FREDERICK J. SCULLIN, Jr., Senior District Judge.
Plaintiff Shawn Marie Newman brought this action pursuant to the Social Security Act, 42 U.S.C. § 405(g) ("Act"), seeking judicial review of a final decision of the Commissioner of Social Security (the "Commissioner"), finding her ineligible for benefits. See generally Dkt. Nos. 1, 11. Currently before the Court are the parties' cross-motions for judgment on the pleadings under Rule 12(c) of the Federal Rules of Civil Procedure. See Dkt. Nos. 11, 16.
Plaintiff applied for benefits on September 18, 2012, alleging disability as of January 1, 2004. See Administrative Record ("AR") at 159-62. The Social Security Administration denied Plaintiff's applications on December 27, 2012. See id. at 87-94. Plaintiff filed a timely request for a hearing on January 22, 2013. See id. at 63. A hearing was held on October 4, 2013, before Administrative Law Judge John Murdock ("ALJ"). See id. at 18-50. After further developing the record, the ALJ convened a supplemental hearing on March 11, 2014. See id. at 51-72. Plaintiff was not represented at either hearing.
On April 25, 2014, the ALJ issued a written decision in which he made the following findings "[a]fter careful consideration of the entire record . . . ."
See AR at 8-15 (citations omitted).
In support of her motion, Plaintiff advances the following arguments. First, Plaintiff argues that the ALJ erred by not finding her mental impairments to be severe at step two of the disability analysis. Second, Plaintiff argues that the ALJ improperly weighed medical opinion evidence. Third, Plaintiff argues that the ALJ failed to develop the administrative record properly. Fourth, Plaintiff argues that the ALJ improperly assessed her credibility. As a result of these errors, Plaintiff argues, there was not substantial evidence supporting the ALJ's finding that Plaintiff could perform past relevant work. See generally Dkt. No. 11, Pl.'s Br.
Absent legal error, a court will uphold the Commissioner's final determination if there is substantial evidence to support it. See 42 U.S.C. § 405(g). The Supreme Court has defined substantial evidence to mean "`more than a mere scintilla'" of evidence and "`such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" Richardson v. Perales, 402 U.S. 389, 401 (1971) (quotation omitted). Accordingly, a reviewing court "`may not substitute [its] own judgment for that of the [Commissioner], even if [it] might justifiably have reached a different result upon a de novo review.'" Cohen v. Comm'r of Soc. Sec., ___ F. App'x ___, 2016 WL 1055351, *1 (2d Cir. Mar. 17, 2016) (quoting Valente v. Sec'y of Health & Human Servs., 733 F.2d 1037, 1041 (2d Cir. 1984)). In other words, "[t]he substantial evidence standard means once an ALJ finds facts, [a reviewing court] can reject those facts `only if a reasonable factfinder would have to conclude otherwise.'" Brault v. Soc. Sec. Admin., Comm'r, 683 F.3d 443, 448 (2d Cir. 2012) (quotation and other citation omitted).
To be eligible for benefits, a claimant must show that she suffers from a disability within the meaning of the Act. The Act defines "disability" as an inability to engage in substantial gainful activity ("SGA") by reason of a medically determinable physical or mental impairment that can be expected to cause death or last for twelve consecutive months. See 42 U.S.C. § 1382c(a)(3)(A). To determine if a claimant has sustained a disability within the meaning of the Act, the ALJ follows a five-step process:
For this test, the burden of proof is on the claimant for the first four steps and on the Commissioner for the fifth step, if the analysis proceeds that far. See Balsamo v. Chater, 142 F.3d 75, 80 (2d Cir. 1998) (quotation omitted).
Between steps three and four of the disability analysis, the ALJ must determine the claimant's residual functioning capacity ("RFC"), which is defined as "the most you can still do [in a work setting] despite your limitations." 20 C.F.R. § 416.945(a)(1); see also 20 C.F.R. § 416.920(e). The RFC analysis considers "all of your medically determinable impairments of which we are aware," even if they are not severe. 20 C.F.R. § 416.945(a)(2). The ALJ is to consider "all of the relevant medical and other evidence" in assessing RFC. 20 C.F.R. § 416.945(a)(3).
At step two of the disability analysis, the ALJ must determine whether the claimant has a severe impairment or combination of impairments. See 20 C.F.R. §§ 404.1520(c), 416.920(c). In order to be severe, an impairment or combination of impairments must "significantly limit[] your physical or mental ability to do basic work activities[.]" Id. An impairment or combination of impairments fails to meet this standard when the evidence "establishes only a slight abnormality or a combination of slight abnormalities which would have no more than a minimal effect on an individual's ability to work. . . ." Social Security Ruling ("SSR") 85-28, 1985 WL 56856, *3 (1985). During the step-two severity analysis, "evidence about the functionally limiting effects of an individual's impairment(s) must be evaluated" and "symptom-related limitations and restrictions must be considered at this step of the sequential evaluation process . . . ." SSR 96-3p, 1996 WL 374181, *2 (July 2, 1996). The ALJ is to assess the severity of a claimant's mental impairments in four broad functional areas: activities of daily living; social functioning; concentration, persistence, or pace; and episodes of decompensation. See 20 C.F.R. §§ 404.1520a(c), 416.920a(c). If the claimant has no more than mild limitation in the first three functional areas and no episodes of decompensation, she generally is not disabled "unless the evidence otherwise indicates that there is more than a minimal limitation in your ability to do basic work activities. . . ." 20 C.F.R. §§ 404.1520a(d)(1) (internal citation omitted), 416.920a(d)(1) (internal citation omitted).
In this case, the ALJ considered Plaintiff's mental impairments including schizophrenia, alcohol abuse, cannabis abuse, posttraumatic stress disorder (resolved), and borderline personality disorder. The ALJ concluded that these impairments, "considered singly and in combination, do not cause more than minimal limitation" in Plaintiff's ability to perform basic work activities. See AR at 11. The ALJ further found that Plaintiff suffered from no more than mild limitations in the three functional areas and that there was no evidence in the record tending to show that Plaintiff suffered from any episodes of decompensation of extended duration. See id. at 12. The ALJ supported these findings by citing to evidence in the record tending to show that Plaintiff managed her daily affairs, generally got along with others, and had intact concentration and memory at medical appointments. See id. at 11-12.
For example, Plaintiff reported to consulting physicians that she could dress, bathe, and groom herself; she cooked, cleaned, and did laundry; managed her own money and used public transportation; and socialized with family, listened to the radio, read, and used the computer. See AR at 239. Further, although Plaintiff reported hearing voices in her head for many years, she never acted on them. Indeed, she reported to her treating psychiatrist in both January of 2013 and February of 2014 that her mental symptoms were under control with medication. See id. at 267-68. By the time of the March, 2014 hearing, she was no longer attending therapy for her mental issues because her symptoms had significantly improved. See id. at 57-59. Nearly all of the medical records, including those from Plaintiff's treating psychiatrist, show normal mental status examinations. See, e.g., id. at 237-38, 261, 263-65, 267-71. For these reasons, the Court finds that substantial evidence supported the ALJ's finding that Plaintiff's mental impairments were not severe as defined in the regulations.
During the disability analysis, the ALJ "will always consider the medical opinions" in the record together with other relevant evidence. 20 C.F.R. § 404.1527(b). Medical opinions are "statements from physicians and psychologists or other acceptable medical sources that reflect judgments" about a claimant's impairments and their effects. 20 C.F.R. § 404.1527(a)(2).
Generally, the ALJ will consider the following factors in deciding what weight to afford the opinion of an acceptable medical source: whether the source examined the claimant; how well the source explains his or her opinion with relevant evidence; how consistent the opinion is with the record as a whole; whether the source is a specialist in the area of his or her opinion; and other factors tending to support or contradict the opinion. See 20 C.F.R. § 404.1527(c)(1)-(6). Additionally, the Commissioner's regulations instruct that,
20 C.F.R. § 404.1527(c)(2).
In this case, Plaintiff argues that the ALJ erred by affording very limited weight to the opinions of consulting physicians Drs. Shapiro and Tabb. The ALJ noted that Dr. Shapiro's opinion that Plaintiff would have difficulty with concentration, following a regular schedule, and making appropriate decisions was inconsistent with Dr. Shapiro's own examination findings. In particular, the ALJ noted that Dr. Shapiro observed that Plaintiff was cooperative with normal speech, that her thought process was coherent with no evidence of hallucinations, and that her concentration and memory were intact. See AR at 11 (citing id. at 237-38). The ALJ further pointed out a number of inconsistencies between Dr. Shapiro's opinion and the balance of the record, including counseling notes and treatment notes of Dr. Patil, Plaintiff's treating psychiatrist. See id. at 11-12.
With respect to Dr. Tabb's opinion that Plaintiff would have mild restrictions in lifting, bending, pushing, pulling, and carrying and that she should avoid work in environments with dusk, smoke, and other respiratory irritants, the ALJ noted that the "medical evidence analyzed above does not show or contain any treatment for [Plaintiff's] seizures or asthma." See AR at 14. The ALJ further noted that Dr. Tabb found no abnormalities in Plaintiff's chest or lungs. See id. Further review of Dr. Tabb's notes shows that Plaintiff's physical examination was entirely normal except for reduced range of motion in the right shoulder. See id. at 244-46. Additionally, although Plaintiff argues that the ALJ ignored her testimony that she uses an inhaler for her asthma, as well as her report to her therapist that she had begun taking Topamax for seizures, the Court finds any such oversight by the ALJ to be harmless to the extent that the ALJ properly found Plaintiff's testimony to be not entirely credible. See infra Part III.E.
For these reasons, the Court finds that the ALJ properly weighed the opinions of Drs. Shapiro and Tabb. See 20 C.F.R. § 404.1527(c); Richardson, 402 U.S. at 401.
The ALJ must "`affirmatively develop the record in light of the essentially nonadversarial nature of a benefits proceeding.'" Lamay v. Comm'r of Soc. Sec., 562 F.3d 503, 509 (2d Cir. 2009) (quotation omitted). This duty is heightened when the claimant is unrepresented. See Ericksson v. Comm'r of Soc. Sec., 557 F.3d 79, 83 (2d Cir. 2009) (citations omitted). Thus, the regulations provide that the Commissioner will "develop your complete medical history for at least the 12 months preceding the month in which you file your application unless there is a reason to believe that development of an earlier period is necessary. . . ." 20 C.F.R. §§ 404.1512(d), 416.912(d). If the evidence is incomplete or inconsistent, the ALJ may recontact medical sources, request additional existing records, order a consultative examination, or ask the claimant or others for more information. See 20 C.F.R. §§ 404.1520b(c)(1)-(4), 416.920b(c)(1)-(4).
In particular, although medical reports should contain an opinion on the claimant's RFC, a medical report is not deemed incomplete because it lacks such an opinion. See 20 C.F.R. §§ 404.1513(b)(6), 416.913(b)(6). Indeed, "`where there are no obvious gaps in the administrative record, and where the ALJ already possesses a "complete medical history," the ALJ is under no obligation to seek additional information in advance of rejecting a benefits claim.'" Swiantek v. Comm'r of Soc. Sec., 588 F. App'x 82, 84 (2d Cir. 2015) (quoting Rosa[ v. Callahan], 168 F.3d [72,] 79 n.5 [(2d Cir. 1999)]).
In this case, the ALJ acknowledged at Plaintiff's hearing that there appeared to be gaps in the record, particularly treatment records from Dr. Patil and Rome Mental Health. See AR at 36, 47-48. The ALJ subsequently supplemented the record with these documents and then convened a second hearing to discuss the new evidence, to allow Plaintiff the opportunity to respond, and to acquire vocational expert testimony. See id. at 54-55. Accordingly, the Court finds that the ALJ took appropriate steps to develop the administrative record and that he did not err by not specifically requesting medical source statements. See 20 C.F.R. §§ 404.1520b(c)(1)-(4), 416.920b(c)(1)-(4).
"`It is the function of the [Commissioner], not [a reviewing court], to resolve evidentiary conflicts and to appraise the credibility of witnesses, including the claimant.'" Aponte v. Sec'y, Dep't of Health & Human Servs., 728 F.2d 588, 591 (2d Cir. 1984) (quotation omitted). When a claimant makes subjective allegations of symptoms limiting her ability to function, the regulations provide that
20 C.F.R. § 416.929(b); see also 20 C.F.R. § 404.1529(b). Accordingly, the Social Security Administration has adopted a two-step standard for assessing a claimant's credibility. See SSR 96-7p, 1996 WL 374186, *2 (July 2, 1996); Meadors v. Astrue, 370 F. App'x 179, 183 (2d Cir. 2010).
Meadors, 370 F. App'x at 183 (internal citations and footnote omitted).
In this case, the ALJ found that Plaintiff's medically determinable impairments could reasonably be expected to cause the alleged symptoms. He then found that Plaintiff's statements concerning the intensity, persistence, and limiting effects of those symptoms were not entirely credible. See AR at 14. The ALJ supported this conclusion by discussing a number of ways in which Plaintiff's testimony and alleged limitations were contradicted by the medical evidence of record, including the treatment notes of her treating psychiatrist. See id. at 14-15. As noted, further review of the record reveals that Plaintiff's statements regarding her activities of daily living and her performing past work while suffering from similar impairments support the ALJ's conclusion that Plaintiff was less than entirely credible. Accordingly, the Court finds that the ALJ sufficiently analyzed Plaintiff's subjective allegations to the extent that they were not substantiated by objective medical evidence. See Meadors, 370 F. App'x at 183.
The Court has considered Plaintiff's additional arguments and finds them to be without merit. In summary, to the extent that Plaintiff points to evidence in the Administrative Record that reasonably might support a different conclusion in her favor, "whether there is substantial evidence supporting the appellant's view is not the question" on appeal. Bonet ex rel. T.B. v. Colvin, 523 F. App'x 58, 59 (2d Cir. 2013). Accordingly, the Court finds that the ALJ applied the appropriate legal standards and further that there is substantial evidence supporting his findings. See Richardson, 402 U.S. at 401.
Having reviewed the entire record in this matter, the parties' submissions, and the applicable law, and for the above-stated reasons, the Court hereby
