, 478, 550-77). An August 14, 2012, discharge summary noted that Plaintiff's affect was improved, and that he denied any thoughts of self-harm. (R. 406). Plaintiff was discharged to Allentown Rescue Mission with instructions to seek follow-up care beginning on August 26, 2012, at Lehigh Valley Community Mental Health Centers ("Lehigh Mental Health"). (R. 403, 409).
Plaintiff's treatment records from Lehigh Mental Health reflect that he first appeared for treatment on March 21, 2013.
Dr. Hyung Y. Yeo, M.D., a psychiatrist at Lehigh Mental Health, also evaluated Plaintiff on April 9, 2013. (R. 780-83). His form report reflects that Plaintiff appeared causal, calm, and cooperative; was oriented to person, place, time and situation; and had normal and coherent speech. (R. 780). Dr. Yeo recorded that Plaintiff felt depressed and experienced intermittent panic attacks, but had a new girlfriend who offered him a good support system. (R. 782). Dr. Yeo affirmed Plaintiff's diagnosis of MDD, further diagnosed him with Generalized Anxiety Disorder, and assigned Plaintiff a GAF greater than or equal to 50 to 55. (R. 782).
Plaintiff continued to receive treatment from Dr. Yeo between April 2013 and September 2013.
On January 9, 2013, Plaintiff was examined by Dr. David J. Smock, a psychologist, at the request of the Social Security Administration. (R. 333-341). Dr. Smock observed in his psychological examination report that Plaintiff was fully cooperative with the evaluation, appeared oriented to person, place, and time, and experienced intermittent bouts of depression and anxiety, most recently culminating his hospitalization in July 2012. (R. 337). Upon testing, Dr. Smock concluded that Plaintiff's attention and concentration were impaired, as Plaintiff could not remember simple instructions or perform simple calculations without substantial difficulty. (R. 338). He affirmed Plaintiff's diagnosis of Generalized Anxiety Disorder with panic attacks, MDD, and alcohol dependence in remission. (R. 339).
Dr. Smock also completed a Medical Source Statement on January 9, 2013, in which he assessed Plaintiff with marked limitations in ability to understand, remember, and carry out simple instructions, and extreme limitation in his ability to ability to understand, remember, and carry out detailed instructions. (R. 333). He further indicated that Plaintiff had extreme limitation in all aspects of interacting and responding appropriately in the work setting. (Id.).
On January 24, 2013, State Agency psychological consultant Dr. Erin Urbanowicz, Psy. D., completed a Disability Determination Explanation Form. (R. 95-106). Based on her review of the records, she opined that Plaintiff had the ability to understand and remember one-to-two step tasks, and that he had no more than moderate limitation in concentration, social interaction, or ability to adapt to work pressures in the normal work setting. (R. 101-02). She found that based on the above limitations, Plaintiff could perform simple, routine, and repetitive work involving simple instructions without special supervision. (Id.).
To receive DIB or SSI benefits, 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), 1382c(a)(3)(A). The Act requires that a claimant for disability benefits show that he has a physical or mental impairment of such a severity that:
42 U.S.C. §§ 423(d)(2)(A), 1382c(a)(3)(B). A five-step sequential evaluation process is used to determine eligibility for disability benefits.
Judicial review of a denial of disability benefits is limited to determining whether there is substantial evidence to support the Commissioner's decision. Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Knepp v. Apfel, 204 F.3d 78, 83 (3d Cir. 2000); Hartranft v. Apfel, 181 F.3d 358, 360 (3d Cir. 1999). 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) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). Substantial evidence is a deferential standard, requiring "less than a preponderance" and only "more than a mere scintilla." Jesurum v. Sec'y of U.S. Dep't of Health & Human Servs., 48 F.3d 114, 117 (3d Cir. 1995) (citing Richardson v. Perales, 402 U.S. 389, 401 (1971)); see also Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005).
Though the Court's duty is "to scrutinize the record as whole to determine whether the conclusions reached [by the ALJ] are rational," Dobrowolsky v. Califano, 606 F.2d 403, 406 (3d Cir. 1979), the Court may not undertake de novo review of an ALJ's decision, nor may it re-weigh the evidence of record. Williams v. Sullivan, 970 F.2d 1178, 1182 (3d Cir. 1992) (A reviewing court is not "empowered to weigh the evidence or substitute its conclusions for those of the factfinder."); Monsour Med. Ctr. v. Heckler, 806 F.2d 1185, 1190 (3d Cir. 1986). However, the court has plenary review of legal issues. Schaudeck v. Comm'r. of Soc. Sec., 181 F.3d 429, 431 (3d Cir. 1999) (citing 42 U.S.C. § 405(g)); see also Friedberg v. Schweiker, 721 F.2d 445, 447 (3d Cir. 1983) ("[E]ven if the Secretary's factual findings are supported by substantial evidence, [a court] may review whether the Secretary, in making his findings, applied the correct legal standards to the facts presented.") (internal quotation omitted).
(R. 20-27). Accordingly, the ALJ reached step five of the disability analysis and found Plaintiff was not disabled under the Act. (R. 28).
In his request for review, Plaintiff argues that the ALJ erred at step four in deriving the RFC because she failed to consider evidence of all of Plaintiff's impairments, and improperly weighed the medical opinions. (Pl.'s Br. 5-14, ECF No. 8). Plaintiff further contends the ALJ erred at step five because she relied on VE testimony that did not incorporate all of Plaintiff's credibly established limitations. (Id. at 14-15).
Having considered the arguments, the evidence of record, the ALJ's decision, and the hearing testimony, I recommend that Plaintiff's Request for Review be denied.
Plaintiff first argues that the ALJ did not fully or fairly consider evidence of all of his impairments when evaluating his RFC. (Pl.'s Br. 6-9). Specifically, Plaintiff asserts that the ALJ unduly focused on Dr. Yeo's opinion from September 2013, that he was only moderately impaired, and failed to address Plaintiff's traumatic personal history, his testimony reflecting that he suffers from severe social anxiety, and Dr. Smock's assessment of his limitations. (Pl.'s Br. 6-8). Had the ALJ properly evaluated the evidence, Plaintiff contends, she would have found him entitled to a closed period of benefits between July 2012 and July 2013. (Id. at 9).
A claimant's RFC is the most the claimant can still do despite the limitations arising from his impairments.
First, Plaintiff argues that the ALJ should have more fulsomely considered his traumatic life experiences, such as his mother's shooting and subsequent paralysis, and that his former girlfriend was the victim of a brutal assault. (Pl.'s Br. 6-7). Plaintiff explains that his "longstanding psychiatric problems . . . have plagued him since childhood," that he has "difficulty coping emotionally with the complications of life that one experiences due to his mental health problems," and that "he experienced conflict in his life" which he was unequipped to deal with because his "layers of mental health problems." (Id.). However, the Court finds no merit to the argument that the ALJ failed to consider this evidence. In the decision, the ALJ noted Plaintiff's difficult upbringing, including his mother's injury, and referenced that much of Plaintiff's difficulty appeared to stem from inability to cope with "significant psychosocial stressors," including financial and familial instability. (R. 23, 25). Plaintiff's argument amounts to little more than recounting portions of the evidence before the ALJ, and explaining why, in his view, such evidence supported a finding of a closed period of disability. However, this Court is not empowered to reweigh the evidence in the fashion proposed by Plaintiff. See Horst v. Comm'r of Soc. Sec., 551 F. App'x 41, 45 (3d Cir. 2014) ("[c]ourts are not permitted to re-weigh the evidence or impose their own factual determinations.") (not precedential) (quoting Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 359 (3d Cir. 2011)). The ALJ appropriately considered evidence pertaining to Plaintiff's history, and her decision that he was not disabled during the relevant period is supported by substantial evidence.
Second, Plaintiff argues that the ALJ did not appropriately address Dr. Smock's opinion that he had significant problems sustaining attention and following directions in the work setting. (Pl.'s Br. 8). This claim is belied by the decision, which reflects that the ALJ fully considered Dr. Smock's opinion. The ALJ accurately relayed that Dr. Smock concluded that Plaintiff suffered from "high levels of anxiety," had difficulty performing certain simple calculations, and had memory recall issues. (R. 24). After reviewing these findings, the ALJ acknowledged that Dr. Smock imposed marked and extreme limitations upon Plaintiff's ability to perform cognitive work-related activities, including extreme limitations in the ability to carry out, understand, and remember detailed instructions. (R. 26). However, the ALJ afforded Dr. Smock's opinion no weight on the basis that he appeared overly reliant on Plaintiff's subjective complaints, and because his opinion was contradicted by the opinion of Dr. Yeo, a treating source, who concluded that Plaintiff was only moderately impaired. (R. 26). Accordingly, the Court does not agree that the ALJ failed to consider probative record evidence from Dr. Smock. Though Plaintiff may disagree with the ALJ's decision to give this opinion no weight, substantial evidence supports the ALJ's determination.
Third, Plaintiff asserts is that ALJ did not consider evidence pertaining to his anxiety and panic attacks; specifically, Plaintiff's testimony that his social anxiety is so severe that he experiences difficulty leaving his home even for short periods of time, such as to take out the trash.
Further, the ALJ noted in the RFC analysis that Plaintiff alleged experiencing regular debilitating panic attacks. (R. 25). She discredited this allegation because such occurrences were not well documented by the treating source records, Plaintiff responded to treatment, and Plaintiff's anxiety appeared related to external stressors such as housing insecurity, financial constraints, and relationship difficulties. (Id.). Substantial evidence supports the conclusion that although Plaintiff experiences anxiety and panic attacks in part due to external stressors, he is able to manage his symptoms through consistent treatment. For instance, Plaintiff's treatment notes at St. Luke's reflect that while he was initially depressed and anxious regarding his life situation, he felt better when distracted by television or group therapy, and medications such as Ativan were effective in reducing his anxiety. (R. 474-76, 486). Over time, Plaintiff reported overall improvement in his anxiety, (R. 406, 489-91); at time of discharge from the hospital, he expressed optimism about leaving hospital and returning to work. (R. 493). The ALJ reasonably concluded that Plaintiff's reports of disabling social anxiety and panic attacks were not fully credible. Moreover, any credibly established limitations arising from Plaintiff's anxiety were accounted for in the RFC restricting Plaintiff to no public interaction and only occasional interaction with co-workers and supervisors.
Accordingly, the Court finds that the ALJ considered all of Plaintiff's alleged impairments in deriving the RFC, and substantial evidence supports his conclusion that Plaintiff retained the RFC to perform simple, routine, repetitive work at all relevant times.
Plaintiff next contends that the ALJ erroneously evaluated the medical opinions in the record. (Pl.'s Br. 10-14).
A medical opinion from a treating source must be given controlling weight if it is "well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record." 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). When a treating sources opinion is not deemed controlling, the amount of weight to which it is entitled is assessed in accordance with the factors provided in 20 C.F.R 404.1527 and 416.927, which also supply the factors used to weigh opinions from non-treating sources.
Ultimately, the ALJ "must consider all the evidence and give some reason for discounting the evidence she rejects." Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir. 1999). An ALJ must always consider medical opinions together with the rest of the relevant evidence submitted, and "must explain the weight given to physician opinions and the degree to which a claimant's testimony is credited." Chandler, 667 F.3d at 362; see also Walker v. Astrue, 733 F.Supp.2d 582, 588 (E.D. Pa. 2010). The ALJ has the duty to adequately explain the evidence that he rejects or to which he affords lesser weight, Diaz v. Comm'r of Soc. Sec., 577 F.3d 500, 505-06 (3d Cir. 2009), and the explanation "must be sufficient enough to permit the court to conduct a meaningful review." Burnett, 220 F.3d at 119-20.
In this case, the ALJ afforded great weight to Dr. Yeo's September 3, 2013 Medical Source Statement, in which he assessed Plaintiff as mildly-to-moderately impaired in seven out of the ten categories pertaining to cognitive work-related activities, with marked impairments only in understanding, remembering, and carrying out complex instructions. The ALJ also afforded great weight to Dr. Urbanowicz, the Agency reviewer, who found Plaintiff only mildly impaired. (R. 25-26). However, the ALJ gave no weight to Dr. Smock, the consultative examiner who assessed Plaintiff with marked and extreme impairments. (Id.). Plaintiff challenges the ALJ's decision to give great weight to Dr. Yeo's opinion, and no weight to Dr. Smock's opinion. (Pl.'s Br. 10-11). Plaintiff further challenges the ALJ's analysis regarding the GAF scores. (Id. at 12-14). The Court will address these arguments in turn.
Plaintiff first challenges the ALJ's decision to give great weight to the opinion of his treating psychiatrist, Dr. Yeo. (Pl.'s Br. 10-11). Plaintiff argues that the ALJ improperly afforded great weight to Dr. Yeo because she failed to expressly address his treatment note from September 3, 2013 — the same day he completed the Medical Source Statement — in which he noted that Plaintiff was "not able to work;" appeared increasingly forgetful, unfocused, and angry; and had decreasing ability to interact with people. (Id.); (R. 788). According to Plaintiff, this treatment note is "arguably" in conflict with the Medical Source Statement. (Pl.'s Br. 10).
The ALJ explained that Dr. Yeo's opinion was entitled to great weight because it "[was] generally supported by Dr. Yeo's treatment records as a whole which reflect some ups-and-downs, but which further reflect the claimant functions relatively well when compliant with his treatment." (R. 25-26). The ALJ reviewed Dr. Yeo's treatment notes as follows:
(R. 25). Additionally, the ALJ found that Dr. Yeo's assessment was more "convincing, persuasive and probative" than Dr. Smock's opinion that Plaintiff was markedly or extremely impaired, because, as a treating source, "Dr. Yeo ha[d] better personal knowledge of the [Plaintiff's] overall level of functioning." (R. 26).
The Court finds the ALJ's decision to afford great weight to this treating source opinion was in accordance with the Regulations and precedent of this Circuit, and was substantially supported by the record. It is well-established that "[a] cardinal principle guiding disability eligibility determinations is that the ALJ accord treating physicians' reports great weight, especially when their opinions reflect expert judgment based on continuing observation of the patient's condition over a prolonged period of time." Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (citations omitted); see also Brownawell v. Comm'r of Soc. Sec., 554 F.3d 352, 355 (3d Cir. 2008). Here, the ALJ expressly noted that Dr. Yeo was entitled to the preference normally afforded to treating sources because his opinion reflected his observations of Plaintiff's condition and progress over time. (R. 26). Furthermore, in determining that Dr. Yeo's opinion was entitled to great weight, the ALJ expressly considered whether his opinion was consistent with the other substantial record evidence. She concluded that his opinion was consistent with his treatment notes at Lehigh Mental Health, and the Court finds this determination to be reasonable in light of the record. As the ALJ indicated, though Plaintiff was assessed with anxious and depressed thought content, the treatment notes reflected overall improvement in April 2013 when he began to receive regular psychiatric treatment. (R. 794-95). The notes then reflect that in May, June, and July of 2013, Plaintiff was distressed, nervous, and tearful, in part due to substantial financial difficulty, including the threat of foreclosure of his home. (R. 792-93). Dr. Yeo subsequently adjusted Plaintiff's medications upward. (R. 790, 792). Though Plaintiff initially reported no improvement, (R. 789), in the last treatment note in the record, dated September 24, 2013, he stated that his mood was overall better, he felt supported by his girlfriend, and that he planned to file for custody of his child. (R. 787). Thus, substantial evidence supports the ALJ's conclusion that the treatment notes are, on the whole, consistent with Dr. Yeo's subsequent finding of only moderate cognitive impairment.
To the extent Plaintiff argues the ALJ needed to expressly consider the September 3, 2013 treatment note or obtain clarification as to its meaning from Dr. Yeo, the Court does not agree. Again, an ALJ is not required to cite to every piece of evidence in the record when rendering her decision, Fargnoli, 247 F.3d at 42, but rather must "ensure that there is sufficient development of the record and explanation of findings to permit meaningful review." Jones v. Barnhart, 364 F.3d 501, 505 (3d Cir. 2004). Here, the ALJ's thorough review of the treatment notes and explanation as to why he found them consistent with Dr. Yeo's opinion suffice to meet this burden. Additionally, Plaintiff has not explained how further consideration of this treatment note would result in a different determination on remand. Dr. Yeo's note that Plaintiff was "not able to work" would be entitled to no special weight, as an ALJ is never bound by "any opinion that a plaintiff is disabled or cannot work, as this is an adjudicatory decision reserved exclusively for the ALJ." See 20 C.F.R. §§ 404.1527(d)-(e), 416.927(d)-(e). The other findings contained in that treatment note, including that Plaintiff had diminished focus, coping skills, and interaction with others, are not necessarily in conflict with the ALJ's reasoning that Dr. Yeo's notes reflect "some ups-and-downs," but are on the whole consistent with his assessment that Plaintiff was only moderately impaired in cognitive functioning. (R. 26). Even if the ALJ had considered that Plaintiff was not improved on September 3, 2013, this conclusion would still reasonable in light of her reliance on the overall trend reflected in the treatment notes. See, e.g., O'Brien v. Comm'r of Soc. Sec., No. 14-6889, 2015 WL 4041147, at *9 (D.N.J. July 1, 2015) (declining to remand where ALJ failed to explicitly discuss three reports submitted by physician that would not change ALJ's overall analysis of physician's opinion).
Accordingly, the Court finds that substantial evidence supports the ALJ's determination to give great weight to the opinion of Plaintiff's treating psychiatrist.
Plaintiff also raises a passing argument that the ALJ should have afforded more weight to Dr. Smock. (Pl.'s Br. 11).
As noted above, the ALJ considered Dr. Smock's findings, (R. 24), and his opinion that Plaintiff was markedly or extremely impaired in all cognitive work-related functions, but concluded that this opinion was entitled to no weight. (R. 26). She reasoned that:
(R. 26). Plaintiff argues that the substantial evidence does not support the conclusion that Dr. Smock overly relied on Plaintiff's subjective complaints. Rather, he asserts that Dr. Smock relied on "his own assessment and observations during a thorough interview" and that Dr. Smock had to rely on the examination because Plaintiff did not obtain care while uninsured and thus, "the record is somewhat slim." (Pl.s' Br. 11).
The Court agrees with Plaintiff that the ALJ's conclusion that Dr. Smock's opinion was overly reliant on Plaintiff's subjective complaints is not well-supported by the record. Though portions of the Dr. Smock's examination report contain Plaintiff's description of his symptoms arising from his anxiety and depression, Dr. Smock also gave Plaintiff objective exercises to test his recent and longer-term memory, attention, and concentration. Dr. Smock observed that Plaintiff was, at times, unable to follow, comprehend, or remember even simple instructions. (R. 338). The record reflects that at least some of Dr. Smock's findings stemmed from his testing of Plaintiff's recall and memory. Accordingly, the ALJ's assertion that his entire opinion was due little weight because it based on Plaintiff's subjective complaints lacks record support.
However, contrary to Plaintiff's arguments, substantial evidence nonetheless supports the ALJ's determination to give no weight to Dr. Smock, and to instead credit Dr. Yeo. "In evaluating medical reports, the ALJ is free to choose the medical opinion of one doctor over that of another." Diaz v. Commissioner, 577 F.3d 500, 505-06 (3d Cir. 2009). However, "[w]hen a conflict in the evidence exists, the ALJ may choose whom to credit but cannot reject evidence for no reason or for the wrong reason." Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir. 1999) (citations omitted). Here, the ALJ explained that Dr. Smock's opinion assessing Plaintiff with extreme and marked impairments contradicted Dr. Yeo's opinion that Plaintiff was at most moderately impaired. (R. 26). In choosing to credit Dr. Yeo, the ALJ explained that she found Dr. Yeo's opinion to be credible because it was derived with the benefit of having observed Plaintiff over time, whereas Dr. Smock only saw Plaintiff on one occasion. This is an appropriate reason to give less weight to an agency examiner as compared to a treating physician. See 20 C.F.R §§ 404.1527(d)(2)(i), 416.927(d)(2)(i) ("Generally, the longer a treating source has treated you and the more times you have been seen by a treating source, the more weight we will give to the source's medical opinion.").
Accordingly, substantial evidence supports the ALJ's determination that Dr. Smock's opinion should be afforded no weight.
Plaintiff's last challenge to the weighing of the evidence is that the ALJ erred in relying on his GAF score of 50 to 55, which was assessed on his intake form at Lehigh Mental Health. (Pl.'s Br. 11-13). Plaintiff argues that a GAF of 50 to 55 is not clearly indicative of an ability to sustain work and that the ALJ relied only his highest GAF score, while failing to give proper weight to his GAF score of 21 while an inpatient at St. Luke's and his GAF score of 39, assessed on March 3, 2006, in his prior disability application. (Id.).
Until recently, GAF scores were used by "mental health clinicians and doctors to rate the social, occupational, and psychological functioning of adults."
This Court's review of the decision reflects that there is no merit to Plaintiff's claim that the ALJ did not address all of the GAF scores in the record, or that the ALJ overly relied on highest score. In reviewing the medical records, the ALJ explained that when Plaintiff was admitted to St. Luke's in July 2012, he underwent a mental status examination in which his "speech was productive and this thought process was coherent, his cognitive functioning appeared average and his insight/judgment were sufficient for a voluntary commitment. The clinical impression was alcohol dependence, moderate to severe, and the claimant was assessed an initial GAF of 21." (R. 23). Thus, she did address this score, but appropriately placed it in context, as it was assessed while Plaintiff was in the midst of moderate to severe alcohol dependency. As the ALJ recounted, with treatment and medication, Plaintiff improved at the time of discharge from St. Luke's, though his GAF was not apparently reevaluated at that time. (R. 24). The ALJ further noted that in April 2013, upon his intake at Lehigh Mental Health, he was given a GAF greater than or equal to 50 to 55. (R. 24). A GAF in this range, the ALJ noted, "generally correlates to a finding of moderate, but not work-preclusive mental health restrictions." (R. 24). Besides briefly mentioning this score in the context of reviewing all of Plaintiff's evidence from Lehigh Mental Health, the ALJ made no further mention of this GAF. With regard to the score given by Dr. Pascal in 2006, Plaintiff himself acknowledges that this score is "arguably not relevant, because of the remoteness of the date to the alleged to onset date." (Pl.'s Br. 13). Accordingly, all of the GAF scores in the record from the relevant time period were expressly considered by the ALJ, and there is no indication that the ALJ only relied on Plaintiff's highest score.
Accordingly, the Court finds remand for reevaluation of the GAF scores is not necessary.
Lastly, Plaintiff challenges the sufficiency of the ALJ's hypothetical to the VE. (Pl.'s Br. 15-16). He argues that the ALJ should have included additional limitations in the hypothetical, based on Dr. Smock's opinion and Plaintiff's testimony, which both demonstrate that Plaintiff would have difficulty maintaining attendance. (Id.). According to Plaintiff, this error was not harmless because the VE testified that there would be no jobs for someone with Plaintiff's impairments who was off task 25% of the time, or who was absent from work more than two days per month. (Pl.'s Br. 15) (citing R. 54).
If a VE's answer to a hypothetical question is to be considered substantial evidence, the question must reflect all of a claimant's impairments that are supported by the record. Chrupcala v. Heckler, 829 F.2d 1269, 1276 (3d Cir. 1987). The ALJ may proffer a variety of assumptions to the expert, but the VE's testimony concerning the claimant's ability to perform alternative employment may be considered for purposes of determining disability only if the question portrays the claimant's individual physical and mental impairments. Podedworny v. Harris, 745 F.2d 210, 218 (3d Cir. 1984). However, in eliciting testimony from a VE, the ALJ's hypothetical need not contain every impairment alleged by the claimant, but must only convey all of the claimant's credibly established limitations. Rutherford v. Barnhart, 399 F.3d 546, 554 (3d Cir. 2005); see also Christie v. Comm'r of Soc. Sec. Admin., 489 F. App'x 581, 585 (3d Cir. 2012). If the record contains medically undisputed evidence of a specific impairment that is not included in the hypothetical, the expert's response is not considered substantial evidence. Podedworny, 745 F.2d at 218.
In the instant case, the VE testified in response to a hypothetical from Plaintiff's counsel: if Plaintiff was off task 25 percent of the time and missed more than two days of work per month, there would be no jobs in the national economy available to him, in light of his age, experience, and RFC. (R. 53-54). However, the ALJ was not required to include these limitations in her hypothetical to the ALJ because they were not credibly established by the record evidence. Plaintiff notes that Dr. Smock would have imposed extreme limitations on Plaintiff's ability to respond to work pressure and change in the normal work setting; however, as explained above, the ALJ appropriately gave no weight to this opinion on the basis that it was inconsistent with the treating source opinion of Dr. Yeo. The only other evidence Plaintiff points to, in support his claim that the ALJ should have imposed additional limitations on his ability to regularly attend work, is his own testimony that he suffers from extreme anxiety even when performing routine household chores. (Pl.'s Br. 15). It is not entirely clear how this testimony in fact demonstrates that Plaintiff would not be able to focus 25% of the time, or would be absent more than two days per month. In any event, the ALJ properly found Plaintiff's testimony regarding his anxiety and panic attacks not fully credible; accordingly, she did not need to credit any limitations arising therefrom in her hypothetical to the VE.
Accordingly, because the ALJ relied on a hypothetical to the VE that included all of the limitations found credible in the RFC analysis, the Court finds no error at step five. The ALJ's conclusion, that work exists in the national economy that Plaintiff can perform in light of his RFC, is substantially supported by the record.
After careful review of the ALJ's decision, the record, and the parties' arguments, I find the ALJ's decision applied the correct legal standards and was supported by substantial evidence. Therefore, I make the following:
AND NOW, this
AND NOW, this __________________ day of _____________________, 2015, upon careful consideration of the Report and Recommendation filed by United States Magistrate Judge Lynne A. Sitarski, and upon independent review of the briefs filed by the parties, it is hereby ORDERED that:
Enclosed herewith please find a copy of the Report and Recommendation filed by United States Magistrate Judge Lynne A. Sitarski, on this date in the above captioned matter. You are hereby notified that within fourteen (14) days from the date of service of this Notice of the filing of the Report and Recommendation of the United States Magistrate Judge, any party may file (in duplicate) with the clerk and serve upon all other parties written objections thereto (See Local Civil Rule 72.1 IV (b)).
In accordance with 28 U.S.C. §636(b)(1)(B), the judge to whom the case is assigned will make a de novo determination of those portions of the report or specified proposed findings or recommendations to which objection is made. The judge may accept, reject or modify, in whole or in part, the findings or recommendations made by the magistrate judge, receive further evidence or recommit the matter to the magistrate judge with instructions.
Where the magistrate judge has been appointed as special master under F.R.Civ.P 53, the procedure under that rule shall be followed.
Sykes v. Apfel, 228 F.3d 259, 262-63 (3d Cir. 2000).
To the extent Plaintiff raises a claim of error at step two, the Court notes that an ALJ's failure to find an impairment severe is typically harmless error, so long as the ALJ finds other impairments severe, continues the analysis, and considers the effects of all impairments at step four. See Salles v. Comm'r of Soc. Sec., 229 F. App'x 140, 145 n.2 (3d Cir. 2007). Here, though the ALJ did not address at step two whether Plaintiff's anxiety and/or panic attacks constituted a severe impairment, he fully addressed these impairments and the limitations arising therefrom in the RFC analysis. Accordingly, any error in the ALJ's step two analysis does not require remand.
