OPINION AND ORDER

SHIRR A. SCHEINDLIN, District Judge.

I. INTRODUCTION

Stephanie Yvonne De La Cruz brings this action, pursuant to the Social Security Act (the "Act"),1 seeking judicial review of a final decision by the Commissioner of Social Security (the "Commissioner") denying her claim for Supplemental Security Income ("SSI") disability benefits. Both parties have moved for judgment on the pleadings. For the reasons set forth below, the Commissioner's motion is granted, the decision denying benefits is affirmed, and plaintiff's motion is denied.

II. BACKGROUND

A. Procedural History

De La Cruz filed an application for SSI disability benefits on June 12, 2008, which was denied on August 22, 2008.2 The application alleged that she has been disabled since February 7, 2008, due to depression, dizziness, chest pain, back pain, and acid reflux.3 De La Cruz requested a hearing before an Administrative Law Judge ("AU"), and ALJ Rosanne M. Dummer presided over a video hearing on November 18, 2009.4 De La Cruz, who was represented by counsel, and David A. Festa, a vocational expert, testified at the hearing. After the hearing, the record was held open for De La Cruz to submit further documentation, which was added to the record. She also underwent additional psychological evaluation at the request of the New York State Office of Temporary and Disability Assistance. The ALJ referred the medical evidence of record for further review by a medical expert before issuing a decision on July 16, 2010, finding that De La Cruz is not "under a disability" as defined in the Act.5 The ALJ's decision became the final decision of the Commissioner on April 24, 2012, when the Appeals Council denied De La Cruz's request for review of the All's decision.6 On March 2, 2013, plaintiff filed the instant action. The period at issue is from June 12, 2008, the date De La Cruz filed her SSI application, through July 16, 2010, when the All issued her decision.7

B. The Administrative Record

The administrative record consists of non-medical evidence, medical evidence, and hearing testimony.

1. Non-Medical Evidence

De La Cruz is a childless twenty-six-year-old single woman who speaks both English and Spanish.8 She was born on August 3, 1987, and was twenty years old at the onset of her alleged disability.9 Prior to her alleged disability, De La Cruz had attended one year of college and had worked in various customer and food services jobs,10 but her work never rose to the level of substantial gainful activity ("SGA").11 At the All hearing, De La Cruz gave the following testimony. She was last employed in the first quarter of 2008 in a donut shop.12 She left this job due to depression and problems concentrating, focusing, remembering, and interacting with others; she also reported back pain.13 De La Cruz recalled being hospitalized as a child for mental problems and stated that she saw doctors at Jacobi Hospital in 2007, who referred her to a psychiatrist and therapist, after her condition worsened around the time of her mother's death in a fire.14 She saw Nurse Practitioner Tirza Santilli once a month, who prescribed and managed her medications. She also saw a therapist weekly, though she had only been seeing her current therapist for about "a month or two" because her previous one resigned.15

She lives with her father, whom she described as a drug addict and schizophrenic.16 She drank occasionally and had smoked marijuana — the last time a month before the hearing.17 She did very little during the day, staying inside most of the time, and experienced frequent crying spells.18 She cooked daily, washed her own laundry, and saw her boyfriend once or twice per week. She was able to use public transportation by herself, could walk ten blocks at a time, and had no problem standing or using her hands. She felt she was not ready to return to work and would have trouble getting a regular job.

2. Medical Evidence: Physical Health

a. Consulting Physicians

i. Dr. Sharon Revan (August 14, 2008)

The Division of Disability Determination referred De La Cruz to Dr. Sharon Revan, who performed a physical examination of plaintiff on August 14, 2008.19 Dr. Revan diagnosed back pain, as well as acid reflux, headaches, and dizziness.20 The doctor opined that De La Cruz had mild limitations in climbing stairs due to fatigue, and mild limitations in activities of daily living "depending [on] her psychological state."21 The doctor noted that plaintiff had no limitation with respect to personal grooming, or in her speech, vision, or hearing. She also found no limitation in plaintiff's fine or gross motor activity using her upper extremities, and no limitation in sitting, standing, or walking distances.22

Dr. Revan found that plaintiff had a normal gait and stance. She could walk on heels and toes, squat fully, rise from a chair, and get on and off the examination table without difficulty. She had full range of motion in her cervical and lumbar spine as well as in her shoulders, elbows, forearms, wrists, hips, knees, and ankles, with full strength throughout. De La Cruz also had intact hand and finger dexterity, with full grip strength, and her joints were stable and non-tender. Straight leg raising was negative bilaterally, and her lumbar x-rays were also negative.23 De La Cruz reported to Dr. Revan that she had "upper back pain for the past two or three years, [which becomes] worse with crying or when she is depressed and is better with a massage."24 She also told Dr. Revan that she tired after climbing three to four flights of stairs, but had no difficulty walking, sitting, standing, or lying down. She stated that she was able to cook, clean, do laundry, and shop.25

ii. FEGS (September 2008)

De La Cruz also underwent a "biopsychosocial evaluation" at the Federation Employment and Guidance Service ("FEGS") in connection with an application for public assistance.26 During the physical examination, she reported suffering from back pain, for which she took ibuprofen.27 Plaintiff also reported that she walked to the appointment, and that she could travel independently on public transportation. She stated that she was able to perform activities of daily living — including washing dishes and clothes, sweeping, mopping, vacuuming, making a bed, cooking meals, shopping for groceries, bathing, and grooming herself-but that she spends her day at home in bed watching television.28

The physical examination was unremarkable except for findings of an "abnormal spine" and "mild mid-thoracic tenderness."29 Despite these findings, Dr. Oksana Luke assessed plaintiff's level of mid-back pain during the appointment as one, on a scale from zero to ten, and opined that De La Cruz could stand for four to five hours in an eight-hour day; bend for one to three hours per day; and lift, carry, and push less than ten pounds between ten and fifteen times per hour.30

3. Medical Evidence: Mental Health

a. Treating Medical Professionals — Nurse Practitioner Tirza Santilli (August 2008 - October 2009)

From August 2008 to October 2009, De La Cruz was treated by Nurse Practitioner Tirza Santilli at the Clay Avenue Health Center in the Bronx, who monitored plaintiff's psychological condition and managed her medication.31 Santilli diagnosed De La Cruz with "Major Depressive Disorder, recurrent" at their first meeting on August 18, 2008, though plaintiff rejected medication at that time.32 Treatment notes indicate that De La Cruz was feeling "depressed [and] irritable" and experiencing "crying spells, poor sleep, hopelessness, and occasional passive [suicidal] [ideation]," though she reportedly also had adequate impulse control and spontaneous, relevant, and goal-directed thoughts whose content was unremarkable.33 At their next meeting on September 17, 2008, Santilli described plaintiff's presentation of symptoms as "[somewhat] contradictory."34 On examination, plaintiff's mood was irritable and her affect constricted, and she exhibited tense behavior, an uncooperative attitude, and poor reasoning. She had clear, challenging speech with an "angry undertone," and was also described as "oddly related."35 However, she was well-groomed, with unremarkable psychomotor behavior and fair impulse control, judgment, and insight.36 She also had logical, concrete thought processes with unremarkable content, no signs of psychosis or mania, and no suicidal or homicidal ideation. Her memory was intact, and her intellect was described as average. The diagnosis was "Recur[rent] Depression] Psych — Severe" and "Personality Disorder [not otherwise specified]," and she was prescribed Lexapro and Ambien.37

In October 2008, De La Cruz reported to Santilli of "minimal improvement" in her symptoms, though she admitted that she had not taken her medication.38 In November, she claimed to be in compliance with her medication as prescribed and reported improved sleep and mood, though she continued to feel depressed, lonely, and irritable, and was experiencing side effects of occasional daytime sedation and nausea.39 In December, she again reported improved sleep and mood, but without medication side effects, and stated that she had started going to church, was getting along with her family, and continued to consider going back to school. Santilli observed that her mood was "euthymic" and her affect was no longer constricted. Santilli discontinued the Ambien prescription.40

At her next appointment on February 23, 2009, De La Cruz's mood was "depressed," and she reported having low motivation.41 She stopped going to church, had not reapplied for school, and was having problems with her father and boyfriend. Her speech and affect were otherwise "appropriate," and her attitude cooperative.42 In May, plaintiff stated that she had stopped therapy two months earlier, after her therapist resigned, and had run out of medication in April.43 She felt depressed and overwhelmed and described occasional crying spells and sleep problems, as well as a recent domestic violence incident with her boyfriend. Santilli re-prescribed Ambien and scheduled an appointment with a new therapist.44 In June, De La Cruz reported feeling depressed daily and having low energy and motivation, despite being compliant with her medication and receiving counseling, though her sleep was improved.45 Santilli increased her Lexapro dosage and discontinued Ambien once again.46 De La Cruz did not see Santilli again until October 2009, even though plaintiff had run out of medication three months earlier, and presented with a "depressed mood, hypersomulence, low energy, crying spells, and isolation."47

On a mental health evaluation form dated October 23, 2009, Santilli confirmed that her patient had "Major Depressive Disorder, recurrent" with signs and symptoms of "depressed mood, low energy, isolation, and crying spells."48 She indicated that plaintiff's condition would "markedly interfere" with her ability to "[r]espond appropriately to work pressures in a job with simple, repetitive tasks [and to] supervisors and fellow workers" and "[p]erform consistently during the work day without intrusion of mental illness symptoms," but not with her ability to "[u]nderstand, remember, and carry out simple work instructions."49

b. Consulting Physicians and Psychologists

i. Dr. Herb Meadow (July 22, 2008)

Dr. Herb Meadow performed a psychiatric examination on July 22, 2008 at the request of the Social Security Administration ("SSA"), and diagnosed De La Cruz with adjustment disorder with depressed mood.50 He noted that his examination findings were consistent with psychiatric problems, but stated that "in itself, this does not appear to be significant enough to interfere with the claimant's ability to function on a daily basis" and that plaintiff "would be able to perform all tasks necessary for vocational functioning."51

De La Cruz described symptoms of "depression with dysphoric mood, crying spells, irritability, low energy, and difficulty concentrating," as well as occasional anxiety.52 She declared that she had "no intent to harm herself," but recalled having had suicidal thoughts in the past.53 On examination, De La Cruz's mood was depressed, but she was otherwise cooperative and fully-oriented, with an adequate manner of relating and appropriate eye contact. She was well-groomed, with appropriate, neat, and casual attire. Her gait, posture, and motor behavior were normal. Her speech was fluent and clear, her expressive and receptive language skills were adequate, and her thoughts were coherent and goal-directed. There was no evidence of hallucinations, delusions, or paranoia, and her affect was appropriate. De La Cruz's attention, concentration, and memory were intact, and her cognitive functioning was described as average, although her general fund of information was "somewhat limited."54

ii. FEGS (September 2008)

A team at FEGS, including Dr. Oksana Luke, conducted a "biopsychosocial evaluation" and diagnosed "depressive d[isorde]r."55 Her mood appeared "sad" and her affect "constricted," though she was also calm and cooperative.56 She reported feeling depressed due to her mother's death the previous year and having problems sleeping, concentrating, and with her memory; she also felt isolated, was unable to experience pleasure from activities she usually found enjoyable, and had a low appetite.57 De La Cruz denied current homicidal ideation and hallucinations, and treatment notes also indicate that she denied suicidal ideation.58 Plaintiff stated that she could socialize, had friends, and obtained emotional support from her sister-in-law, but also that it was "very difficult" to "work, take care of things at home, or get along with other people" due to her psychological state.59 Dr. Luke placed restrictions on De La Cruz's ability to be around noise, groups of people, and enclosed spaces.60

iii. Dr. Howard Tedoff (March 22, 2010)

Psychologist Howard Tedoff examined De La Cruz on March 22, 2010 in response to the New York State Office of Temporary and Disability Assistance's request for an Intelligence Evaluation.61 Plaintiff had traveled to the appointment alone, using public transportation.62 She wore glasses, but stated that her hearing was adequate and her balance and coordination were fair. She also stated that her eating habits were inconsistent and she slept poorly, but that her personal grooming and hygiene were normal. She reported helping her father with household maintenance and seeing friends on occasion, but stated that she mostly stays home watching television.63

Dr. Tedoff noted that De La Cruz was cooperative, with an adequate manner of relating, social skills, and overall presentation.64 Her grooming was adequate, her posture and gait were normal, her eye contact was appropriate, and her speech was intelligible. Her conversation was interactive, relevant, and goaldirected.65 Wechsler Adult Intelligence Scale testing suggested a full scale IQ score of 67.66 Dr. Tedoff diagnosed a learning disorder — particularly in math, mildly deficient to borderline intellectual functioning, and insomnia.67

Dr. Tedoff wrote that plaintiff was "unable to maintain a regular schedule," that her decision-making skills "seem[ed] to be questionable," and that she "might have difficulty learning and performing complex tasks because of cognitive deficits." He also stated that her ability to "look for, obtain and sustain herself in gainful employment [was] guarded . . . because of her current psychiatric and cognitive issues, as well as an attitude that suggested] she [could not] concentrate or follow instructions effectively." Dr. Tedoff nonetheless opined that "[r]elative to vocational function[ing], the claimant can follow and understand simple directions and instructions and perform simple tasks, [and h]er attention and concentration skills are up to those tasks." He further stated, "[s]he has the capacity to relate adequately with others, [but] it remains to be seen if she can deal effectively with stress in the workplace."68

Dr. Tedoff also completed a form to assess De La Cruz's mental residual functional capacity ("RFC").69 He reported that she had either no limitations or minimal limitations in her ability to understand, remember, and carry out simple instructions, or make judgments on simple work-related decisions.70 He assessed mild restrictions in her ability to understand, remember, and carry out complex instructions; make judgments on complex work-related decisions; and interact appropriately with the public, supervisors, and co-workers.71 He also assessed a moderate restriction in her ability to respond appropriately to usual work situations and changes in a routine work setting.72 He based his assessments on plaintiff's reported depression, reaction to stress, poor concentration, recent isolation, "intensive" psychiatric care, and history of a suicide attempt.73

c. Reviewing Physicians

i. Dr. T. Harding (August 20, 2008)

Dr. T. Harding, a state agency review psychologist, reviewed the evidence of record on August 20, 2008, and assessed that plaintiff had mental impairments that were "not severe."74

ii. Dr. Stuart Gitlow (May 30, 2010)

On May 30, 2010, psychiatrist Dr. Stuart Gitlow reviewed the medical evidence of record and responded to interrogatories propounded by the All.75 Dr. Gitlow graduated from the Mount Sinai School of Medicine at New York University and completed his residency in psychiatry at the University of Pittsburgh. He is board certified in general psychiatry, addiction psychiatry, and forensic psychiatry.76 In assessing De La Cruz's condition, Dr. Gitlow considered the results of Dr. Revan's and Dr. Meadow's examinations, noting that plaintiff's report of a suicide attempt in March 2008 did not appear in the other medical histories provided.77

Dr. Gitlow opined that Santilli's report, which indicated the presence of a depressed mood, was "not consistent with anything more than a mild level of symptom severity, one of which would not typically be impairing" and assessed that the limitations Santilli described were not supported by the record, including the relatively conservative treatment provided and relatively mild findings upon examination.78 Dr. Gitlow reported that Dr. Meadow's July 2008 evaluation supported the presence of "[n]ormal [b]ereavement," which was "again not typically impairing."79 He also concluded that Dr. Revan's August 2008 report indicated no more than a mild impairment in activities of daily living. Dr. Gitlow opined that the results of Dr. Tedoff's IQ testing did not establish the presence of a psychiatric illness or condition — and could be consistent with depression or marijuana use — because plaintiff had finished both high school and a year of college.80 Because he noted that the record did not clearly establish a cause for any impairment, Dr. Gitlow declined to complete a more detailed medical source statement assessing plaintiff's limitations as requested by the All.81

C. The ALJ's Decision and Analysis

The All applied the five-step sequential process to evaluate De La Cruz's claim. At step one of her analysis, the All determined that De La Cruz had not engaged in SGA since June 12, 2008.82 Next, at step two, the All concluded that claimant's back pain was severe, while her acid reflux and heartburn were not.83 However, the All determined that claimant's medically determinable mental impairments, including dysthymia depression, adjustment disorder with depressed mood, anxiety, and insomnia, as well as marijuana use, are not severe because individually or in combination they "do not cause more than minimal limitation in the claimant's ability to perform basic mental work activities."84 At the third step, the All determined that "Waking all of the claimant's impairments alone and in combination, to include those deemed not severe, the impairments of record do not meet or equal any Listing of Impairments."85 At step four, the All found that De La Cruz had the RFC "to perform the full range of medium work" as defined by statute.86 After summarizing plaintiff's testimony at the hearing and the medical evidence in the record, the ALJ found that "the claimant's medically determinable impairments could reasonably be expected to cause the alleged symptoms" but that the "overall evidence does not indicate that the claimant's impairments are as severe as alleged or that she is unable to work."87 The All found that De La Cruz's mental impairments did not cause more than minimal limitation in her ability to perform basic work activities. Santilli's treatment notes "appear to indicate mild severity," and Dr. Meadow's diagnosis of adjustment disorder with depressed mood "supports the presence of normal bereavement, which is not typically impairing."88 Further, Dr. Meadow found that plaintiff's symptoms "[did] not appear significant enough to interfere with the claimant's ability to function on a daily basis."89 The All relied heavily on the opinion of Dr. Gitlow, "a medical expert recognized by the Commissioner of Social Security, with a specialty in . . . psychiatry," who concluded that De La Cruz did not have an established medically determinable mental impairment.90 Finally, the All concluded that De La Cruz's own statements "concerning the intensity, persistence and limiting effects of [her] symptoms [were] not credible to the extent they [were] inconsistent" with the objective medical evidence.91

At the final step of the analysis, the All concluded that claimant's age, education, work experience, and RFC allow her to perform other work in the national economy, which "exists in significant numbers."92 Because claimant is a "younger individual" with a high school education and is able to communicate in English, and given the RFC finding for the full range of medium work — which "includes the functional capacity to perform sedentary, light, and medium work" — the All determined that De La Cruz "has not been under a disability . . . since June 12, 2008," and denied her claim for benefits.93

III. LEGAL STANDARD

A. Standard of Review

1. Substantial Evidence Standard

In reviewing an All's decision, a district court does not conduct a de novo review of the All's decision.94 The All must set forth the crucial factors supporting her decision with sufficient specificity,95 but a district court must not disturb the All's decision if "correct legal standards were applied" and "substantial evidence supports the decision."96 "Substantial evidence is `more than a scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'"97

"`To determine whether the findings are supported by substantial evidence, the reviewing court is required to examine the entire record, including contradictory evidence and evidence from which conflicting inferences can be drawn.'"98 Even if there is substantial evidence for the claimant's position, the Commissioner's decision must be affirmed when substantial evidence exists to support it.99 Moreover, the Commissioner's findings of fact, as well as the inferences and conclusions drawn from those findings, are conclusive even in cases where a reviewing court's independent analysis of the evidence might differ from the Commissioner's analysis.100

2. Full and Fair Hearing

However, the reviewing court must be satisfied "that `the claimant has had a full and fair hearing under the Secretary's regulations and in accordance with the beneficent purposes of the Act.'"101 In this regard, the ALJ must affirmatively develop the record in light of the essentially non-adversarial nature of a benefits proceeding.102 "This duty arises from the Commissioner's regulatory obligations,"103 which include developing plaintiff's "complete medical history," and making "every reasonable effort" to help the plaintiff get the required medical reports.104 This duty "exists even when . . . the claimant is represented by counsel."105 "Where there are gaps in the administrative record, remand to the Commissioner for further development of the evidence is appropriate."106

B. Five-Step Process

1. Physical Impairment

Pursuant to the Act, the SSA has established a five-step sequential process to determine whether a claimant is disabled.107 At step one, the All must decide whether the claimant is engaging in SGA.108 Generally, if the claimant has earnings from employment above a certain level, she is presumed to be able to engage in SGA and is deemed not disabled.109 If the claimant is not engaging in SGA, the analysis continues.

At step two, the All must determine whether the claimant has a "severe" medically determinable impairment or combination of impairments.110 An impairment or combination of impairments is severe if it significantly limits the claimant's ability to perform basic work-related activities."111 An impairment is not severe when the evidence establishes only a slight abnormality or a combination of slight abnormalities that would have no more than a minimal effect on the claimant's ability to work.112 If the claimant has a severe impairment or combination thereof, the analysis must proceed. If no severe impairment is found, the claimant is deemed not disabled.

At step three, the ALJ determines whether the claimant's impairment meets or medically equals the criteria of a listed impairment.113 If the impairment is contained in the Listings, the claimant is considered disabled and the ALJ does not reach steps four or five.114 If the impairment does not meet the Listings, the analysis continues.

At step four, the ALJ determines the claimant's RFC,"115 which is "the most [claimant] can still do despite [her] limitations," with respect to past relevant work.116 In making this finding, the ALJ must consider all of the claimant's impairments, including any "related symptoms, such as pain, [which] may cause physical and mental limitations that affect what [claimant] can do in a work setting."117 Then, the ALJ must determine whether the claimant has the RFC to perform any relevant work that the claimant has done in the past.118 If the claimant is unable to do any past relevant work, the analysis proceeds.119

At the last step of the evaluation, step five, the ALJ must determine whether the claimant's RFC, age, education and work experience allow her to perform any other work in the national economy.120 If so, the claimant is not disabled. But if she is unable to do other work, the claimant is disabled.

In making this determination, the ALJ considers whether a claimant has exertional or non-exertional impairments or a combination of both. "Exertional" limitations affect a claimant's ability "to meet the strength demands of jobs (sitting, standing, walking, lifting, carrying, pushing, and pulling)," and "non-exertional" limitations affect the claimant's ability to meet job demands other than those relating to strength.121 When a claimant only has exertional limitations, the ALJ makes her disability determination by reference to the Commissioner's Medical-Vocational Guidelines (the "Grids"), a matrix of exertional capacity levels and vocational characteristics.122 However, "[t]he Grids are inapplicable in cases where the claimant exhibits a significant [or non-negligible] non-exertional impairment (i.e., an impairment not related to strength)."123

Although the claimant generally continues to have the burden of proving disability, a limited burden of production shifts to the Commissioner at step five. To support a finding that the claimant is not disabled at this step, the Commissioner must provide evidence demonstrating that other work exists in significant numbers in the national economy that the claimant can perform, given her RFC, age, education and work experience.124

2. "Special Technique" Applied to Mental Impairments

"[T]he Commissioner has promulgated additional regulations governing evaluations of the severity of mental impairments."125 The regulations require the application of a "special technique" at steps two and three and at each level of the administrative review process.126 The ALJ "must first evaluate [claimant's] pertinent symptoms, signs, and laboratory findings to determine whether [claimant has] a medically determinable mental impairment[.]"127 If a medically determinable mental impairment is found, the ALJ "must specify the symptoms, signs, and laboratory findings that substantiate the presence of the impairment[ or impairments] and document [her] findings in accordance with paragraph (e) of this section."128 The ALJ must then "rate the degree of functional limitation resulting from the impairment(s) in accordance with paragraph (c),"129 which specifies four broad functional areas: (1) activities of daily living; (2) social functioning; (3) concentration, persistence, or pace; and (4) episodes of decompensation.130 The first three areas are rated on a five-point scale, none, mild, moderate, marked, and extreme; and the fourth area is rated on a four-point scale, none, one or two, three, and four or more.131 At step two, "if the degree of limitation in each of the first three areas is rated `mild' or better, and no episodes of decompensation are identified, then the reviewing authority generally will conclude that the claimant's mental impairment is not `severe' and will deny benefits."132 But if the claimant's mental impairment is deemed severe, the ALJ must determine at step three whether the impairment meets or equals the severity of a mental disorder identified in the Listings.133 The ALF's written decision must reflect application of the technique, including "a specific finding as to the degree of limitation in each of the" four functional areas.134 Finally, an analysis under the four broad categories is not a substitute for an RFC determination, which requires a more detailed assessment.135

C. Medical Sources and the "Treating Physician" Rule

"The term `medical sources' refers to both `acceptable medical sources' and other health care providers who are not `acceptable medical sources.'"136 Medical sources include licensed physicians, licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speechlanguage pathologists.137 Medical sources who are not acceptable medical sources include nurse practitioners, physician assistants, as well as other sources.138

Only acceptable medical sources can be relied on to establish the existence of a medically determinable impairment or be considered treating sources whose opinions are entitled to controlling weight under the "treating physician" rule.139 Under the "treating physician" rule, "the medical opinion of a claimant's treating physician is given controlling weight if it is well supported by medical findings and not inconsistent with other substantial record evidence."140 When a treating physician's opinion is not given controlling weight, the regulations require the ALJ to consider several factors in determining how much weight it should receive. These factors include: (1) the frequency of examination and the length, nature, and extent of the treatment relationship; (2) the evidence in support of the opinion; (3) the opinion's consistency with the record as a whole; and (4) whether the opinion is from a specialist.141 After considering the above factors, the ALJ must "`comprehensively set forth [her] reasons for the weight assigned to a treating physician's opinion.'"142 Failure to provide `good reasons for not crediting the opinion of a claimant's treating physician' is grounds for remand.143

While information from medical sources that are not acceptable medical sources cannot establish the existence of an impairment and are not subject to the treating physician rule, the information and opinions they provide are relevant when assessing the severity of an impairment and a claimant's RFC.144 Indeed,

In addition, it may be appropriate to give more weight to the opinion of such a medical source where "she has seen the individual more often than the treating source and has provided better supporting evidence and a better explanation" for her opinion.146

D. Claimant Credibility

An All is permitted to consider an individual's activity level in making a determination of credibility. The All will consider "all of the medical and non-medical information in determining credibility."147 Additionally, while 444 [a] claimant with a good work record is entitled to substantial credibility when claiming an inability to work because of a disability,'"148 the ALJ "`is not required to accept the claimant's subjective complaints without question; [s]he may exercise discretion in weighing the credibility of the claimant's testimony in light of the other evidence in the record.'"149 In weighing the credibility of the claimant's testimony, her work history is just one of many factors the ALJ may consider.150

IV. DISCUSSION

A. The ALJ Applied the Correct Legal Procedures and Her Findings Are Supported by Substantial Evidence

1. The ALJ Gave Appropriate Weight to Dr. Tedoff's Findings

Dr. Tedoff concluded that De La Cruz's prognosis for obtaining and maintaining employment is "guarded" because of her psychiatric and cognitive issues.151 De La Cruz argues that it was error for the All to place little weight on Dr. Tedoff's findings based on Dr. Gitlow's suggestion that the IQ results were inconclusive because they only showed "the patient's condition in a narrow slice of time" and were not "part of a longitudinal picture that could give the results added meaning," such as a "medical/psychiatric workup."152 According to De La Cruz, Dr. Tedoff's findings demonstrated that the "record needed to be augmented" to develop this longitudinal picture.153

These arguments are unavailing. First, the All did not err in placing limited weight on Dr. Tedoff's findings because they were inconsistent with the medical evidence, De La Cruz's past educational and employment history,154 the substance of her testimony, and her demeanor while testifying. For example, as Dr. Tedoff recognized, the intelligence scores were "not consistent with her alleged year of college and reading levels in terms of work recognition."155 Nor were they consistent with Dr. Meadow's evaluation;156 Dr. Revan's evaluation,157 Santilli's opinion and treatment notes;158 or the FEGS records.159

Second, the ALJ made a reasonable effort to develop the record, and De La Cruz failed to submit evidence to support Dr. Tedoff's findings. Prior to the hearing, the All advised De La Cruz of her right to obtain and present evidence.160 The "Disability Worksheet" shows that multiple attempts were made to obtain medical records from De La Cruz's treating sources.161 Furthermore, at the conclusion of the hearing before the All, the record was held open for De La Cruz to submit additional medical records from the therapists and other medical sources she identified at the hearing.162 However, on February 10, 2010, De La Cruz's attorney only mailed Santilli's treatment notes to the All, and did not mention whether he made an effort to obtain records from other sources.163 Moreover, on July 16, 2010, a month before she issued her decision, the All held the record open a second time, for the specific purpose of providing De La Cruz an opportunity to respond to the Tedoff and Gitlow materials. The All's letter explained that De La Cruz could request a supplemental hearing to present additional evidence and ask the All to issue subpoenas for the production of witnesses and records.164 However, there is no indication that De La Cruz or her counsel followed up on this invitation. Notwithstanding the All's duty to develop the record, the Commissioner's Regulations explicitly place the burden of supplying all relevant medical evidence on the claimant.165 There is no excuse for De La Cruz's failure to submit records and opinions, including in response to Dr. Tedoff's findings or Dr. Gitlow's opinion characterizing those findings.166 In short, the All adequately explained the basis for placing limited weight on Dr. Tedoff's findings and the All's conclusions are otherwise supported by substantial evidence.

2. The ALJ Considered Nurse Santilli's Notes and Opinion and Dr. Luke's Findings

De La Cruz contends that the All failed to consider relevant evidence, arguing that the "record contains multiple evaluations [] showing impairing mental conditions," including Nurse Santilli's clinical notes, diagnoses, and functional capacity statement, and Dr. Luke's diagnosis of depressive disorder.167 However, the ALJ considered each of these sources.

As a threshold matter, the ALJ properly disregarded Santilli's opinion when considering whether De La Cruz had a medically determinable mental impairment because, as a nurse practitioner, Santilli is not an acceptable medical source.168 At the same time, the ALJ considered Santilli's records throughout her decision, including at step two when determining the severity of De La Cruz's mental impairments,169 and at step four when assessing De La Cruz's RFC.170 With respect to severity, the ALJ, relying on Dr. Gitlow's opinion, determined that Santilli's treatment notes indicated only mild severity.171 With regard to RFC, the ALJ found that Santilli's opinion, which placed significant limitations on De La Cruz's ability to perform work, was "completely inconsistent with the treatment notes provided," as well as the other evidence in the file.172

The All's determinations are well supported by the record. Nurse Santilli's treatment notes reflect primarily unremarkable examination findings throughout the relevant period. For example, at her first appointment in August 2008, plaintiff had spontaneous, relevant, and goal-directed thought with unremarkable content.173 The following month, De La Cruz presented with "unremarkable . . . psychomotor behavior[,]" "intact" memory, and "clear" "sensorium," as well as "logical, concrete" thought processes with "unremarkable .. . content," "no signs of mania . . . or psychosis," and no suicidal or homicidal ideation.174 In December 2008, De La Cruz's "mood [was] euthymic," she had "intact" memory, "logical" thought processes, and "appropriate" appearance, speech, and affect.175 In addition, Santilli found that De La Cruz's condition would not interfere markedly with her ability to understand, remember, and carry out simple work instructions, which is consistent with the All's determination that De La Cruz can perform basic work activities.176 Accordingly, Santilli's treatment notes tend to support, rather than undermine, the All's conclusions. Thus, the

ALJ properly considered Santilli's opinion, but found it to have little value because it was contradicted by her own contemporaneous treatment notes.177

De La Cruz also argues that the ALJ erred in finding that De La Cruz was `seen infrequently, and was not referred to a psychiatrist for evaluation, consultation, or treatment.'"178 De La Cruz contends that "[a]ppointments were missed [] not because of a cavalier attitude . . . about treatment, but because of dislocations in treatment caused by staff changes and, in part, by feelings of helplessness and discouragement that are part of [her] diagnosed condition.'179 She also points out that Santilli's treatment notes indicate that in addition to seeing Santilli, De La Cruz was getting weekly therapy from other sources.180 However, De La Cruz does not explain how these alleged oversights impact the ALF's specific findings, and the ALF's decision demonstrates a close review of Santilli's treatment notes, making it unlikely that the All simply failed to take note of the fact that De La Cruz was receiving weekly therapy. In fact, during the hearing before the All, De La Cruz testified at length about her therapy sessions,181 at one point describing them as "couples therapy" for her and her boyfriend.182 Moreover, De La Cruz failed to provide medical records from these sources, and the All's opinion is otherwise supported by ample evidence.

With respect to Dr. Luke, the All not only considered her findings, but relied on them when concluding that Santilli's opinion was contradicted by Dr. Luke's "preliminary restrictions."183 While the All does not specifically refer to Dr. Luke's diagnosis of depressive disorder (or depression) at step two, she found that De La Cruz's medically determinable mental impairments included both dysthymia depression and adjustment disorder with depressed mood.184 De La Cruz has failed to explain how these impairments are inconsistent with Dr. Luke's diagnosis:185

Thus, I find that the All examined all the relevant sources. In doing so, she determined that they did not support a finding of either a severe mental impairment or an RFC inconsistent with the full range of medium work. Mere disagreement with those findings is insufficient to overturn the All's decision.186

3. The ALJ Gave Appropriate Weight to Dr. Gitlow's Opinion

The opinions of consultants such as Dr. Gitlow are entitled to considerable weight.187 De La Cruz argues that Dr. Gitlow gave insufficient weight to Santilli's opinion and that his opinion was based on the erroneous assumption that "De La Cruz had never been diagnosed with a serious mental illness by an M.D. or psychologist," ignoring Dr. Luke's diagnosis and findings.188 However, as discussed earlier, there is no basis to disturb the ALF's determination that Santilli's opinion was neither supported by her treatment notes nor the record.189 Nor did Dr. Gitlow overlook Dr. Luke's report in his opinion. He indicated that while the report stated that "the claimant tried to kill herself [recently]; this is not, however, revealed in the [other] histories [provided]."190 Moreover, as noted, De La Cruz has not explained how Dr. Luke's diagnosis of depressive disorder is otherwise inconsistent with the record evidence or the ALF's determinations that De La Cruz's mental impairments were not severe and that she could perform the full range of medium work.191 Accordingly, I find that the All did not err in giving Dr. Gitlow's opinion substantial weight.

C. The ALJ's Determination that There Are Jobs that Exist in Significant Numbers in the National Economy that Plaintiff Can Perform Is Based on Substantial Evidence

De La Cruz argues that the All should have found that she could not sustain employment based on the vocational expert's opinion with respect to a hypothetical worker who was restricted to `simple work involving one or two step tasks [and] involving brief but superficial contact with others.'"192 However, the All determined that De La Cruz did not have these restrictions based on the record evidence discussed throughout this opinion,193 and there is no basis to disturb this finding.194 Accordingly, the ALJ did not err in rejecting a comparison between De La Cruz and this hypothetical worker.

V. CONCLUSION

For the foregoing reasons, the Commissioner's motion is GRANTED, the decision denying benefits is affirmed, and De La Cruz's motion is DENIED. The Clerk of Court is directed to close these motions [Docket numbers 16 and 30], and this case.

SO ORDERED.