Lauren Horowitz v. Commissioner of Social Securit

Filing

Opinion issued by court as to Appellant Lauren J. Horowitz. Decision: Affirmed. Opinion type: Non-Published. Opinion method: Per Curiam. The opinion is also available through the Court's Opinions page at this link http://www.ca11.uscourts.gov/opinions.

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[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 16-11837
Non-Argument Calendar
________________________
D.C. Docket No. 9:14-cv-81398-BB

LAUREN J. HOROWITZ,
Plaintiff - Appellant,
versus
COMMISSIONER OF SOCIAL SECURITY,
Defendant - Appellee.
________________________
Appeal from the United States District Court
for the Southern District of Florida
________________________
(June 5, 2017)

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Before TJOFLAT, WILLIAM PRYOR and JILL PRYOR, Circuit Judges.
PER CURIAM:
Lauren Horowitz appeals the district court’s order affirming the
Commissioner of Social Security’s decision denying her application for disability
insurance benefits. On appeal, she argues that the Commissioner’s denial of
benefits was erroneous because the administrative law judge (“ALJ”) improperly
assigned little weight to the opinions of her treating psychologist and determined
that her testimony about the intensity, persistence, and limiting effect of her
symptoms was not credible. She also argues that the Appeals Council improperly
denied review and refused to consider additional evidence that she submitted for
the first time to the Appeals Council. After careful consideration, we affirm the
district court’s judgment in favor of the Commissioner.
I.

FACTUAL BACKGROUND

Horowitz filed for disability benefits, alleging that she became disabled as of
December 2011, on the basis that she suffered from numerous mental and physical
impairments, including post-traumatic stress disorder, depression, obsessive
compulsive disorder, anxiety, and fibromyalgia. She requested and received a
hearing before an ALJ.

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A.

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The ALJ Hearing
At the hearing, Horowitz testified that she was no longer able to work

because of her physical and mental impairments. With respect to her physical
condition, she testified that she suffered from fibromyalgia. She described how
she experienced pain throughout her body including in her jaw, neck, back, and
shoulders. She also testified that she was further injured when she was abducted
and held hostage for two months. She claimed that her right leg was injured in the
abduction and that as a result she needed a cane to walk. She also stated that she
suffered from other physical ailments including migraines, hyperhidrosis
(excessive sweating), and irritable bowel syndrome. She also testified that she was
unable to sleep, had restless sleep, or experienced too much sleep. With respect to
her mental condition, she asserted that her depression left her unable to leave her
home. She also explained that she had trouble concentrating and remembering
things and heard noises other people could not hear.
Horowitz described how her injuries impacted her daily life. She explained
that she spent most days in bed watching television. Several days a week, she was
unable to get out of bed because of the pain, and about two days a week she was
unable to walk. She testified that she bathed infrequently, ate only frozen food to
avoid cooking, depended on family to do her laundry, and was unable to do chores
around her house. Horowitz stated that her only hobby was playing with her cat.
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She further claimed that as a result of her injuries she could lift no more than five
pounds, stand for only ten minutes at a time, and sit for only ten minutes at a time.
Horowitz also presented medical evidence to the ALJ. The medical records
about her physical condition reflected that she had suffered from fibromyalgia and
pain since 2005, as well as hyperhidrosis. Horowitz claimed that she was disabled
as of December 2011, but the medical evidence reflected that she received no
treatment for her physical injuries from December 2011 until September 2013.
There were records of medical examinations by non-treating physicians during this
time who examined Horowitz to determine whether she was disabled.
One of these examinations was performed by Dr. Nader Daryace in
December 2012. Dr. Daryace noted that Horowitz was complaining of pain in her
neck and lower back but experienced no weakness or numbness. Horowitz told Dr.
Daryace that she was able to do her own grocery shopping, cooking, cleaning,
laundry, and gardening. Dr. Daryace’s examination showed that Horowitz had a
full range of motion except in her cervical spine, a normal gait, normal reflexes,
and 5/5 grip strength.
About three months later, Dr. Steven Kanner examined Horowitz in
connection with her disability application. Dr. Kanner noted that Horowitz
reported that she suffered from arthritis and was in pain all the time. She
complained about neck and back pain, claiming that her back pain sometimes
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radiated down her right leg. Horowitz further reported that she could only sit or
stand for 15 minutes before the pain worsened. In his examination, Dr. Kanner
observed that Horowitz had multiple tender trigger points and a decreased range of
motion of her cervical and thoracolumbar spine. After observing that she had no
motor reflex deficits and ambulated easily and without assistive devices, he opined
that she could sit, stand, and walk without difficulty. He further noted that she had
extensive psychiatric issues.
Several months later, in September 2013, Horowitz was treated by Dr.
Howard Busch, a rheumatologist. Horowitz was referred to Dr. Busch by another
physician for evaluation of her pain. Dr. Busch’s notes show that Horowitz
complained to him about pain in her joints and neck as well as leg cramps and
achiness. Dr. Busch noted that he believed that her problems were not caused by
arthritis and that her sleep disturbances were contributing to her pain and fatigue.
He indicated that further investigation was required to differentiate or demonstrate
illness. Dr. Busch recommended that Horowitz undergo several laboratory tests.
He also prescribed medication for Horowitz’s pain and to help her sleep.
About a month later, Horowitz returned to Dr. Busch for a follow-up visit.
He noted that her laboratory test came back essentially normal. Because she
continued to experience pain, he prescribed her a narcotic and additional
medication to help her sleep. Although Dr. Busch recommended that Horowitz
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return for a follow up appointment in a few weeks, there are no other medical
records reflecting treatment from Dr. Busch.
With regard to her mental condition, Horowitz presented medical records for
treatment she received from the Jerome Golden Center for Behavior Health. These
records show that Dr. Sultana, a psychiatrist, treated her in five appointments over
the course of five months. Dr. Sultana diagnosed Horowitz with post-traumatic
stress disorder, a mood disorder, opioid disorder, and benzodiazepine dependence.
Dr. Sultana’s records reflect that each appointment was for medication
management and lasted only 15 minutes. Dr. Sultana’s treatment notes reflect that
Horowitz reported experiencing anxiety, anger, flashbacks, and nightmares and
that she was pulling out her eyelashes. Her notes also indicated that after a few
appointments Horowitz’s affect and mood improved.
While treating Horowitz, Dr. Sultana completed a Treating Source Mental
Status Report. In the report, Dr. Sultana described Horowitz as having a depressed
mood and affect but found that her thought process was goal-directed; her
concentration was fair; and she was oriented to time, place, and persons. But at the
end of the report, Dr. Sultana opined that Horowitz’s memory and concertation
was impaired. She also stated that Horowitz was incapable of sustaining work
activity for eight hours a day. Although the report asked Dr. Sultana to provided

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examples of behavioral objective data that supported her opinion, she cited no such
data.
Other records from the Jerome Golden Center show that after Horowitz
completed five appointments with Dr. Sultana, she had three other medication
management appointments with other providers. Horowitz went several months
between these appointments.
Other evidence before the ALJ about Horowitz’s mental health status came
from a mini-mental status exam that Dr. Daryace performed when he examined
her. He reported that Horowitz was alert and oriented; that she had intact cognitive
functions, good judgment and insight, and a logical thought process; that she could
recall five of five objects after 20 minutes; and that she could perform two-step
instructions without difficulties. In addition, two other state agency psychologists
who reviewed Horowitz’s records (but neither treated nor examined her) opined
that based on their review Horowitz could understand, remember, and carry out
simple tasks; relate adequately to co-workers and supervisors; and adapt to simple
changes and avoid hazards in a routine work environment.
B.

The ALJ’s Decision
After the hearing, the ALJ denied Horowitz’s application for benefits. The

ALJ concluded that Horowitz was not engaged in substantial gainful activity and
had severe impairments including lumbar and cervical spine disorder, chronic pain
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syndrome, fibromyalgia, myofascitis, post-traumatic stress disorder, and mood
disorder. But the ALJ found that Horowitz’s impairments did not meet or
medically equal the severity of a listed impairment.
The ALJ then found that Horowitz had the residual functional capacity to
stand or walk for six hours a day, sit for six hours a day, lift or carry and push or
pull up to 20 pounds occasionally and up to ten pounds frequently. The ALJ
further concluded that Horowitz could understand, remember, and carry out simple
tasks and job instructions; sustain concentration and persistence for two-hour
periods; and have brief, superficial interactions with supervisors, coworkers, and
the general public.
The ALJ found that Horowitz’s testimony about her symptoms was not
credible. Although Horowitz’s symptoms could reasonably be expected to produce
her pain or other symptoms, the ALJ found that her testimony about the intensity,
persistence, and limiting effects of her symptoms was not entirely credible. With
respect to her physical impairments, the ALJ found that the record did not support
that Horowitz’s physical injuries were as disabling as she claimed. The ALJ noted
that the examinations of Horowitz did not reveal ineffective ambulation, abnormal
gait, significant decreases in her range of motion, or reflex abnormalities. The ALJ
also emphasized that Horowitz’s examinations included no recommendations of
invasive treatment.
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Similarly, the ALJ found that Horowitz’s mental limitations were not as
disabling as she alleged. The ALJ pointed out that Dr. Sultana’s treatment notes
showed that after a few appointments, Horowitz’s affect and mood had improved.
The ALJ noted that despite claiming disabling mental symptoms, Horowitz’s
mental status exams were conservative in nature, reflecting that although there
were some deficits, she had a goal-oriented thought process, appropriate
orientation, and fair memory. The ALJ also noted that a consulting exam, which
included a mini-mental status exam, showed that Horowitz had good judgment and
insight, a functioning memory, and the ability to follow two-step directions. 1 The
ALJ also relied on the fact that Horowitz’s appointments had not become more
frequent over time due to increasing symptoms, changes in medication, changes in
clinical signs, or test results.2 Given the limited treatment that Horowitz received
for both her physical and mental impairments, the ALJ noted that she had not
generally received the type of medical treatment that one would expect for a totally
disabled individual.
The ALJ also addressed the weight it should assign to the providers’
opinions assessing Horowitz’s residual functional capacity. The ALJ generally
gave controlling weight to the assessments of Horowitz’s treating doctors but gave
1

Although the ALJ stated that Dr. Kammer performed this examination, the record
clearly reflects that Dr. Daryace performed it.
2

The ALJ also found that Horowitz’s credibility was further reduced because she
received unemployment benefits during the relevant period of disability.
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little weight to Dr. Sultana’s opinions. The ALJ explained that Dr. Sultana’s
opinions were not consistent with the record as a whole or the objective medical
evidence in the file revealing Horowitz’s conservative mental status exam findings.
Given Horowitz’s residual functional capacity, the ALJ found that Horowitz
was unable to continue her past relevant work as a sales clerk. But the ALJ found
that given Horowitz’s residual functional capacity she could work as a laundry
worker or mail clerk. Because there were a significant number of jobs in the
national economy that she could perform, the ALJ found that Horowitz was not
disabled.
C.

The Appeals Council’s Review
Horowitz sought review of the ALJ’s decision from the Appeals Council.

She submitted additional evidence to the Appeals Council, including two
questionnaires completed by Dr. Busch, her treating rheumatologist. Dr. Busch
completed the questionnaires approximately three months after the ALJ rendered
her decision but gave no indication whether his opinion was based on his two
previous appointments, which occurred more than nine months earlier, or a
subsequent appointment that occurred after the ALJ rendered her decision.
In these questionnaires, Dr. Busch opined that Horowitz was unable to work.
In the first questionnaire, Dr. Busch stated that Horowitz could lift or carry no
more than 5 pounds, could stand or walk for zero hours a day, and could sit for
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zero hours a day. He further explained that she could never climb, balance, stop,
crouch, kneel, or crawl. Although the questionnaire asked Dr. Busch to identify
the medical findings that support his opinions, he provided no such medical
findings.
In the second questionnaire, which focused on fibromyalgia, Dr. Busch
opined that Horowitz could not work. He explained that she had issues with
chronic pain and that she was on chronic pain medications. He indicated that
Horowitz’s pain has lasted for three or more months and the pain was located in 11
or more pressure points. He explained that she also had stiffness, irritable bowel
syndrome, tension headaches, paresthesias, sleep disturbance, chronic fatigue,
memory loss, and inability to ambulate effectively.
The Appeals Council denied Horowitz’s request to review the ALJ’s
decision. The Appeals Council explained that it had not considered Dr. Busch’s
questionnaires because they concerned a later time period.
D.

District Court Proceedings
Horowitz then filed an action in federal district court, asking the court to

reverse the Commissioner’s decision. After briefing, the magistrate judge prepared
a report and recommendation that the district court affirm the Commissioner’s
decision. Horowitz objected. The district court overruled Horowitz’s objections,

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adopted the magistrate judge’s recommendation, and affirmed the Commissioner’s
decision. Horowitz has appealed that decision.
II.

STANDARD OF REVIEW

We review the Commissioner’s decision to determine if it is supported by
substantial evidence, but we review de novo the legal principles upon which the
decision is based. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005).
“Even if we find that the evidence preponderates against the [] decision, we must
affirm if the decision is supported by substantial evidence.” Barnes v. Sullivan,
932 F.2d 1356, 1358 (11th Cir. 1991). Substantial evidence refers to “such
relevant evidence as a reasonable person would accept as adequate to support a
conclusion.” Moore, 405 F.3d at 1211. Our limited review precludes us from
“deciding the facts anew, making credibility determinations, or re-weighing the
evidence.” Id.
Furthermore, we review the Appeals Council’s decision not to consider
additional evidence that Horowitz submitted de novo. Washington v. Soc. Sec.
Admin., Comm’r, 806 F.3d 1317, 1321 (11th Cir. 2015).
III.

LEGAL ANALYSIS

An individual claiming disability benefits must prove that she is disabled.
42 U.S.C. § 423(a)(1)(E). To determine whether a claimant is “disabled,” the ALJ
applies a sequential process and examines whether the claimant: (1) is engaging in
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substantial gainful activity; (2) has a severe and medically determinable
impairment; (3) has an impairment or combination of impairments that satisfies the
criteria of a “listing”; (4) can perform her past relevant work in light of her residual
functional capacity; and (5) can adjust to other work in light of her residual
functional capacity, age, education, and work experience. 20 C.F.R.
§ 404.1520(a)(4).
On appeal, Horowitz asserts that the ALJ erred in analyzing her residual
functional capacity because the ALJ failed to give proper weight to the opinion of
her treating psychologist, Dr. Sultana, and improperly discounted her testimony
regarding her pain and other symptoms. She also argues that the Appeals Council
erred when it refused to consider the additional materials from Dr. Busch. We
consider these arguments in turn.
A.

The ALJ Did Not Err in Giving Little Weight to Dr. Sultana’s Opinion.
Horowitz first contends that the ALJ erred in determining her residual

functional capacity by giving little weight to the opinion of her treating
psychiatrist, Dr. Sultana. We disagree.
The ALJ must give a treating physician’s opinion “substantial or
considerable weight unless good cause is shown to the contrary.” Phillips v.
Barnhart, 357 F.3d 1232, 1240 (11th Cir. 2004) (internal quotation marks
omitted); see 20 C.F.R. § 404.1527(c)(2). Good cause exists when: (1) the opinion
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“was not bolstered by the evidence,” (2) the “evidence supported a contrary
finding,” or (3) the “treating physician’s opinion was conclusory or inconsistent
with the doctor’s own medical records.” Phillips, 357 F.3d at 1240-41. We have
explained that “[t]he ALJ must clearly articulate the reasons for giving less weight
to the opinion of a treating physician, and the failure to do so is reversible error.”
Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997). But if an ALJ articulates
specific reasons for declining to give the opinion of a treating physician controlling
weight, and those reasons are supported by substantial evidence, there is no
reversible error. Moore, 405 F.3d at 1212.
Horowitz contends that the ALJ erred in failing to give Dr. Sultana’s
opinions substantial or considerable weight. But the ALJ explained that Dr.
Sultana’s opinions were not entitled to controlling weight because they were
inconsistent with the record as a whole or the objective medical evidence in the
record. Substantial evidence supports the conclusion. Although Dr. Sultana
opined that Horowitz’s mental impairments left her unable to work, the record
reflects that Dr. Sultana provided conservative mental health treatment, which
consisted only of 15-minute medication management appointments. The
conservative and routine nature of this treatment plan suggests that Horowitz’s
impairments—while significant—were not so severe that she could not perform
any job duties. See Wolfe v. Chater, 86 F.3d 1072, 1078 (11th Cir. 1996)
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(recognizing that a physician’s conservative medical treatment for a particular
condition may negate a claim of disability). 3
Dr. Sultana’s opinion that Horowitz’s concentration was impaired was
contradicted by the medical evidence in the record. First, it was contradicted by
Dr. Sultanta’s own records, which indicated that Horowitz’s concentration was fair
with no noted impairments. In addition, the opinion was contradicted by Dr.
Daryace’s mini-mental status exam, which showed that Horowitz’s memory was
intact. Viewing this evidence together, we conclude that the ALJ’s conclusion
that Dr. Sultana’s opinions were contradicted by other evidence is supported by
substantial evidence.
We also observe that the ALJ could have disregarded Dr. Sultana’s opinions
on the basis that they were wholly conclusory. Although Dr. Sultana opined that
Horowitz was unable to work and that her concertation was impaired, Dr. Sultana
gave no explanation to support these opinions, even though the form that Dr.

3

We pause to note that if a claimant failed to seek treatment altogether or comply with a
course of treatment prescribed by a provider, an ALJ may not rely on the lack of treatment or
noncompliance to conclude that claimant was not disabled. An ALJ is prohibited from drawing
“any inferences about an individual’s symptoms and their functional effects from a failure to
seek or pursue regular medical treatment without first considering any explanations that the
individual may provide.” Social Security Regulation 96-7p (SSR 96-7) at 7; see Henry v.
Comm’r of Soc. Sec., 802 F.3d 1264, 1268 (11th Cir. 2015). As such, an ALJ must consider
evidence showing that the claimant is unable to afford medical care before denying benefits
based upon the claimant’s non-compliance with prescribed care. See Ellison v. Barnhart, 355
F.3d 1272, 1275 (11th Cir. 2003). But the ALJ could consider that while treating Horowitz, Dr.
Sultana did not recommend a more frequent or intense treatment plan than monthly medication
management appointments.
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Sultana used asked her to provide behavioral objective data that supported them.
After careful consideration, we simply cannot say that the ALJ erred in assigning
little weight to Dr. Sultana’s opinions. 4
B.

The ALJ Did Not Err in Determining that Horowitz Was Not Credible.
We must next consider whether the ALJ erred in finding that Horwitz’s

subjective complaints about the intensity, persistence, and limiting effects of her
symptoms were not credible. Horowitz testified before the ALJ about her physical
and emotional impairments. She described the pain that she experienced as a result
of her fibromyalgia and how her depression left her unable to leave her house most
days. She also explained that she walked with a cane because of injuries she
suffered to her right leg when she was abducted. Although Horowitz asserts that
the ALJ erred by rejecting her subjective description of her symptoms, given our
deferential standard of review, we discern no error.
When a claimant attempts to establish a disability through her own
testimony concerning pain or other subjective symptoms, we require “(1) evidence
of an underlying medical condition; and (2) either (a) objective medical evidence
confirming the severity of the alleged pain; or (b) that the objectively determined
4

Horowitz also argues that the case should be remanded to the ALJ because it is
impossible to determine from the ALJ’s opinion whether she assigned significant weight or little
weight to Dr. Sultana’s opinions. Certainly, remand is required if we are “unable to determine
whether the ALJ . . . gave the treating [source’s] evidence substantial or considerable weight or
found no good cause to do so.” Wiggins v. Schweiker, 679 F.2d 1387, 1390 (11th Cir. 1982).
But because we can discern that the ALJ gave Dr. Sultana’s opinion little weight, no remand is
required.
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medical condition can reasonably be expected to give rise to the claimed pain.”
Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002). If the record shows that
the claimant has a medically determinable impairment that could reasonably be
expected to produce her symptoms, the ALJ must evaluate the intensity and
persistence of the symptoms to determine how they limit the claimant’s capacity
for work. 20 C.F.R. § 404.1529(c)(1). In assessing the claimant’s credibility about
her symptoms and their effects, the ALJ will consider in addition to the objective
medical evidence: the individual’s daily activities; the location, duration,
frequency, and intensity of the individual’s symptoms; precipitating and
aggravating factors; the type, dosage, effectiveness, and side effects of medication
taken to relieve the symptoms; treatment, other than medication, for the symptoms;
any other measure used to relieve the symptoms; and any other factors concerning
functional limitations and restrictions due to the symptoms. Id. § 404.1529(c)(3).
We have recognized that unique issues arise when a claimant suffers from
fibromyalgia. Fibromyalgia “often lacks medical or laboratory signs, and is
generally diagnosed mostly on a[n] individual’s described symptoms.” Moore,
405 F.3d at 1211. Because the “hallmark” of fibromyalgia is a “lack of objective
evidence,” a claimant’s subjective complaints may be the only means of
determining the severity of the claimant’s condition and the functional limitations
she experiences. Id. This Court will reverse an ALJ’s determination that a
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fibromyalgia claimant’s testimony was incredible where the lack of objective
findings provided the basis for the adverse credibility determination. Id.
Here, the ALJ found that because Horowitz’s subjective complaints were
inconsistent with the medical evidence in this case, her testimony was not credible.
The ALJ pointed out that Horowitz’s physical examinations showed no ineffective
ambulation, abnormal gait, significant decrease in range of motion, sensory
changes, reflex abnormalities, or deficiencies in positive straight leg raises.
Horowitz argues that because her conditions were caused by fibromyalgia, the ALJ
could not rely on the lack of objective evidence to make an adverse credibility
determination. The flaw in Horowitz’s argument is that she testified that at least
some of her physical impairments, such as the injuries to her right leg that required
her to walk with a cane, were the result of injuries she suffered when she was the
victim of a violent crime. As such, it was appropriate for the ALJ to consider
whether there was objective evidence corroborating this injury. And because there
are no objective findings—such as evidence that she had ineffective ambulation or
abnormal gait—to corroborate her account about the symptoms and pain in her
right leg, substantial evidence supported the ALJ’s credibility determination.
The ALJ’s credibility determination is supported by substantial evidence for
a second reason as well: Horowitz received conservative treatment for her
impairments. ALJs are permitted to consider the type of a treatment a claimant
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received in assessing the credibility of her subjective complaints. 20 C.F.R.
§ 405.1529(c)(3)(iv), (v); see Wolfe, 86 F.3d at 1078. As we explained above, for
Horowitz’s mental impairments, her treatment plan was conservative in nature and
essentially limited to short medication management appointments. Similarly, for
her physical impairments, Dr. Busch provided conservative treatment for
Horowitz’s pain and never indicated that she should have been receiving more or
different treatments. In light of this evidence, we conclude that the ALJ’s adverse
credibility determination was appropriate.
C.

The Appeals Council Did Not Err in Refusing to Consider Horowitz’s
Additional Evidence.
Horowitz argues that the Appeals Council erred in refusing to consider the

additional evidence that she submitted from Dr. Busch. “[T]he Appeals Council
must consider new, material, and chronologically relevant evidence that the
claimant submits. Washington, 806 F.3d at 1320 (internal quotation marks
omitted). We have explained that evidence is chronologically relevant when it
relates to the period or on before the date of the ALJ’s decision. Id. at 1322. An
examination conducted after the ALJ’s decision may still be chronologically
relevant if it relates back to the period before the ALJ’s decision. Id.
Here, the Appeals Council appropriately determined that Dr. Busch’s
opinions were not chronologically relevant. Dr. Busch issued his opinions after the
ALJ rendered her decision. Nonetheless, Horowitz argues that Dr. Busch’s
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opinions are chronologically relevant because they were based on care that Dr.
Busch provided before the ALJ rendered her decision. The problem for Horowitz
is that there is nothing in Dr. Busch’s opinions showing that he based them on
treatment provided to Horowitz before the ALJ’s decision.
Horowitz asserts that our opinion in Washington shows that Dr. Busch’s
opinions are chronologically relevant. But in Washington, we held that the opinion
of a psychologist who examined the claimant after the ALJ’s decision was
chronologically relevant when the psychologist stated in his opinion that his
conclusions were based on, among other things, his review of the medical records
from the period before the ALJ’s decision. See 806 F.3d at 1322. Dr. Busch’s
opinions fail to show directly or indirectly that he based his opinion on medical
records from the time period before the ALJ’s decision, making Washington
inapplicable here. Dr. Busch’s opinions were not chronologically relevant; we thus
hold that the Appeals Council properly refused to consider them.
IV.

CONCLUSION

For the reasons set forth above, we affirm the Commissioner’s decision to
deny Horowitz benefits.
AFFIRMED.

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