CHRISTINE A. NOWAK, Magistrate Judge.
Plaintiff brings this appeal under 42 U.S.C. § 405(g) for judicial review of the final decision of the Commissioner of Social Security ("Commissioner") denying his claim for social security insurance benefits [Dkts. 1; 13]. After reviewing the Briefs submitted by the Parties, as well as the evidence contained in the Administrative Record, the Court finds that the Commissioner's decision should be
On February 28, 2012, Paul Reyna Olvera ("Plaintiff") filed his application for supplemental security income ("SSI") benefits under Title XVI of the Social Security Act ("Act"), alleging an onset of disability date of February 23, 2012 [TR at 200]. Plaintiff's application was initially denied by notice on April 10, 2012, and again upon reconsideration on May 16, 2012, after which Plaintiff requested a hearing before an administrative law judge ("ALJ"). Id. at 60, 73, 76-78. The ALJ conducted a hearing on June 13, 2013 ("Hearing"), and heard testimony from Plaintiff and Vocational Expert Sugi Kamarov ("Ms. Kamarov"). Id. at 27-28.
On September 18, 2014, Plaintiff filed his Complaint with this Court [Dkt. 1]. Plaintiff filed his Brief on June 10, 2015 [Dkt. 13]. On June 23, 2015, this case was assigned to the undersigned by consent of all Parties for further proceedings and entry of judgment [Dkt. 15]. On August 7, 2015, the Commissioner filed her Brief in Support of the Commissioner's Decision [Dkt. 16], and on August 11, 2015, the Administrative Record was received from the Social Security Administration ("SSA") [Dkt. 17].
Plaintiff was born on May 16, 1970, making him forty-three years of age at the time of the Commissioner's final decision [TR at 200]. Plaintiff completed the seventh grade. Id. at 242. Plaintiff's past relevant work experience includes a wire drawing machine tender, food production helper, fry cook, janitor, kitchen helper, and air-conditioning installer-servicer helper, window unit. Id. at 218-25. Plaintiff asserts that his onset date of disability is February 23, 2012. Id. at 200. Plaintiff has a criminal history, and has been incarcerated several times for drug-related offenses. Id. at 31-32, 279.
Plaintiff completed Functional Reports on each of March 21, 2012 and May 1, 2012 [TR at 226-32, 257-64]. Plaintiff's March Report reflects Plaintiff's complaints of frequent leg and hand pain and numbness causing difficulties with dressing, standing for long periods of time, sleep, and some personal care activities. Id. at 226-32. Plaintiff therein further indicates that he can maintain his own personal hygiene, completes household chores such as gardening when he is able, drives a vehicle occasionally, prepares some meals such as TV dinners and sandwiches, is able to go to the grocery store, and socializes with friends via telephone. Id. Plaintiff also indicated that his medications cause fatigue and dizziness and that he has mood swings, panic attacks, anxiety, flashbacks, and difficulties dealing with stress. Id.
Plaintiff's proffered medical records consist of reports from three different facilities: (1) Medical Center of McKinney ("MCMK" or collectively the "MCMK Records"); (2) Correctional Healthcare Management ("CHM" or collectively the "CHM Records"); and (3) PrimaCare Medical Centers ("PrimaCare" or the collectively the "PrimaCare Records") [TR 282-356]. The Administrative Record also contains two State Agency Assessments performed by Dr. Betty Santiago ("Dr. Santiago") and Dr. Frederick Cremona ("Dr. Cremona"). Id. at 302-05.
On April 23, 2006, Plaintiff was treated at MCMK. Id. at 341-45. The MCMK Records reflect that Plaintiff's outer extremities (feet, legs, hands, arms) were examined and found to have normal range of motion ("ROM") and no pedal edema (accumulation of fluid in the feet and lower legs). Id.
Records from CHM are also provided [TR at 283-89]. The earliest record, dated August 4, 2010, indicates that Plaintiff had been diagnosed with diabetes mellitus type II approximately eighteen years prior and prescribed a diabetic diet. Id. at 283-84. It was further noted on August 4, 2010, that Plaintiff was non-compliant with his diabetes medication and the foot exam performed reflected Plaintiff had "no edema. 2+ pedal pulses. [f]ull sensation." Id. Plaintiff also reportedly stated at that time that he had last seen a physician two years ago and did not feel he needed medication for his diabetes. Id. Subsequent CHM Records reflect two lab test refusals and appointment refusals on August 5, 2010, February 6, 2011, and May 5, 2011 respectively. Id. at 285-86, 288. CHM Records from February 21, 2011 and May 25, 2011 further reflect treatment for bilateral chronic otitis externa (inflammation of the ear) with ear pain, and that Plaintiff received antibiotic treatment and multiple surgeries for such condition in the past. Id. at 287, 289.
The PrimaCare Records generally reflect a diagnosis of diabetes mellitus type II, peripheral autonomic neuropathy, and elevated blood pressure reading without diagnosis of hypertension, and also reflect Plaintiff's subjective symptom reports of numbness, pain, and tingling in his legs, feet, and hands [TR at 291, 296-301, 309-14, 318-19, 347-53]. More specifically, on February 2, 2012, Plaintiff was seen for an initial diabetes treatment appointment. Id. at 291, 296-301. Plaintiff reported being out of medication for over one year. Id. A foot exam was performed on February 2, 2012, with normal results including 2+ pulses and normal sensory function. Id. The PrimaCare Records also include prescriptions for several diabetes medications and a glucometer and patient reports of numbness and tingling in both legs. Id.
In addition, as part of the SSI evaluation process, Dr. Santiago and Dr. Cremona each completed a case assessment based on their review of Plaintiff's medical records ("State Agency Assessments") [TR at 302-05]. Dr. Santiago noted medically determinable impairments of diabetes mellitus (DM) and peripheral neuropathy, but found them to be non-severe. Id. at 302. Dr. Santiago's assessment specifically referenced the February 12, 2012 PrimaCare Records which indicated that Plaintiff's foot and neurological exam and sensory examination were normal, and further commented that the field office claims representative had reported Plaintiff presented no physical difficulties during the interview. Id. Dr. Santiago concluded that Plaintiff's alleged subjective symptoms were not supported by the medical expert record. Id. Dr. Cremona's assessment, performed on May 15, 2012, indicated that no new allegations or treatment had occurred since Dr. Santiago's assessment. Id. at 304. Dr. Cremona noted that a field officer met with Plaintiff on April 8, 2012, and again noted no physical impairments. Id. Dr. Cremona found there was no indication of functional decline warranting changes to the prior functional assessment. Id.
At Hearing before the ALJ on June 13, 2013, Plaintiff testified that he was married at 14 years old and had been in and out of prison from approximately 1996 to 2007 [sic] for drugs [TR at 30-34]. Plaintiff reported living with his sister, who performs most of the cleaning and household chores. Id. at 33-34, 45-47. Plaintiff testified that he was terminated from several previous positions, including as a cook at Kentucky Fried Chicken and as a warehouse worker, for missing too much work due to alleged leg numbness. Id. at 35-43. Plaintiff testified he has been unable to afford treatment for his diabetes due to his erratic work history and criminal convictions, and has only seen a doctor once in a while. Id. Plaintiff further testified that he experiences leg numbness such that he cannot stand longer than ten minutes at a time, everything he holds in his hands he ends up dropping, and he has anger and other mental problems for which he has not sought treatment. Id. at 35-48. Additionally, Plaintiff explained that he has a chronic infection of the left ear, and that his diabetes medications cause fatigue. Id. Plaintiff reported that extreme heat aggravates his symptoms. Id.
Ms. Kamarov testified as a vocational expert at Hearing [TR at 49-53]. The ALJ asked Ms. Kamarov to describe Plaintiff's work history, which she classified into six positions: (1) wire drawing machine tender (medium, but as performed light exertion; semi-skilled; specific vocational preparation ("SVP") of 3); (2) food production helper (medium, but as performed light exertion; unskilled; SVP of 2); (3) janitor (heavy; unskilled; SVP of 2); (4) fry cook (medium; unskilled; SVP of 2); (5) kitchen helper (medium; SVP of 2); and (6) air-conditioning installer-servicer helper, window unit (heavy, but as performed light exertion; semi-skilled; SVP of 3). Id.
Pursuant to the statutory provisions governing disability determinations, the Commissioner has promulgated regulations that establish a five-step process to determine whether a claimant suffers from a disability. 20 C.F.R. § 404.1520. First, a claimant who is engaged in substantial gainful employment at the time of his disability claim is not disabled. 20 C.F.R. § 404.1520(b). Second, the claimant is not disabled if his alleged impairment is not severe, without consideration of his residual functional capacity, age, education, or work experience. 20 C.F.R. § 404.1520(c). Third, if the alleged impairment is severe, the claimant is considered disabled if his impairment corresponds to a listed impairment in 20 C.F.R., Part 404, Subpart P, Appendix 1. 20 C.F.R. § 404.1520(d). Fourth, a claimant with a severe impairment that does not correspond to a listed impairment is not considered to be disabled if he is capable of performing his past work. 20 C.F.R. § 404.1520(e). Finally, a claimant who cannot return to his past work is not disabled if he has the residual functional capacity to engage in work available in the national economy. 20 C.F.R. § 404.1520(f). Under the first four steps of the analysis, the burden lies with the claimant to prove disability and at the last step the burden shifts to the Commissioner. Leggett v. Chater, 67 F.3d 558, 564 (5th Cir. 1995). If at any step the Commissioner finds that the claimant is or is not disabled, the inquiry terminates. Id.
After hearing testimony and conducting a review of the facts of Plaintiff's case, the ALJ made the following sequential evaluation. At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity since February 28, 2012, the application date, and any work done after that date was not performed at a substantial gainful activity level [TR at 11]. At step two, the ALJ determined that Plaintiff had the severe impairments of diabetes and peripheral neuropathy, and such impairments were medically determinable. Id.
In an appeal under § 405(g), this Court must review the Commissioner's decision to determine whether there is substantial evidence in the record to support the Commissioner's factual findings and whether the Commissioner applied the proper legal standards in evaluating the evidence. Greenspan v. Shalala, 38 F.3d 232, 236 (5th Cir. 1994); 42 U.S.C. § 405(g). Substantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Cook v. Heckler, 750 F.2d 391, 392 (5th Cir. 1985); Jones v. Heckler, 702 F.2d 616, 620 (5th Cir. 1983). This Court cannot reweigh the evidence or substitute its judgment for that of the Commissioner. Bowling v. Shalala, 36 F.3d 431, 434 (5th Cir. 1995). Additionally, any conflicts in the evidence, including the medical evidence, are resolved by the ALJ, not the reviewing court. Carry v. Heckler, 750 F.2d 479, 484 (5th Cir. 1985).
The legal standard for determining disability under Titles II and XVI of the Act is whether the claimant is unable to perform substantial gainful activity for at least twelve months because of a medically determinable impairment. 42 U.S.C. §§ 423(d), 1382c(a)(3)(A); see also Cook, 750 F.2d at 393. "Substantial gainful activity" is determined by a five-step sequential evaluation process, as described above. 20 C.F.R. § 404.1520(a)(4).
Plaintiff raises one issue upon appeal: whether the ALJ's finding regarding residual functional capacity is supported by substantial evidence [Dkt. 13].
At step four of the sequential analysis, the ALJ found that Plaintiff had residual functional capacity to perform light work as defined in 20 C.F.R. § 416.967(b) in that he can lift and/or carry 20 pounds occasionally, lift and/or carry 10 pounds frequently, stand/walk for 6 hours in an 8-hour workday, and sit for 6 hours in an 8-hour workday [TR 12-16]. The ALJ further found Plaintiff should limit exposure to extreme temperatures. Id. Plaintiff argues that the ALJ did not take all of his limitations into account, and specifically failed to include his standing, walking, gripping, and handling limitations in the residual functional capacity finding [Dkt. 13 at 2-5]. For these reasons, Plaintiff asserts, the ALJ erroneously found that Plaintiff would be able to perform his past work as an air-conditioning installer-servicer helper, window unit. Id. The Commissioner argues, to the contrary, that the ALJ's residual functional capacity determination is supported by substantial medical evidence, and reflects that the ALJ properly weighed all relevant evidence, including Plaintiff's testimony which the ALJ found, in part, to not be credible [Dkt. 16 at 4-10].
A finding of no substantial evidence is appropriate only when no credible evidentiary choices or medical findings exist to support the decision. Hames v. Heckler, 707 F.2d 162, 164 (5th Cir. 1983). "Substantial evidence is more than a scintilla, less than a preponderance, and is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. It must do more than create a suspicion of the existence of the fact to be established, but no substantial evidence will be found only where there is a `conspicuous absence of credible choices' or `no contrary medical evidence.'" Id. (citing Hemphill v. Weinberger, 483 F.2d 1137 (5th Cir. 1973) and Payne v. Weinberger, 480 F.2d 1006 (5th Cir. 1973) (finding substantial evidence did not support the conclusion that plaintiff was not disabled where all evidence on the records reflected that plaintiff was disabled and no evidence on the record contradicted it)); see also Johnson v. Bowen, 864 F.2d 340, 343-44 (5th Cir. 1988) (finding that reports of four doctors that plaintiff was not disabled versus one report stating he was disabled was substantial evidence); Williams v. Comm'r of Soc. Sec. Admin., No. 4:11-CV-00373, 2013 WL 1282460, at *3 (E.D. Tex. Mar. 27, 2013). Plaintiff has the burden at step four of the analysis. Leggett, 67 F.3d at 564.
As an initial matter, the Court considers Plaintiff's argument that the ALJ did not take each of Plaintiff's alleged limitations into account [Dkt. 13 at 4-6]. The record reflects the ALJ considered Plaintiff's complaints of pain, numbness, and difficulties with standing for long periods, and ultimately found Plaintiff's subjective complaints regarding these limitations to not be credible and/or to be self-serving to the extent they are not compatible with the objective medical evidence in the record [TR at 12-16].
As part of the five-step sequential evaluation process, the ALJ acts as fact finder considering both objective evidence, such as medical records, and subjective evidence, such as a claimant's allegations regarding symptoms and pain. Salgado v. Astrue, 271 F. App'x 456, 458 (5th Cir. 2008); see also Griego v. Sullivan, 940 F.2d 942, 945 (5th Cir. 1991). In evaluating the claimant's subjective evidence and credibility, the ALJ is required to follow a two-step process. See Salgado, 271 F. App'x at 458; see also Titles II & XVI: Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual's Statements, SSR 96-7P (S.S.A. July 2, 1996). First, the ALJ must determine whether there is an impairment that reasonably produces the symptoms of which the claimant complains. Salgado, 271 F. App'x at 458; see also Stevenson v. Colvin, No. 1:11-cv-168, 2013 WL 1181456, at *3-4 (E.D. Tex. Mar. 20, 2013). If the ALJ finds no impairment, the claimant is not disabled. Salgado, 271 F. App'x at 458. If the ALJ identifies an impairment, the ALJ then considers the claimant's statements regarding his or her symptoms and the remaining evidence in the record to determine the strength of the symptoms and how the symptoms affect the claimant's ability to do basic work. Stevenson, 2013 WL 1181456, at *3. Furthermore, the ALJ must consider the claimant's subjective complaints and allegations regarding his or her capacity to do work, but may find that those complaints are not credible or are exaggerated in light of the medical evidence. See Wilson, 2014 WL 5343200, at *7.
The law requires that when an ALJ finds a claimant/plaintiff to be non-credible, the ALJ must articulate reasons for such determination. Abshire v. Bowen, 848 F.2d 638, 642 (5th Cir. 1988). To that end, the regulations provide a list of non-exclusive factors to be considered by the ALJ in evaluating the credibility of an individual's subjective complaints: (1) the plaintiff's daily activities; (2) the location, duration, frequency, and intensity of the pain and other symptoms; (3) factors that precipitate and aggravate symptoms; (4) the type, dosage, effectiveness, and side effects of any medication taken to alleviate pain or other symptoms; (5) treatment, other than medication, for relief of pain and other symptoms; (6) any other measures, other than treatment the claimant uses or has used to relieve pain or other symptoms; and (7) any other factors concerning the plaintiff's functional limitations and restrictions due to pain and other symptoms. 20 C.F.R. § 416.929(c)(3). An ALJ need not articulate a finding as to each factor; it is sufficient to state that the factors were considered. Prince v. Barnhart, 418 F.Supp.2d 863, 871 (E.D. Tex. 2005). In addition, while not an express factor, the ALJ may consider compliance or lackthereof with prescribed treatment. Griego, 940 F.2d at 945; Villa v. Sullivan, 895 F.2d 1019, 1024 (5th Cir. 1990) (finding lack of treatment may be considered as an indication of non-disability); Johnson, 864 F.2d at 348. The ALJ is also not bound to accept a plaintiff's self-serving statements, standing alone, as true; and the ALJ's determination with respect to a plaintiff's credibility is entitled to substantial deference by this Court. Johnson, 864 F.2d at 347 (citing James v. Bowen, 793 F.2d 702, 706 (5th Cir. 1986)) (finding ALJ's determination regarding plaintiff's credibility and subjective statements regarding his pain symptoms is entitled to substantial deference, including where medical evidence does not support plaintiff's allegations of pain); Teague v. Astrue, No. 4:07-CV-773-A, 2008 WL 5101717, at *3 (N.D. Tex. Dec. 1, 2008), aff'd, 342 F. App'x 962 (5th Cir. 2009) (finding the ALJ considered plaintiff's testimony regarding her self-described functional limitations, but rejecting such limitations based on the medical evidence which showed "an absence of objective factors indicating the existence of severe pain, such as limitations in the range of motion, muscular atrophy, weight loss. . . ."); Steimer v. Gardner, 395 F.2d 197, 198 (9th Cir. 1968) (finding the SSA not bound to accept Plaintiff's self-serving statements regarding her disability onset date as true where "the record is almost totally devoid of medical testimony that would bring [plaintiffs] case within the statute" by showing her disabilities existed prior to her date last insured).
Here, the ALJ made specific findings that Plaintiff had the impairments of diabetes and peripheral neuropathy, but found that Plaintiff's symptoms were less severe than indicated by his testimony and not supported by the objective medical records [TR at 11-16]. Importantly, the ALJ did not find Plaintiff's testimony to be wholly not credible, but rather not credible to the extent it was unsubstantiated by the medical evidence [see TR at 12-16]. Teague, 2008 WL 5101717, at *3 (finding ALJ could find plaintiff's pain allegations and limitations to be non-credible where there was "an absence of objective factors indicating the existence of severe pain"). The ALJ referenced the required credibility factors, and made findings that portions of Plaintiff's testimony were not credible because: (1) Plaintiff's daily activities, including maintaining his own personal hygiene, helping with yard work, going shopping, and driving a vehicle were inconsistent with Plaintiff's described severity of symptoms; (2) Plaintiff's diabetes appeared to be readily controlled with medication; (3) Plaintiff never sought treatment from a physician specialist or ongoing medical care consistent with his reported symptom severity, nor did Plaintiff's treating physicians order anything but routine, conservative treatment for diabetes; (4) the medical records reflected no evidence of recurrent hospitalization or emergent treatment for naturally occurring complications of diabetes or peripheral neuropathy, except complications after non-compliance with medical treatment; (5) there was significant evidence of non-compliance with medical treatment for Plaintiff's conditions, including emergent treatment for naturally occurring complications of Plaintiff's untreated conditions, such as ulcers; and (6) Plaintiff had limited treatment for his impairments, with significant gaps in treatment and medical appointments [TR 13-14] The ALJ also noted that the State Agency Assessments, although of lesser probative value, were consistent with the ALJ's residual functional capacity and credibility determinations. Id. The ALJ went on to find that Plaintiff's "statements concerning the intensity, persistence and limiting effects of [his symptoms] are not credible to the extent they are inconsistent with the residual functional capacity assessment [listed above]." Id.
Upon review of the ALJ's determination and the record, the Court finds that the ALJ conducted a detailed factual analysis, weighing Plaintiff's testimony regarding his impairments with the medical evidence in the record, and made findings under SSR 96-7P and the factors set forth in 20 C.F.R. § 416.929(c)(3). The ALJ's credibility determination was not merely conclusory, and is supported by the record before the ALJ. The ALJ thus appropriately declined to incorporate Plaintiff's claimed limitations because he properly found Plaintiff's statements to not be credible.
In addition, the Court now turns to the remaining record evidence. Again, Plaintiff has provided no evidence, besides his own testimony, to substantiate the limitations related to peripheral neuropathy [see generally TR at 30-48, 282-356]. The medical evidence in the record reflects normal hand and foot function (discussed infra). Further, Plaintiff has not shown that he could not perform the duties of his past position as an air-conditioning installer-servicer helper, window unit as he performed it [Dkt. 13; TR at 12-16].
However, as to the additional limitations Plaintiff asserts the ALJ should have included, related to standing, walking, gripping, and handling, these limitations relate not to Plaintiff's diabetes mellitus, but to Plaintiff's peripheral neuropathy impairment. [Dkt. 13 at 3-4; TR at 282-356]. The ALJ identifies that no physician has found Plaintiff's peripheral neuropathy physical symptoms to be severe enough to order additional diagnostic testing or recommend physical limitations [see generally TR at 282-356]. Indeed, the MCMK Records, the CHM Records, and the PrimaCare Records, reflecting foot and outer extremity examinations on Plaintiff, all indicate normal foot and hand function. Id. at 283-84, 291, 296-301, 309-14, 341-45. The State Agency Assessments reflect the same. Id. at 302-05.
Further, the ALJ notes that Plaintiff's medical treatment frequency and type of treatment received are inconsistent with the severe peripheral neuropathy symptomology and significant standing, walking, gripping, and handling limitations requested by Plaintiff [Dkt. 13 at 2-4]. The medical records reflect sporadic medical visits separated by months, and no hospitalizations or emergent treatment related to Plaintiff's peripheral neuropathy [TR at 282-356]. For example, the PrimaCare Records from 2012 and 2013 indicate three month, eight month, and two month gaps, respectively, between appointments. Id. at 291, 296-301, 309-14, 318-19, 347-51. Emergent treatment of Plaintiff, where it did occur, was unrelated to Plaintiff's diabetes and peripheral neuropathy (e.g. the flu and ear infections) and/or was accompanied by reports of non-compliance with prescribed treatment or was a natural complication resulting from non-compliance (e.g. ulcers and scales). Id. at 287, 289 (inflammation of the ear), 318-19 (flu), 341-45 (ulcer of the neck), 347-51 (ear pain and fatigue), 352-53 (ulcers and scales of the feet). The frequent reports of non-compliance with treatment raise a presumption that Plaintiff's symptoms are less severe than reported by Plaintiff and/or can be controlled by treatment. Id. at 283-89, 291, 296-301, 309-14, 341-45; Villa, 895 F.2d at 1024 (finding non-compliance with treatment, or lack of treatment indicative of absence of disability). Additionally, the MCMK Records, CHM Records, and PrimaCare Records reflect only two types of treatment related to Plaintiff's diabetes and peripheral neuropathy: (1) medication; and (2) treatment of natural complications arising from diabetes (e.g. ulcers) [TR at 282-356]. Plaintiff never found his symptoms severe enough to seek treatment from a diabetes specialist such as an endocrinologist, although one was recommended. Id. at 309-14. Plaintiff also did not find his symptoms to be of a severity level to request more regular care appointments or to seek emergency room or urgent care treatment for emergent symptoms. See id. at 282-356. Generally, Plaintiff's medical history reflects routine medication treatment for type II diabetes with no unusual treatments or severe symptoms. Id. Plaintiff's diabetes and/or peripheral neuropathy do not give rise to residual functional limitations, if they can be controlled by routine medication or other treatment. Johnson, 864 F.2d at 348 (finding that plaintiff's depression was not an impairment and thus not disabling because it could be controlled by medication). Plaintiff's self-reported daily activities also reflect Plaintiff is able to complete routine personal hygiene and household tasks such as gardening and grocery shopping [TR at 30-34, 45-47, 226-32, 257-64]. Thus, Plaintiff's medical history and daily activities are inconsistent with the additional functional limitations requested and do not support the severe symptoms Plaintiff argues exist. Id. at 30-48, 226-32, 257-64, 282-356.
The Court acknowledges Plaintiff's argument that the lack of medical evidence (such as frequent medical appointments and extensive treatment) supporting severity of Plaintiff's symptoms is due to and/or is the result of Plaintiff's difficulties affording treatment and lack of insurance, and does not reflect the true severity of Plaintiff's symptoms [Dkt. 13 at 4-5; TR at 12-16, 32, 42-48]. However, the ALJ's determination specifically addressed Plaintiff's alleged lack of financial means, and found that it was unsubstantiated by documentation reflecting inability to pay or efforts to seek financial assistance for medical treatment or low cost care [TR at 12-14; see generally TR at 282-356]. Villa, 895 F.2d at 1024 (finding lack of treatment can be considered in the disability analysis particularly where the only evidence of severity of an impairment is the plaintiff's testimony).
The Court therefore finds that there is substantial evidence in the record to support the ALJ's residual functional capacity determination, including all limitations incorporated and/or excluded. Hames, 707 F.2d at 164. There is a lack of substantial evidence, other than Plaintiff's own testimony, to support any additional residual functional capacity limitations. Id.
The Court concludes that the Appeals Council did not err in upholding the ALJ's decision that Plaintiff is not disabled. Pursuant to the foregoing, the decision of the Commissioner is
20 C.F.R. § 404.1567.