MARTIN C. CARLSON, Magistrate Judge.
In this Social Security appeal we do not write upon a blank slate. Quite the contrary, this is Justin Stugart's second appeal of an adverse disability decision. Both of Stugart's appeals have involved a consideration of two inextricably intertwined issues. In both appeals, Stugart, a younger worker in his 30's, asserts that he is totally disabled due to the combined effects of degenerative disc disease and obesity. Further, in both appeals Stugart has argued that the Administrative Law Judge (ALJ) erred in determining that he retained the residual functional capacity to perform a range of sedentary work despite his spinal impairments. Moreover, in both of these appeals, the gravamen of Stugart's argument has been his assertion that the ALJ's evaluation of his residual functional capacity failed to fully account for the debilitating effect of Stugart's reported back pain. Thus, at the heart of both of these appeals has been a legal and factual dispute regarding the sufficiency of the ALJ's evaluation of Stugart's subjective complaints of disabling pain.
The ALJ performs this analysis of a claimant's subjective complaints of pain guided by a series of legal guideposts which provide that:
McKean v. Colvin, 150 F.Supp.3d 406, 415-16 (M.D. Pa. 2015)(footnotes omitted). See Higbie v. Berryhill, No. 3:17-CV-00433, 2018 WL 1474559, at *1 (M.D. Pa. Mar. 7, 2018), report and recommendation adopted, No. 3:17-CV-433, 2018 WL 1471121 (M.D. Pa. Mar. 26, 2018).
Once the ALJ has made this determination:
Deiter v. Berryhill, No. 3:16-CV-2146, 2018 WL 1322067, at *1 (M.D. Pa. Feb. 5, 2018), report and recommendation adopted, No. 3:16-CV-2146, 2018 WL 1315655 (M.D. Pa. Mar. 14, 2018).
Given the deferential standard of review that applies to Social Security Appeals, which calls upon us simply to determine whether substantial evidence supports the ALJ's findings, we conclude that substantial evidence exists in this case which justified the ALJ's credibility determinations that led to the denial of this particular claim. We further conclude that the basis for these credibility determinations has now been adequately articulated by the ALJ in this, the second agency decision addressing this claim. Therefore, for the reasons set forth below, we recommend that the district court affirm the decision of the Commissioner in this case.
On November 3, 2011, Justin Stugart protectively applied for disability insurance benefits and supplemental security income pursuant to Titles II and XVI of the Social Security Act ("Act"). (Tr. 623.) In his disability applications Stugart alleged that he had become disabled due to the combined effects of degenerative disc disease and obesity. (Tr. 516.) According to Stugart the alleged onset of this disability occurred on or about January 5, 2011. (Tr. 623.)
Stugart was born in 1982, (Tr. 161), was in his late 20's at the time of the alleged onset of his disability, and was considered a younger worker under the Commissioner's regulations. Stugart had a high school education and past relevant work as cashier/checker, a foreman/supervisor in a sawmill, a supervisor in log sorting, and a boomer conveyor operator. (Tr. 30, 49, 72-73.)
Stugart's medical history was prolonged, complex, and marked by contradictory clinical and opinion evidence. Moreover, that medical history, which now spans some five years, reflected both periods of recovery and episodes of relapse. This medical history began in early January 2011 after Stugart went to a hospital emergency room reporting that he had reported injured himself at work, and was experiencing low back pain that radiated into his legs. (Tr. 221.) While Stugart was initially diagnosed with acute low back pain or strain and left sciatica, (Tr. 222), subsequent MRI and EMG examinations in 2011 revealed lumbar herniations, with varying degrees of spinal stenosis, (Tr. 235), and chronic lumbar radiculopathy.
In March of 2011, Stugart underwent a laminectomy and discectomy to address these spinal conditions. (Tr. 291, 326.) The initial results of this medical procedure were promising. Thus, the neurosurgeon who performed the procedure, reported that Stugart did "extremely well" postoperatively with pain, and cleared him to return to sedentary work on March 28, 2011. (Tr. 291.) However, within days, by March 30, 2011, Stugart reported the onset of severe pain in his right leg, (Tr. 291), and a lumbar MRI scan on April 7, 2011 showed a new large herniation. (Tr. 292, 353.) Consequently, Stugart underwent a second laminectomy and discectomy on April 15, 2011.(Tr. 291.) Stugart's neurosurgeon reported that he did "remarkably well," with this procedure and experienced a dramatic resolution of his leg pain. (Tr. 300.) On May 6, 2011, Stugart's doctor reported that he was doing "very well with continued resolution of the leg pain," recommended that he increase his activities as tolerated, and released him to return to work on May 9, 2011. (Tr. 364.)
However, despite these procedures Stugart's medical history in 2011 and 2012 continued to be marked by mixed, equivocal and contradictory medical reports and evaluations. Thus, in 2011 Stugart continued to periodically report to emergency room personnel and his primary treating source that he was experiencing severe back pain. (Tr. 269, 279, 387.) Examinations in December of 2011 revealed some decreased range of motion, (Tr. 449-50), as did examinations conducted February of 2012, (Tr. 444-5) but physical therapy notes from October through December 2011 reported improvement in Stugart's strength and mobility. (Tr. 397-410.)
By 2012 physicians who were treating Stugart were documenting that he reported experiencing intractable back pain, and were recommending that he engage in further physical therapy or consider surgical fusion to alleviate his pain. (Tr. 428, 473-4, 496.) These doctors noted one complicating factor that Stugart needed to address prior to undergoing surgery, which they predicted enjoyed a 60-70% success rate in alleviating his pain—Stugart would need to cease tobacco use in order to enhance his chances for recovery and pain relief through surgery. (Id.)
This mixed and equivocal picture, marked by clear evidence of some back impairment but uncertainty regarding the severity of that impairment, was also reflected in the November 24, 2011Adult Function Report submitted by Stugart. (Tr. 173.) In this report Stugart, stated that he could walk "50 y[a]rds on a good day," before needing to rest for 10 to 15 minutes, (Tr. 178), and listed problems with lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, stair climbing, and completing tasks. (Tr. 178.) However, Stugart's self-report also indicated that he had no problems performing personal care activities, was able to prepare frozen meals for himself, and was able to go out of the house every couple of days either walking, riding in a car, or using public transportation. (Tr. 176.) According to Stugart he was also able to shop in stores for "basic things" once a week for 15 to 20 minutes, (Tr. 176), had no problems managing his money, and engaged in hobbies, including playing video games and playing pool (Tr. 177). Stugart also related that he had daily social contact with his girlfriend, attended physical therapy and went to doctors' appointments, as needed. (Tr. 177.)
The complex and contradictory nature of this medical history was further underscored by a consultative examination conducted by Dr. R. Craig Nielsen on December 23, 2011. (Tr. 413.) During this examination, Dr. Nielsen reported that Stugart appeared to be in distress in that he moved in a guarded fashion, and got in and out of his chair and on and off of the examination table "rather gingerly." (Tr. 417.) A physical examination revealed that Stugart's back was diffusely tender to light tapping, (Tr. 417), and Stugart could not perform a straight leg raising test from the supine position because he complained of pain, but he performed a straight leg raising test from the sitting position without difficulty.(Tr. 417.) Likewise, Stugart was only able to bend forward at the waist to about 10 or 20 degrees due to pain and the sensation that he was falling and would not be able to pull himself back up. (Tr. 417.) His gait was slow, but normal; his stance was normal; his lifting and grasping were normal; and he had no joint deformities. (Tr. 418.) Given these clinical results, Dr. Nielsen diagnosed Stugart with persistent low back pain and pelvic and groin pains of unclear etiology, (Tr. 418), but stated that he had "no idea why [Stugart] should have so much pain upon moving his hip joints on today's exam," (Tr. 418), rated Stugart's prognosis as "fair to good," and opined that he had no physical limitations. (Tr. 418-20.)
On September 13, 2012, an initial administrative hearing was conducted in this case. Stugart and a vocational expert appeared and testified at this hearing. Following this hearing, on December 10, 2012, the ALJ issued a decision denying Stugart's application for benefits. (Tr. 620-32.) In this decision, the ALJ found that Stugart retained the residual functional capacity to perform a range of sedentary work despite his chronic back pain, and concluded that Stugart's assertions of wholly disabling spinal pain were not fully credible. (Id.)
Stugart appealed this decision and on February 18, 2015, the district court remanded this matter for further consideration by the Commissioner. (Tr. 590-614.) In this decision directing a remand, the district court concluded that the ALJ's initial opinion did not adequately address and explain the basis for the credibility determination which partially discounted the credibility of Stugart's claims of totally disabling pain. (Id.)
Following this remand a second administrative hearing was conducted on August 28, 2015. Once again, Stugart and a vocational expert appeared and testified at this hearing. In addition, on remand, the ALJ had the benefit of further medical records and opinions. This additional evidence continued to present a profoundly mixed and contradictory portrait of the severity of Stugart's condition.
For example, in July of 2013, Dr. Michael Haak, examined Stugart. (Tr. 819.) At that time the doctor found that Stugart was in no apparent distress, and had a normal gait as well as a well-healed surgical scar, (Tr. 819), but had tenderness and a reduced range of motion secondary to low back pain. (Tr. 819.) Stugart displayed equal and symmetric motion in his hips and knees; straight leg testing was negative for radicular complaints, but increased his low back pain; his motor strength was equal and symmetric; and his pulses were normal. (Tr. 819.) While Dr. Haak concluded based upon this examination that Stugart could not return to work as a saw mill operator, the doctor did not offer an opinion on whether he could otherwise perform sedentary work.
Similarly, in January 2015, the neurosurgeon who had treated Stugart in 2012 examined him because Stugart had complained of pain for the last few months in his low back, right groin, and right thigh. (Tr. 841.) On examination, the doctor found Stugart to be in good condition, without any acute distress, and his mechanical and neurological examinations were all satisfactory. (Tr. 841.) The doctor also examined a December 2014 lumbar MRI conducted on Stugart, and concluded that it showed no evidence of nerve root compression. (Tr. 841.)
One month later, in February 2015, Stugart had a surgical consultation with Dr. Haak. (Tr. 834). At that time, Stugart was still smoking, even though he had been informed nearly three years earlier that cessation of smoking was a pre-condition to successful surgery. Accordingly, Dr. Haak told Stugart to see him after he stopped smoking. (Tr. 834.)
On October 1, 2015, at the request of the ALJ, Dr. Eric Schmitter, an orthopedic specialist, completed a series of medical interrogatories relating to Stugart's condition. (Tr. 908.) After reviewing Stugart's medical records Dr. Schmitter determined that his symptoms were "probably exaggerated," because there were "no objective or documented neurologic deficits." (Tr. 909.) Dr. Schmitter concluded that Stugart could perform medium to light work, carry and lift 20 and ten pounds, respectively, stand/walk up to six hours in an eight-hour workday, sit without restrictions . (Tr. 910). He further opined that Stugart should not climb ropes, scaffolds; but could climb ladders, stoop, bend, and crawl occasionally. (Tr. 910.)
Finally, on December 2, 2015, Ronald DiSimone, M.D., diagnosed Stugart as suffering from lumbar spine pain, spinal stenosis in his lumbar region with neurogenic claudication, spondylolisthesis in the lumbar region, and lumbar degenerative disc disease. (Tr. 921-22.) Dr. DeSimone did not opine on whether Stugart was permanently disabled but recommended that he not work for three months. (Tr. 924.)
It was against this backdrop that the ALJ issued a second decision in this case on January 11, 2016. (Tr. 510-30.) In this decision the ALJ once again addressed the issue of Stugart's residual functional capacity and the integrally related question of whether his claims of totally disabling pain were entirely credible. (Id.)
The ALJ answered these questions by finding that Stugart's subjective complaints of pain were only partially credible, and concluding that he retained the residual functional capacity to perform a limited range of sedentary work. In reaching this result, the ALJ provided a much more fulsome assessment of Stugart's credibility, along with a more detailed evaluation of the most recent medical opinion evidence. On this score, the ALJ explained that:
(Tr. 525-26.)
The ALJ also considered the most recent and comprehensive medical disability assessment, the October 2015 opinion of Dr. Schmitter, noting that:
(Tr. 525.)
Upon consideration of all of the evidence, the ALJ adopted a limited sedentary work residual functional capacity assessment for Stugart, concluding that:
(Tr. 528.)
Concluding based upon this residual functional capacity assessment that there were jobs in the regional and national economy which Stugart could perform, the ALJ then denied his applications for disability benefits. (Tr. 529-30.)
This appeal followed. (Doc. 1.) On appeal, Stugart reprises the arguments which he made in his first Social Security appeal, contending that the ALJ's determination that he retained the residual functional capacity to perform a range of sedentary work despite his spinal impairments failed to fully account for the debilitating effect of Stugart's reported back pain. Thus, the gravamen of this appeal remains a legal and factual dispute regarding the sufficiency of the ALJ's evaluation of Stugart's subjective complaints of disabling pain.
This case is now fully briefed and is, therefore, ripe for resolution. For the reasons set forth below, given the much more detailed rationale articulated by the ALJ in the second decision issued in this case, and mindful of the deferential standard of review which applies here, it is recommended that the decision of the Commissioner be affirmed.
Resolution of the instant Social Security appeal involves an informed consideration of the respective roles of two adjudicators—the ALJ and this court. At the outset, it is the responsibility of the ALJ in the first instance to determine whether a claimant has met the statutory prerequisites for entitlement to benefits. To receive disability benefits, a claimant must present evidence that demonstrates that the claimant has 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); 42 U.S.C. §1382c(a)(3)(A); see also 20 C.F.R. §§404.1505(a), 416.905(a).
42 U.S.C. § 423(d)(2)(A); 42 U.S.C. §1382c(a)(3)(B); see also 20 C.F.R. §§404.1505(a), 416.905(a). Finally, to qualify for benefits under Title II of the Social Security Act, a claimant must also show that he or she contributed to the insurance program and became disabled prior to the date on which he or she was last insured. 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
In making this determination the ALJ employs a five-step evaluation process to determine if a person is eligible for disability benefits. See 20 C.F.R. §§ 404.1520, 416.920; see also Plummer v. Apfel, 186 F.3d 422, 428 (3d Cir. 1999). If the ALJ finds that a claimant is disabled or not disabled at any point in the sequence, review does not proceed any further. See 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). As part of this analysis the ALJ must sequentially determine: (1) whether the claimant is engaged in substantial gainful activity; (2) whether the claimant has a severe impairment; and (3) whether the claimant's impairment meets or equals a listed impairment.
Once the ALJ completes this Step 3 analysis, at Steps 4 and 5 of this sequential analysis the ALJ must determine whether the claimant's impairment prevents the claimant from doing past relevant work; and whether the claimant's impairment prevents the claimant from doing any other work. Id. Before considering Step 4 in this process, the ALJ must also determine the claimant's residual functional capacity, or RFC. 20 C.F.R. §§ 404.1520(e), 416.920(e). RFC is defined as "that which an individual is still able to do despite the limitations caused by his or her impairment(s)." Burnett v. Comm'r of Soc. Sec., 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted); see also 20 C.F.R. §§ 404.1545, 416.945. In making this assessment, the ALJ considers all of the claimant's impairments, including any medically determinable nonsevere impairments. 20 C.F.R. §§ 404.1545(a)(2), 416.945(a)(2).
There is an undeniable medical aspect to an RFC determination, since that determination entails an assessment of what work the claimant can do given the physical limitations that he experiences. Yet, when considering the role and necessity of medical opinion evidence in making this determination, courts have followed several different paths. Some courts emphasize the importance of medical opinion support for an RFC determination and have suggested that "[r]arely can a decision be made regarding a claimant's residual functional capacity without an assessment from a physician regarding the functional abilities of the claimant." Biller v. Acting Comm'r of Soc. Sec., 962 F.Supp.2d 761, 778-79 (W.D. Pa. 2013) (quoting Gormont v. Astrue, Civ. No. 11-2145, 2013 WL 791455 at *7 (M.D. Pa. Mar. 4, 2013)). In other instances, it has been held that: "There is no legal requirement that a physician have made the particular findings that an ALJ adopts in the course of determining an RFC." Titterington v. Barnhart, 174 F. App'x 6, 11 (3d Cir. 2006). Further, courts have held in cases where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability that "the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided." Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015).
These seemingly discordant legal propositions can be reconciled by evaluation of the factual context of these decisions. Those cases which emphasize the importance of medical opinion support for an RFC assessment typically arise in a factual setting where a factually-supported and well-reasoned medical source opinion regarding limitations that would support a disability claim is rejected by an ALJ based solely upon a lay assessment of other evidence by the ALJ. In contrast, when an ALJ fashions an RFC determination on a sparse factual record, in the absence of any competent medical opinion evidence, or by carefully evaluating multiple pieces of clinical and opinion evidence, courts have adopted a more pragmatic view and have sustained the ALJ's exercise of independent judgment based upon all of the facts and evidence. See Titterington v. Barnhart, 174 F. App'x 6, 11 (3d Cir. 2006); Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015). In either event, once the ALJ has made this determination, our review of the ALJ's assessment of the plaintiff's RFC is deferential, and that RFC assessment will not be set aside if it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d Cir. 2002); see, e.g., Metzger v. Berryhill, No. 3:16-CV-1929, 2017 WL 1483328, at *5 (M.D. Pa. Mar. 29, 2017), report and recommendation adopted sub nom. Metzgar v. Colvin, No. 3:16-CV-1929, 2017 WL 1479426 (M.D. Pa. Apr. 21, 2017); Rathbun v. Berryhill, No. 3:17-CV-00301, 2018 WL 1514383, at *6 (M.D. Pa. Mar. 12, 2018), report and recommendation adopted, No. 3:17-CV-301, 2018 WL 1479366 (M.D. Pa. Mar. 27, 2018).
At Steps 1 through 4, the claimant bears the initial burden of demonstrating the existence of a medically determinable impairment that prevents him or her from engaging in any of his or her past relevant work. 42 U.S.C. §1382c(a)(3)(H)(i)(incorporating 42 U.S.C. §423(d)(5) by reference); 20 C.F.R. §416.912; Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). Once the claimant has met this burden, the burden then shifts to the Commissioner at Step 5 to show that jobs exist in significant number in the national economy that the claimant could perform that are consistent with the claimant's age, education, work experience and RFC. 20 C.F.R. §416.912(f); Mason, 994 F.2d at 1064.
The ALJ's disability determination must also meet certain basic procedural and substantive requirements. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, the ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-707. In addition, "[t]he ALJ must indicate in his decision which evidence he [or she] has rejected and which he [or she] is relying on as the basis for his [or her] finding." Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999). In short, an ALJ's disability determination must also adequately explain the legal and factual basis for this disability determination. This burden of articulation applies with particular force to all aspects of an ALJ's assessment and evaluation of what is often conflicting evidence. Thus, "[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) (quoting Mason v. Shalala, 994 F.2d 1058, 1066 (3d Cir. 1993)).
Once the ALJ has made a disability determination, it is then the responsibility of this Court to independently review that finding. In undertaking this task, this Court applies a specific, well-settled and carefully articulated standard of review. In an action under 42 U.S.C. § 405(g) or 42 U.S.C. §1383(c)(3) to review the decision of the Commissioner of Social Security denying a claim for disability benefits, the "findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive[.]" 42 U.S.C. § 405(g).
The "substantial evidence" standard of review prescribed by statute is a deferential standard of review. Jones v. Barnhart, 364 F.3d 501, 503 (3d Cir. 2004). When reviewing the denial of disability benefits, we must simply determine whether the denial is supported by substantial evidence. Brown v. Bowen, 845 F.2d 1211, 1213 (3d Cir. 1988); see also Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008). 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, 108 S.Ct. 2541, 101 L. Ed. 2d 490 (1988). It is less than a preponderance of the evidence but more than a mere scintilla of proof. Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L. Ed. 2d 842 (1971). Substantial evidence means "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Plummer, 186 F.3d at 427 (quoting Ventura v. Shalala, 55 F.3d 900, 901 (3d Cir. 1995)).
A single piece of evidence is not substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the evidence. Mason, 994 F.2d at 1064. However, in an adequately developed factual record, substantial evidence may be "something less than the weight of the evidence, and the possibility of drawing two inconsistent conclusions from the evidence does not prevent [the decision] from being supported by substantial evidence." Consolo v. Federal Maritime Comm'n, 383 U.S. 607, 620, 86 S.Ct. 1018, 16 L. Ed. 2d 131 (1966). In determining if the ALJ's decision is supported by substantial evidence the court may not parse the record but rather must scrutinize the record as a whole. Smith v. Califano, 637 F.2d 968, 970 (3d Cir. 1981); Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D. Pa. 2003). The question before this Court, therefore, is not whether a claimant is disabled, but whether the Commissioner's finding that he was not disabled is supported by substantial evidence and was reached based upon a correct application of the relevant law. See Arnold v. Colvin, No. 3:12-CV-02417, 2014 U.S. Dist. LEXIS 31292, 2014 WL 940205, at *1 (M.D. Pa. Mar. 11, 2014) ("[I]t has been held that an ALJ's errors of law denote a lack of substantial evidence.") (alterations omitted); Burton v. Schweiker, 512 F.Supp. 913, 914 (W.D. Pa. 1981) ("The Secretary's determination as to the status of a claim requires the correct application of the law to the facts."); see also Wright v. Sullivan, 900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal matters is plenary); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D. Pa. 2012) ("[T]he court has plenary review of all legal issues. . . .").
Several fundamental legal propositions flow from this deferential standard of review. First, when conducting this review "we are mindful that we must not substitute our own judgment for that of the fact finder." Zirnsak v. Colvin, 777 F.3d 607, 611 (3d Cir. 2014) (citing Rutherford, 399 F.3d at 552). Thus, we are enjoined to refrain from trying to re-weigh the evidence. Rather our task is to simply determine whether substantial evidence supported the ALJ's findings. However, we must also ascertain whether the ALJ's decision meets the burden of articulation demanded by the courts to enable informed judicial review. Simply put, "this Court requires the ALJ to set forth the reasons for his decision." Burnett v. Comm'r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000). As the court of appeals has noted on this score:
Diaz v. Comm'r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009).
Thus, in practice ours is a twofold task. We must evaluate the substance of the ALJ's decision under a deferential standard of review, but we must also give that decision careful scrutiny to ensure that the rationale for the ALJ's actions is sufficiently articulated to permit meaningful judicial review.
The interplay between this deferential substantive standard of review, and the requirement that courts carefully assess whether an ALJ has met the standards of articulation required by law, is aptly illustrated by those cases which consider analysis of a claimant's reported pain. When evaluating lay testimony regarding a claimant's reported degree of pain and disability, we are reminded that:
Zirnsak v. Colvin, 777 F.3d 607, 612-13 (3d Cir. 2014).
Yet, it is also clear that:
McKean v. Colvin, 150 F.Supp.3d 406, 415-16 (M.D. Pa. 2015)(footnotes omitted). Thus, we are instructed to review an ALJ's evaluation of a claimant's subjective reports of pain under a standard of review which is deferential with respect to the ALJ's well-articulated findings, but imposes a duty of clear articulation upon the ALJ so that we may conduct meaningful review of the ALJ's conclusions.
Further, the Social Security Rulings and Regulations provide a framework under which a claimant's subjective complaints are to be considered. 20 C.F.R. § 404.1529. First, symptoms, such as pain or fatigue, will only be considered to affect a claimant's ability to perform work activities if such symptoms result from an underlying physical or mental impairment that has been demonstrated to exist by medical signs or laboratory findings. 20 C.F.R. § 404.1529(b). During the second step of this credibility assessment, the ALJ must determine whether the claimant's statements about the intensity, persistence or functionally limiting effects of his or her symptoms are substantiated based on the ALJ's evaluation of the entire case record. 20 C.F.R. § 404.1529(c). This includes, but is not limited to: medical signs and laboratory findings, diagnosis and other medical opinions provided by treating or examining sources, and other medical sources, as well as information concerning the claimant's symptoms and how they affect his or her ability to work. Id. The Social Security Administration has recognized that individuals may experience their symptoms differently and may be limited by their symptoms to a greater or lesser extent than other individuals with the same medical impairments, signs, and laboratory findings.
Thus, to assist in the evaluation of a claimant's subjective symptoms, the Social Security Regulations identify seven factors which may be relevant to the assessment of the severity or limiting effects of a claimant's impairment based on a claimant's symptoms. 20 C.F.R. § 404.1529(c)(3). These factors include: activities of daily living; the location, duration, frequency, and intensity of the claimant's symptoms; precipitating and aggravating factors; the type dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate his or her symptoms; treatment, other than medication that a claimant has received for relief; any measures the claimant has used to relieve his or her symptoms; and, any other factors concerning the claimant's functional limitations and restrictions. Id.; see George v. Colvin, No. 4:13-CV-2803, 2014 WL 5449706, at *4 (M.D.Pa. Oct. 24, 2014); Martinez v. Colvin, No. 3:14-CV-1090, 2015 WL 5781202, at *8-9 (M.D. Pa. Sept. 30, 2015).
Applying these legal benchmarks, in the final analysis:
In this case our review of the ALJ's decision is limited to determining whether the findings of the ALJ are supported by substantial evidence in the record. See 42 U.S.C. §405(g); 42 U.S.C. §1383(c)(3); Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D. Pa. 2012). In this context, 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), and substantial evidence is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971).
Guided by these legal benchmarks we find that substantial evidence supported the ALJ's findings in this case that Stugart's reported back pain was not wholly disabling, and still permitted him to perform a limited range of sedentary work. Unlike the cursory treatment afforded to these issues by the ALJ in her initial 2012 decision, this second opinion provides a fulsome explanation of the reasons why the ALJ found that Stugart's claims of disabling pain were not entirely credible.
These factors which were articulated by the ALJ included Stugart's occasional non-compliance with medication and physical therapy regimens, non-compliance which cast doubt over the on-going severity of this condition. Further, the ALJ aptly observed that Stugart's delay in smoking cessation for nearly three years, knowing that such cessation was a pre-condition to potentially pain relieving surgery, cast further questions upon the on-going severity of this reported pain. The ALJ also noted that Stugart's activities of daily living were not congruent with a claim of total disability, but seemed to allow for some limited sedentary activity. Moreover, the medical treatment records were mixed in terms of their description of the severity of Stugart's pain and revealed "lumbar spine pain with subjective radiculopathy symptoms, which are quite variable." Given the variability of these symptoms, the ALJ found that the 2015 medical opinion of Dr. Schmitter, which found that Stugart could perform some light work, warranted some weight, but giving Stugart the benefit of all reasonable inferences, restricted his activities to a limited range of sedentary employment.
In our view, this analysis met the burden of articulation demanded by the courts. The ALJ's decision specifically identified what evidence the ALJ found to be not credible and explained why this evidence lacked credibility. Adorno v. Shalala, 40 F.3d 43, 48 (3d Cir.1994) (citing Stewart v. Sec'y of Health, Education and Welfare, 714 F.2d 287, 290 (3d Cir.1983)). Moreover, the factors cited by the ALJ when making this determination—which included contrary clinical and opinion evidence, Stugart's activities of daily living, and his non-compliance with treatment regimens—were all legitimate considerations to take into account when making this crucial credibility assessment. Further, substantial, albeit disputed, evidence supported each of the findings made by the ALJ with respect to Stugart's subjective claims of pain and his ability to perform some sedentary work notwithstanding his impairments.
In sum, the ALJ's assessment of the evidence in this case fully complied with the dictates of the law and was supported by substantial evidence. This is all that the law requires, and all that a claimant like Stugart can demand in a disability proceeding. Therefore, notwithstanding Stugart's argument that this evidence could have been further explained, or might have been viewed in a way which would have also supported a different finding, we are obliged to affirm this ruling once we find that it is "supported by substantial evidence, `even [where] this court acting de novo might have reached a different conclusion.'" Monsour Med. Ctr. v. Heckler, 806 F.2d 1185, 1190-91 (3d Cir. 1986) (quoting Hunter Douglas, Inc. v. NLRB, 804 F.2d 808, 812 (3d Cir. 1986)). Accordingly, under the deferential standard of review that applies to appeals of Social Security disability determinations we conclude that substantial evidence supported the ALJ's evaluation of this case. Therefore, we recommend that the district court affirm this decision, direct that judgment be entered in favor of the defendant, and instruct the clerk to close this case.
In summary, we find that the ALJ's decision represents the careful and methodical assessment of the factual, medical and opinion evidence that was presented. The decision was thorough, was adequately explained, and was based upon substantial evidence that the ALJ evaluated in accordance with prevailing legal and regulatory guidelines. Therefore, that decision should be affirmed and the plaintiff's appeal denied.
The parties are further placed on notice that pursuant to Local Rule 72.3:
