SUZANNE H. SEGAL, Magistrate Judge.
Catherine D. Van Holland ("Plaintiff") brings this action seeking to overturn the decision of the Commissioner of the Social Security Administration (the "Commissioner" or "Agency") denying her application for Disability Insurance Benefits ("DIB"). The parties consented, pursuant to 28 U.S.C. § 636(c), to the jurisdiction of the undersigned United States Magistrate Judge. (Dkt. Nos. 9, 10). For the reasons stated below, the Court AFFIRMS the Commissioner's decision.
On February 17, 2012, Plaintiff filed an application for Disability Insurance Benefits ("DIB") pursuant to Title II of the Social Security Act alleging a disability onset date of December 5, 2011. (AR 173-79). The Commissioner denied Plaintiff's application initially and on reconsideration. (AR 92-95, 101-06). Thereafter, Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"), (AR 114), which took place on May 21, 2014. (AR 34-60). The ALJ issued an adverse decision on September 2, 2014, finding that Plaintiff was not disabled because she could perform her past relevant work. (AR 16-28). On May 6, 2016, the Appeals Council denied Plaintiff's request for review. (AR 1-4). This action followed on June 23, 2016.
Plaintiff was born on July 26, 1958. (AR 37, 173). She was just over fifty-three years old on the alleged disability onset date of December 5, 2011, and almost fifty-six years old when she appeared before the ALJ on May 21, 2014. (AR 16). Plaintiff attended college for three years, but did not obtain a degree. (AR 38). She is married and has one son from a prior marriage, who was sixteen years old at the time of the hearing. (AR 38). Plaintiff previously worked as a secretary and office manager. (AR 49-50).
Plaintiff receives long-term disability payments of $2,024.00 per month through a Met Life Disability Insurance policy, though she did not know when the payments would end. (AR 39). As summarized by the ALJ, Plaintiff's DIB application alleges disability due to: degenerative disc disease of the cervical (neck) and lumbar (low back) spine; spinal stenosis;
Plaintiff testified that the only reason that she cannot work is because of her "debilitating pain." (AR 41). She stated,
(AR 53). Plaintiff stated that even sitting is painful and the only relief she finds is in laying down on an adjustable bed. (AR 54). She claimed not be healthy enough at present to undergo the additional "spinal fusion surgery and the carpal tunnel surgery and all the other surgeries [she is] going to have to face" in the future. (AR 55).
To treat her pain, Plaintiff takes Vicodin two to six times a day, as well as Soma, another pain reliever. (AR 41). Plaintiff's daily prescription medications include Atenolol (hypertension), Lisinopril (hypertension), Metformin (diabetes), and Onglyza (diabetes). (
Plaintiff stated that she suffers from diverticulitis and fatty liver. (AR 55). She still has "a lot of issues from [her] colectomy," including complications from a hernia. (AR 56). Plaintiff still wears a binder, and while the hernia is better, "it is still very painful." (
Plaintiff also claimed to suffer from numbness in her arms. She testified that her right arm is "completely numb" "all the time." (
Plaintiff filed a long term disability application with Met Life in September 2012. (AR 518-540). In the application, Plaintiff stated that "[b]oth hands and wrists are so painful that doing basic household chores and personal hygiene are difficult." (AR 522). Plaintiff described her activities of daily living as follows:
(AR 526). Plaintiff states that she does housework, like doing the dishes, every day so long as she does not have to bend. (AR 531). While Plaintiff shops for groceries, her husband or son must accompany her "to push the cart & load & unload groceries." (
Plaintiff was diagnosed with diabetes well before her December 2011 disability onset date. (
Nonetheless, by December 14, 2013, Plaintiff's endocrinologist, Dr. John W. Geier, M.D., reported that Plaintiff had gained "good overall control" over her diabetes using oral medications and insulin therapy. (AR 1087). At that time, Plaintiff's "diabetic therapy was adjusted to Actos 30mg, Nesina 25mg, and Glumetza 1000mg."
On October 15, 2010, oncologist Dr. Timothy E. Byun, M.D. diagnosed Plaintiff with chronic moderate thrombocytopenia, noting that Plaintiff reported easy bruising of the arms and legs. (AR 491). On November 3, 2011, Dr. Byun cleared Plaintiff for her neck surgery scheduled for December 5, 2011, noting that "[c]urrently the patient is feeling well. She denies any problem with blood sugar control, edema, or facial swelling." (AR 486). On August 7, 2012, Dr. Byun cleared Plaintiff for carpal tunnel surgery, noting "[w]ith her current platelet count, the patient should be able to tolerate carpal tunnel release surgery without increased risk of bleeding complication." (AR 485). Plaintiff denied "any bleeding or bruising problems" at that time. (
Plaintiff continued her treatment for thrombocytopenia with Dr. Edward A. Wagner, M.D. On December 5, 2013, Dr. Wagner noted that Plaintiff "describe[d] to [him] clearly that she [has] never had any major bleeding or hemorrhage spontaneously and all her surgeries that she's had documented have not resulted in any bleeding or hemorrhage or transfusion of red cells or platelets." (AR 1048). Dr. Wagner cleared Plaintiff for hernia surgery, stating, "As long as her platelet count is over 50,000, the other studies are unremarkable and [if] she discontinues the medications [with a risk of causing bleeding, such as aspirin], her bleeding risk during ventral hernia repair is minimal but not normal." (AR 1052). Dr. Wagner specifically noted in his exam that Plaintiff's upper and lower extremities on both sides were of "normal strength and tone," and that her mobility and gait were likewise normal. (AR 1050-51).
On April 3, 2014, Dr. Wagner noted that there were "no major complications" and "no bleeding episodes" from Plaintiff's hernia operation on January 27, 2014, (AR 1044), and observed once again that Plaintiff's upper and lower extremities were normal in strength and tone, and that her gait was normal. (AR 1046). Dr. Wagner determined that there was "[n]o need for any treatment at this time," and that he would see Plaintiff again in nine months. (AR 1047).
On May 19, 2009, Plaintiff consulted with orthopedist Dr. Jeffrey E. Deckey, M.D. (AR 663). While Plaintiff's MRI scan showed severe degenerative disk disease at L4-5, Dr. Decky stated that he "certainly . . . would not recommend any surgical intervention" at that time. (AR 664). Similarly, on June 29, 2010, Dr. Deckey declined to "recommend any surgical intervention," but recommended instead "a course of epidurals as well as core strengthening." (AR 665). On September 8, 2011, Plaintiff reported to Dr. Deckey that she has "severe pain" on a daily basis and that her two most recent epidural injections "did not help." (AR 670). Plaintiff informed Dr. Deckey that she "wishe[d] to proceed toward surgery." (AR 671).
Dr. Deckey performed cervical spinal (neck) fusion surgery on Plaintiff on December 5, 2011, her claimed disability onset date. (AR 396, 522). Plaintiff was discharged the following day. (AR 406). On December 20, 2011, Dr. Deckey reported that Plaintiff's "anterior incision [was well healed" and that "there are no signs of infection." (AR 326). On January 16, 2012, Plaintiff reported to her primary care physician that her arm numbness had "resolved" and that she was taking a muscle relaxant for the post-surgery pain in the back of her head. (AR 301).
The next day, on January 17, 2012, Dr. Deckey reported that Plaintiff was "doing extremely well" and that the "fusion is consolidating." (AR 323). On March 6, 2012, Dr. Deckey observed that Plaintiff's "neck [was] improving," even though the fusion was "not 100% healed." (AR 321). Nonetheless, on June 5, 2012, Dr. Deckey determined that Plaintiff's neck appeared to be "doing reasonably well." (AR 683).
On July 17, 2012, Physician's Assistant Jason R. Cook observed that Plaintiff was "doing very well with regard to her cervical spine," but that she complained of lower back pain. (AR 508). On August 14, 2012, Dr. Deckey reported that Plaintiff has "good overall alignment" and that she "is actually doing fairly well with regard to her neck." (AR 505). Dr. Deckey recommended that Plaintiff see Dr. Albert Lai for pain management. (AR 506).
On February 14, 2013, Mr. Cook noted that although Plaintiff stated that she had "some persistent neck pain, she denies any radicular type symptoms." (AR 583). On February 19, 2013, upon reviewing the results of the CT scan, Mr. Cook noted that Plaintiff had pseudarthroses at the C5-C6 bone graft, (AR 586), but not at the C4-C5 and the C6-C7 disc levels. (AR 598). On June 25, 2013, Mr. Cook noted that Plaintiff "appear[ed] to have consolidation of her fusion and bone healing at C5-6." (AR 694).
On January 27, 2012, Dr. Tackson Tam treated Plaintiff for an episode of diverticulitis, noting that because this was Plaintiff's "3d attack, she should consider surgery in [the] near future." (AR 340). Plaintiff was advised to go on a clear liquid diet and began medication (Cipro and Flagyl) "for better control." (AR 340). On February 3, 2012, Plaintiff was "much improved" and was "advancing her diet" to include more fiber. (AR 337). On February 22, 2012, Plaintiff reported to St. Joseph's Hospital for a pre-op visit, stating that her "pain was almost gone." (AR 425). On March 1, 2012, gastroenterologist Dr. Haig Najarian, M.D. gave a second opinion concurring with the decision to operate given that Plaintiff had had "multiple bouts of diverticulitis at [a] younger age." (AR 371).
On March 13, 2012, Dr. Theodore Coutsoftides, M.D., performed a laparascopic sigmoid resection with colorectal anastomosis.
Two years later, on July 17, 2014, Plaintiff presented to Dr. Shahram Javaheri, M.D., complaining of "severe abdominal pain" that she thought might be a recurrence of diverticulitis. (AR 1106). Dr. Javaheri noted that Plaintiff "seem[ed] to be in mild pain," (AR 1107), and concluded that he was "not sure if she has diverticulitis." (AR 1108). Dr. Javaheri advised Plaintiff to complete her course of antibiotics and ordered additional tests. (
On August 14, 2012, Plaintiff consulted with Dr. Mark Halikis, M.D. after an "EMG" test demonstrated "moderate carpal tunnel syndrome."
On September 17, 2012, Dr. Halikis informed Plaintiff that surgery on her right hand "would likely give her good relief" and gave her an injection in her left hand "not for the carpal tunnel, but for the arthrosis itself." (AR 632). On October 15, 2012, Plaintiff reported that she was "doing well," including "quite well" in her right hand and "fairly well" in her left. (AR 634). On December 5, 2012, Dr. Halikis stated that Plaintiff's injections were "holding her up okay" on her right side, but that the results on the left side were "transient." (AR 636).
On January 9, 2013, Plaintiff decided to undergo an "ulnar shortening osteoplasty as well as excision of the ossicles in the left wrist." (AR 638). Dr. Halikis performed the osteoplasty on February 26, 2013. (AR 643). On March 4, 2013, Plaintiff's "wounds look well healed," and her x-rays showed "good placement of the plate, good apposition of the osteotomy site, and debridement of the wrist." (AR 640). Plaintiff reported "significant discomfort," but Dr. Halikis referred her to her pain management doctor. (
On June 17, 2013, Dr. Halikis told Plaintiff that "she needs to get into therapy at least once a week," and that even though "that is a problem for her, . . . [if] she wants to move along, she needs to get on it." (AR 776). On July 15, 2013, Dr. Halikis noted that Plaintiff had been attending therapy and her functionality had "increased significantly." (AR 758). On September 16, 2013, Dr. Halikis reported that at Plaintiff's "[l]ast visit we explained to her that we did not have much else to offer," once again told her "that there is not much more for [him] to do." (AR 743).
On September 20, 2012, Plaintiff consulted Dr. Albert Lai, M.D. for pain management. (AR 1027). Plaintiff complained of constant pain in her back, bones, and joints and rated the degree of pain a "seven" on a scale of zero to ten. (AR 1028). Dr. Lai prescribed a "medial branch block" and gave her a right heel lift. (AR 1030). On October 19, 2012, Plaintiff received an injection to manage pain in her lower back and both hands. (AR 1020). On October 23, 2012, Plaintiff reported that there was no change in her pain level after the October 19 injection. (AR 1019). On November 8, 2012, Plaintiff stated that the shoe lift seemed to help her walk straighter, and that the medications were helping. (AR 1014). Dr. Lai observed that Plaintiff was ambulatory without an assistive device and was not in "apparent distress." (AR 1016).
On December 7, 2012, Dr. Lai prescribed Soma for pain management and administered an injection. (AR 608, 1008-10). On December 13, 2012, Plaintiff reported that her pain level had improved. (AR 610, 1007). Nonetheless, on January 3, 2013, Plaintiff complained that her pain interfered with her concentration and mood "sometimes," and with her family function and recreation "a lot." (AR 612). However, Dr. Lai noted that Plaintiff did not appear to be in any stress, (AR 613), and Plaintiff admitted that the medications "are helping" and did not cause any side effects. (AR 614). Plaintiff received an injection on February 1, 2013, and reported that her condition had improved. (AR 619). However, on both February 21 and March 21, 2013, Plaintiff stated that her pain level had not changed since her last visit and that her "medications are less effective." (AR 620, 989).
On April 11 and May 16, 2013, Plaintiff reported that her pain levels had decreased since the last visit. (AR 981, 985). On June 21, 2013, a lumbar epidurogram showed "adequate flow into the epidural space," with no "filling defects," and Plaintiff continued to report that medications were helping. (AR 979). On August 22, 2013, Plaintiff stated that her pain level had increased since her prior visit on July 30, 2013 (AR 974), but once again admitted that "medications are helping." (AR 969). On September 27, 2013, Plaintiff received an injection to treat sacroiliac joint pain. (AR 960, 962). On October 31, 2013, Plaintiff complained to Dr. Lai that while her pain medications were "helpful," they did not alleviate the pain entirely. (AR 954).
On October 8, 2012, Plaintiff consulted with Dr. Joo-Hyng Lee, M.D. regarding joint pain. (AR 724). Dr. Lee explained to Plaintiff that he "did not feel that she had an underlying connective tissue disorder." (AR 726). In a follow-up visit on November 5, 2012, Dr. Lee reported that Plaintiff's upper and lower extremities were "normal" and that Plaintiff has "no current signs of rheumatoid arthritis," even though she did have "a low positive rheumatoid factor." (AR 730). On January 29, 2013, Dr. Lee reported that the MRI of Plaintiff's hands revealed "no indication of any inflammatory arthritis currently." (AR 736).
On January 27, 2014, Plaintiff had a ventral hernia operation. (AR 1038). A physician's assistant reported on February 3, 2014, that Plaintiff was "doing well postoperatively" with "no obstruction." (
Plaintiff saw psychotherapist Anne Laptin, M.S., LCSW, for a total of seven sessions between October and December 2012. (AR 1092). Ms. Laptin wrote a letter on April 30, 2014 stating that Plaintiff had presented with signs of depression. (
In addition to Ms. Laptin and Dr. Zachariah, many of Plaintiff's treating physicians assessed Plaintiff's mental condition. They typically described her general mental status in positive terms, even as they acknowledged that she presented with some level of depression. (
On June 22, 2012, Dr. M. Yee provided a Disability Determination Explanation based on his review of Plaintiff's medical records. (AR 63). Dr. Yee assessed Plaintiff's Residual Functional Capacity for the first twelve months after her alleged disability onset date,
On May 28, 2013, Dr. R. Weeks provided a Disability Determination Explanation based on his review of Plaintiff's medical records, which he divided into two periods. (AR 76). The first period overlapped with Dr. Yee's assessment, and continued for approximately three months longer,
For the period between December 5, 2011 and February 25, 2013, Dr. Weeks determined that Plaintiff had the same four severe impairments identified by Dr. Yee — (1) "Disorders of Back — Discogenic and Degenerative," (2) "Disorders of Gastrointestinal System," (3) diabetes, and (4) anemia — and added a fifth, (5) peripheral neuropathy. (AR 84). Also like Dr. Yee, Dr. Weeks found that Plaintiff would be able to: lift ten pounds occasionally; less than ten pounds frequently; stand for two hours and sit for six hours in a normal eight-hour workday; climb ramps or stairs, stoop (bend at the waist), crouch (bend at the knees), kneel and crawl occasionally, but never climb ladders, ropes or scaffolds. (AR 85-86).
However, unlike Dr. Yee, Dr. Weeks determined that Plaintiff had manipulative limitations in that she had a "limited" ability to reach overhead with either arm and to handle or "finger" items (gross and fine manipulation). (AR 86). Dr. Weeks also found that Plaintiff's environmental limitations included not just the need to avoid concentrated exposure to hazards like machinery and heights, but also to extreme cold and vibration. (AR 87).
For the period between February 26, 2013 through February 26, 2014, Dr. Weeks assessed an RFC that was nearly identical to his RFC assessment for the earlier period, with the following two differences: for the latter period, Dr. Weeks concluded that Plaintiff could "never" crawl, (AR 88), instead of "occasionally" crawl; and that her gross manipulation ability was "unlimited," (
Impartial Medical Expert Dr. Malcolm Brahms testified at the ALJ hearing on May 21, 2014. (AR 42-48). Dr. Brahms stated that the record reflects that Plaintiff is a "diabetic, slightly obese individual who has a series of problems." (AR 43). These problems include "a cervical spine problem, shoulder problems, carpal tunnel syndrome," thrombocytopenia, diabetes, neuropathy, pain, pseudoarthrosis, and cavovarus foot with related ankle problems.
To qualify for disability benefits, a claimant must demonstrate a medically determinable physical or mental impairment that prevents the claimant from engaging in substantial gainful activity and that is expected to result in death or to last for a continuous period of at least twelve months.
To decide if a claimant is entitled to benefits, an ALJ conducts a five-step inquiry. 20 C.F.R. §§ 404.1520, 416.920. The steps are:
The claimant has the burden of proof at steps one through four and the Commissioner has the burden of proof at step five.
The ALJ employed the five-step sequential evaluation process and concluded that Plaintiff was not disabled within the meaning of the Social Security Act. (AR 28). At step one, the ALJ found that Plaintiff met the insured status requirements through March 31, 2017 and had not engaged in substantial gainful activity since December 5, 2011, the alleged disability onset date. (AR 18). At step two, the ALJ found that Plaintiff had the severe medically determinable impairments of slight obesity; diabetes mellitus; degenerative disc disease of the cervical spine, status post laminectomy
At step three, the ALJ found that the severe impairments at step two did not meet or medically equal a listed impairment. (AR 20). The ALJ then found that Plaintiff had the residual functional capacity ("RFC") to perform sedentary work as defined in 20 C.F.R. 404.156(a),
Under 42 U.S.C. § 405(g), a district court may review the Commissioner's decision to deny benefits. "[The] court may set aside the Commissioner's denial of benefits when the ALJ's findings are based on legal error or are not supported by substantial evidence in the record as a whole."
"Substantial evidence is more than a scintilla, but less than a preponderance."
Plaintiff challenges the ALJ's decision on the sole ground that the ALJ improperly assessed Plaintiff's credibility. (Plaintiff's Memorandum in Support of Complaint ("P Memo.") at 3). Plaintiff first contends that the ALJ improperly used boilerplate language in finding her to be not entirely credible. (P Memo. at 6). Second, Plaintiff argues that the ALJ's reliance on the purported lack of objective medical evidence to support her subjective claims of pain "is always legally insufficient" because in
The ALJ generally contended that "the evidence submitted does not support the severity of symptoms alleged," (AR 26), and provided four primary reasons for finding that Plaintiff's testimony regarding her symptoms and limitations was "not entirely credible," (AR 23): (1) Plaintiff's "generally successful" treatment history; (2) her failure to follow up on recommendations made by her doctors; (3) inconsistencies between her testimony and objective medical evidence, (AR 26-27), and (4) discrepancies between Plaintiff's activities of daily living and her allegations of depression.
When assessing a claimant's credibility regarding subjective pain or intensity of symptoms, the ALJ must engage in a two-step analysis.
Further, the ALJ must make a credibility determination with findings that are "sufficiently specific to permit the court to conclude that the ALJ did not arbitrarily discredit [the claimant's] testimony."
The ALJ provided two specific, clear and convincing reasons to find Plaintiff's complaints of constant, all-consuming pain not fully credible. (AR 26-27). These reasons are sufficient to support the Commissioner's decision.
The ALJ found Plaintiff not entirely credible because even though Plaintiff sought treatment for medical treatment for her symptoms, the treatment was "generally successful in controlling those symptoms," which Plaintiff's complaints of constant, debilitating pain do not acknowledge. (AR 26). For example, the ALJ explained that after Plaintiff underwent neck fusion surgery on December 5, 2011 to treat cervical degenerative disc disease, by "January 2012, her arm numbness had resolved and she was reportedly doing extremely well. Physical examination revealed motor and sensory exam was grossly within normal limits; subsequent examinations revealed her pain was well controlled with medication[.]" (
Similarly, the ALJ noted that Plaintiff's thrombocytopenia significantly improved with treatment. (AR 26). The record shows that on November 3, 2011, Dr. Byun cleared Plaintiff for her neck surgery, noting that "[c]urrently the patient is feeling well," (AR 486), and on August 7, 2012, Dr. Byun cleared Plaintiff for carpal tunnel surgery, noting that in light of her current platelet counts, Plaintiff should be able to tolerate the surgery without increased risk of bleeding complications. (AR 485). In December 2013, Dr. Wagner also cleared Plaintiff for hernia surgery. (AR 1052). Finally, the ALJ noted that Plaintiff's diverticulitis responded well to her sigmoid colon resection in March 2012. (
The ALJ properly could infer, on the basis of ample medical evidence demonstrating that Plaintiff was doing well after her successful procedures, that Plaintiff's testimony regarding her degree of pain was exaggerated and not credible.
The ALJ found Plaintiff's credibility diminished based on inconsistencies between her testimony describing her pain as "debilitating" and "unrelenting," (AR 41, 53), and the objective medical evidence. (AR 26). Specifically, the ALJ observed that Plaintiff's claims were inconsistent with her physical examination with Dr. Wagner in December 2013. According to the ALJ, that examination "revealed normal strength and tone in both upper and lower extremities, intact neurological findings, normal gait, no memory impairment, and normal affect." (AR 26) (citing AR 1048-52). The ALJ further noted that "Dr. Wagner concluded there was no need for any treatment (unless the platelet count dropped) in an April 2014 follow-up visit and advised the claimant to return in nine months for re-evaluation." (AR 26-27) (citing AR 1044-47). The ALJ noted that, despite Plaintiff's claims of depression and sleep disturbance, her "neurological and mental status examinations have been described as normal on numerous occasions by her treating physicians." (AR 27). The record supports the ALJ's observations. (
Furthermore, there is a contradiction between Plaintiff's claims of debilitating, constant pain and her own repeated reported admissions to Dr. Lai that her pain levels improved under his care. (
The inconsistencies between Plaintiff's testimony and the objective medical evidence constituted a clear and convincing reason for the ALJ's adverse credibility determination.
An ALJ may consider the claimant's daily activities in weighing credibility.
The ALJ also found Plaintiff not credible in part because she had allegedly failed to "follow up on recommendations made by her treating doctors," which "suggests that the symptoms may not have been as serious as [Plaintiff] alleged" in her disability application. (AR 26). A claimant's refusal to follow a recommended course of treatment supports a finding that the claimant is not fully credible.
The ALJ based her conclusion that Plaintiff was noncompliant on a single, specific example:
(AR 26) (some internal record citations omitted).
The specific records cited by the ALJ as do not support the contention that Plaintiff's diabetes was uncontrolled in May 2014, and suggest that the reason she was no longer taking insulin was because it was no longer prescribed. (
To support the proposition that Plaintiff's diabetes was uncontrolled in May 2014, the ALJ cited a May 2, 2014 medical record drafted by Physician's Assistant Kelly Fee. (
(
Additionally, the fact that Plaintiff was no longer taking insulin did not necessarily mean that she was not following her providers' recommendations. Dr. Geier's record for December 14, 2013, indicated that Plaintiff's diabetes was being treated with oral medications and "insulin therapy," with good control. (AR 1087). However, that same record indicates that Plaintiff's diabetes "therapy was adjusted to Actos 30mg, Nesina 25mg, and Glumetza 1000mg." (
An invalid reason cited in support of an adverse credibility finding does not require remand if the ALJ's reliance on that reason was harmless error.
Here, the specific example chosen by the ALJ in support of the contention that Plaintiff was noncompliant appears to have been based on an erroneous reading of the record. However, whether or not Plaintiff was compliant with her providers' recommendations is not essential to the ALJ's ultimate determination that Plaintiff's claims of debilitating pain were not entirely credible. The ALJ's other reasons, amply supported by evidence in the record, support the ALJ's conclusion. Accordingly, to the extent that the ALJ's reading of the May 2, 2014 record was erroneous, the error was harmless.
In sum, the ALJ offered clear and convincing reasons, supported by substantial evidence in the record, for her adverse credibility findings. Accordingly, because substantial evidence supports the ALJ's assessment of Plaintiff's credibility, no remand is required.
Consistent with the foregoing, IT IS ORDERED that Judgment be entered AFFIRMING the decision of the Commissioner. The Clerk of the Court shall serve copies of this Order and the Judgment on counsel for both parties.
Ulnar shortening is distinct from a "carpal tunnel release," during which "a surgeon makes an incision in the palm of [the patient's] hand over the carpal tunnel ligament and cuts through the ligament to relieve pressure on the median nerve." (
