CAMPBELL v. KIJAKAZI

Filing 22

MEMORANDUM AND/OR OPINION. SIGNED BY MAGISTRATE JUDGE CRAIG M. STRAW ON 3/26/24. 3/26/24 ENTERED AND COPIES E-MAILED. (mbh)

IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF PENNSYLVANIA
LACOYIA MARIE CAMPBELL,
v.
MARTIN O’MALLEY

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CIVIL ACTION

No. 21-cv-4166

MEMORANDUM OPINION
CRAIG M. STRAW
United States Magistrate Judge

March 26, 2024

Lacoyia Marie Campbell seeks review of the Commissioner’s decision denying her
applications for Supplemental Social Security (SSI) and Disability Insurance Benefits (DIB).
Doc. 10, at 1. The matter was referred to me 1 on consent of the parties. 2 For the following
reasons, I deny Campbell’s request for review and affirm the Commissioner’s decision.
I.

PROCEDURAL HISTORY
On August 8, 2019, Campbell filed applications for DIB and SSI benefits under Titles II

and XVI of the Social Security Act. R.17; 228; 235. In both applications, Campbell alleged she
became disabled on September 24, 2017. R.17; 285. These claims were denied initially on
January 16, 2020, and then again on reconsideration on August 3, 2020. R. 17; 135-39; 144.
Campbell filed a written request for a hearing. R. 17; 151-52. Due to the COVID-19 Pandemic,
the Administrative Law Judge (ALJ) held a telephone hearing on December 17, 2020. R. 17; 44;
221-22. Campbell was represented by counsel. R. 45. At the hearing, counsel moved to amend

1

I was reassigned the case from Magistrate Judge David R. Strawbridge on July 27, 2023. Doc.
18.
2
See Doc. 20; 8 U.S.C. § 636(c) & Rule 73, Fed. R. Civ. P.

the alleged onset date to July 25, 2019, and the motion was granted. R. 49-52. Vocational
Expert (VE) Daniel Rappucci testified at the hearing. R. 17; 44.
The ALJ issued a written decision denying benefits on January 21, 2021. R. 36.
Campbell filed a request for review of the ALJ’s decision, which was denied. R. 1-3; 13; 22325. Thus, the ALJ’s decision became the final decision of the Commissioner of Social Security.
R. 1-3; 20 C.F.R. §§ 404.981, 416.1481. Campbell’s counsel then brought this action in federal
court. Doc. 1. Campbell filed a Brief and Statement of Issues in Support of Request for Review.
Doc. 10. Defendant filed a Response to Request for Review of Plaintiff. Doc. 11. Campbell
filed a Reply Brief in Support of Request for Judicial Review. Doc. 17.
II.

LEGAL STANDARDS
To prove disability, a claimant must demonstrate an “inability to engage in any

substantial gainful activity by reason of any medically determinable physical or mental
impairment . . . 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). The Commissioner employs a five-step sequential
process to determine if a claimant is disabled, evaluating:
1.

Whether the claimant is currently engaged in substantial gainful activity;

2.

If not, whether the claimant has a “severe impairment” that significantly
limits their physical or mental ability to perform basic work activities;

3.

If so, whether based on the medical evidence, the impairment meets
or equals the criteria of an impairment listed in the listing of
impairments (“Listings,” see 20 C.F.R. pt. 404, subpt. P, app. 1), which
results in a presumption of disability;

4.

If the impairment does not meet or equal the criteria for a listed
impairment, whether, despite the severe impairment, the claimant has the
Residual Functional Capacity (RFC) to perform their past work; and
2

5.

If the claimant cannot perform their past work, whether there is other work
in the national economy that the claimant can perform.

See Zirnsak v. Colvin, 777 F.3d 607, 611 (3d Cir. 2014); see also 20 C.F.R. §§ 404.1520(a)(4),
416.920(a)(4). Plaintiff bears the burden of proof at steps one through four, while the burden
shifts to the Commissioner at the fifth step to establish that the claimant can perform other jobs
in the local and national economies in light of their age, education, work experience, and RFC.
See Poulos v. Comm’r of Soc. Sec., 474 F.3d 88, 92 (3d Cir. 2007) (citation omitted).
The court’s role on judicial review is to determine whether the Commissioner’s decision
is supported by substantial evidence. See 42 U.S.C. § 405(g); Schaudeck v. Comm’r of Soc.
Sec., 181 F.3d 429, 431 (3d Cir. 1999). “Substantial evidence is ‘such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion,’” and must be “more than a
mere scintilla but may be somewhat less than a preponderance of the evidence.” Zirnsak, 777
F.3d at 610 (quoting Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005)); see also Biestek
v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (explaining substantial evidence “means only – ‘such
relevant evidence as a reasonable mind might accept as adequate to support a conclusion’”)
(quoting Consol. Edison Co. v. NLRB, 305 U.S. 197, 229 (1938) (additional citations omitted)).
It is a deferential standard of review. Jones v. Barnhart, 364 F.3d 501, 503 (3d Cir. 2004) (citing
Schaudeck, 181 F.3d at 431).
III.

ALJ’S DECISION AND PLAINTIFF’S REQUEST FOR REVIEW
The ALJ determined that Campbell had not engaged in substantial gainful activity since

July 25, 2019. R.19. The ALJ found that Campbell had several severe impairments including
syncope, anxiety, panic disorder, and depression. R. 20; see also 20 C.F.R. §§ 404.1520(c),
416.920(c). These impairments or combination of impairments did not, however, meet or
3

medically equal the severity of one of the Listings. R. 20-21; 20 C.F.R. pt. 404, subpt. P, app. 1;
see also 20 C.F.R. §§ 416.920(d), 416.925, & 416.926. When evaluating Campbell’s mental
impairments pursuant to the “paragraph B” criteria, the ALJ found that Campbell had mild
limitations interacting with others and understanding, remembering, or applying information. R.
22. Campbell had moderate limitations concentrating, persisting, or maintaining pace and
adapting or managing herself. R. 22-23. Consequently, the ALJ determined that Campbell’s
mental impairments did not satisfy the “paragraph B” criteria. 3 R. 23. The ALJ also found that
the evidence failed to establish the presence of the “paragraph C” criteria. 4 Id.
Considering the entire record, the ALJ found that Campbell had the RFC to perform a full
range of work at all exertional levels. R. 24. The ALJ, however, limited Campbell to
performing simple, routine tasks at a consistent pace but not a production-rate pace where each
task must be completed within a strict time deadline. Id. Campbell was further restricted to only
occasional climbing of ramps and stairs; never climbing ladders, ropes, or scaffolds; and no
exposure to driving vehicles, unprotected heights and moving machinery. Id. Campbell was
also limited to work involving frequent interaction with supervisors, the general public, and with
co-workers; low stress jobs, defined as requiring only occasional decision-making and changes
in the work setting; and no work involving shared tasks with co-workers. Id.
Campbell had no past relevant work. R. 35; 20 C.F.R. §§ 404.1565, 416.965. Relying on
the testimony of VE Rappucci, the ALJ determined that based on Campbell’s age, education,

3

See 20 C.F.R. pt. 404, subpt. P, app. 1.
See 20 C.F.R. pt. 404 subpt. P, app. 1, § 12.00(G)(2)(b)-(c). Regarding the paragraph C
criteria, the ALJ noted that Campbell had been capable of traveling out of state and maintaining
a marriage, and that her care had been conservative, without referrals for higher level of care
such as an intensive program or hospitalization. R. 23.
4
4

work experience, and RFC, a significant number of jobs existed in the national economy she
could perform including linen room attendant, electrical accessories assembler, and table worker.
R. 35-36; see also 20 C.F.R. §§ 404.1566(b), 416.969, 416.969a. Therefore, the ALJ found that
Campbell was not disabled. R. 36.
In her request for review, Campbell raises three issues. First, Campbell asserts the ALJ
erroneously rejected the opinion of her treating psychologist. Doc. 10, at 4-13. Next, Campbell
contends the ALJ erroneously discounted the severity of Campbell’s syncope symptoms. Id. at
13-16. Finally, Campbell argues the ALJ failed to include all of Campbell’s credibly established
limitations in her RFC and hypothetical questions to the VE. Id. at 16-19. The Commissioner
counters stating substantial evidence supports the ALJ’s findings regarding Campbell’s treating
psychologist, the severity of Campbell’s symptoms, and her RFC. Doc. 11, at 7-21.
IV.

FACTUAL BACKGROUND
A. Medical opinions 5
Campbell was twenty-five years old on the disability onset date and is therefore

considered a “younger individual.” R. 35; 20 C.F.R. §§ 404.1563(c), 416.963(c). Campbell
suffers from syncope, panic disorder, anxiety, and depression. R. 20; 461; 465; 643-58; 661;
666; 935-45.
Campbell reported that her first syncopal episode occurred on September 18, 2017. R.
445. From October 2017 to April 2018, Campbell had a normal neurology exam, stress and
cognitive tests, and a generally normal echocardiogram. R. 26; 378; 401; 429-38; 443-44. She

5

Two additional state agency consultants, Bettye Stanley, D.O., and Crescenzo Calise, PhD,
assessed Campbell’s physical limitations, but Campbell’s physical limitations are not at issue
here.
5

had a 24-hour Holter monitor test that did not correspond with significant findings (although
Campbell reported several syncopal episodes); an abnormal tilt-table test consistent with cardiodepressor syncope; a brain MRI that showed diagnostic possibilities of migraines, vasculitis,
Lyme disease, or demyelinating disease; and a normal EEG. 6 R. 26; 375-78; 439-42. During that
time period, Campbell reported syncopal episodes two to three times per day and memory
problems. R. 26; 435; 464; 470; 604. Neither a beta blocker nor Florinef helped her symptoms.
R. 26; 464; 600; 604. In June 2018, Campbell’s primary care provider attributed the syncopal
episodes to anxiety and advised Campbell to avoid driving, to follow up with neuropsychiatry,
and restart Paxil. R. 27; 464. Campbell elected not to take Paxil as she had previously taken it
for seven years and had weaned herself off. R. 464; 638.
By May 2019, Campbell reported that her syncopal episodes had improved to once per
day. R. 27, 657. Campbell was reluctant to take any prescribed medication due to the side
effects she had suffered in the past but would take Hydroxyzine as needed for anxiety and began
taking Buspar beginning in July 2019. R. 640-41; 644-45. Campbell’s primary care physician
referred her to a psychologist, and she began weekly psychotherapy treatments with Dr. Robin
Beaumont, PhD, in June 2019. R. 954-1044. In March 2020, Christine Marshall, MD,
prescribed Campbell Lexapro to replace her Buspar prescription. R. 680-81.
Dr. Beaumont provided a medical report in November 2019. R. 661-62. She diagnosed
Campbell with panic disorder and noted that Campbell experienced panic attacks and daily
anxiety, along with sudden losses of consciousness approximately twice per day. R. 661-62;

6

According to the administering physician, Jessica Feldman, MD, Campbell experienced one
instance of head slumping and eye fluttering during the EEG. However, there was no
measurable epileptiform correlate to this. R. 439
6

955; 971. Dr. Beaumont reported that Campbell’s symptoms “significantly impact[] her ability
to engage in typical daily life activities such as going to the grocery store, attending doctor
appointments independently, and employment.” R. 661. In July 2020, Dr. Beaumont reported a
change in Campbell’s symptoms. R. 840. Campbell began behaving in an agitated manner prior
to an episode, where she described “run[ning] out of her home, and [being] unable to identify
familiar people who are with her during the episode.” R. 31; 840.
In October 2020, Dr. Beaumont provided another medical source statement (MSS),
stating that Campbell had “no useful ability to function” in the following areas: remembering
work-like procedures; maintaining a routine without supervision; working without interruptions
from symptoms; performing without unreasonable rest periods; and accepting instructions and
responding appropriately to criticism from supervisors. R. 34; 927. In the same assessment, Dr.
Beaumont stated that Campbell was “unable to meet competitive standards” in the following
areas: understanding and remembering simple instructions; making simple work-related
decisions; asking questions or requesting assistance; maintaining attention and regular
attendance; working with others without being distracted or distracting them; interacting
appropriately with the public; responding appropriately to changes in routine or normal work
stress; being aware of hazards and taking precautions; and adhering to standards of neatness and
cleanliness. Id. Dr. Beaumont reported that Campbell lost consciousness two to five times daily
and was “unable to focus, make decisions, interact with the public/customers for a period of 3045 minutes before or after losing consciousness.” R. 928. Campbell “had difficulty word
finding, problem solving, lethargy[,] and confusion for extended periods, [90 minutes or more] a
day, [two to five times] a day.” Id. Dr. Beaumont opined that Campbell would be absent more
7

than three days per month. R. 34; 928. Dr. Beaumont noted that “changes in routine [or]
environment, such as working with customers or interacting with coworkers heightens [her]
anxiety which increases the frequency of her [syncope].” R. 929.
Dr. Debra Mashberg, a consultive examiner, conducted a mental status evaluation of
Campbell in December 2019. R. 663-74. Dr. Mashberg diagnosed Campbell with panic disorder
and generalized anxiety disorder. R. 28; 666. Dr. Mashberg opined that Campbell had no
limitations understanding, remembering, or carrying out simple or complex instructions, making
judgments on simple or complex work-related decisions, interacting appropriately with the
public, supervisors, or coworkers, or responding appropriately to usual work situations or
changes in a routine work setting. R. 32; 668-69.
In December 2019, Melissa Franks, Psy. D., a state psychological consultant, also
evaluated the evidence of record and determined that Campbell had mild limitations
understanding, remembering, or applying information, interacting with others, concentrating,
persisting, or maintaining pace, and adapting or managing herself. R. 85.
In July 2020, state psychological consultant Anthony Galdieri, PhD, reviewed the
evidence of record and opined that Campbell had mild limitations understanding, remembering,
or applying information, and adapting or managing herself. R. 121. She had moderate
limitations interacting with others and concentrating, persisting, and maintaining pace. Id.
B. Non-medical evidence
Campbell has completed one year of college. R. 265. She has no past relevant work but
previously worked as a cashier and barista. R. 35; 265. Campbell outlined her health issues and
limitations at the hearing. R. 53-57. She testified that she passes out two to five times a day and
8

is tired, dizzy, and nauseous throughout the day. R. 53. Additionally, she testified that she has
memory problems, headaches, and low energy. R. 54, 57. Although treatment has helped her
anxiety and panic attacks, she reported her syncopal episodes have not improved. R. 54.
Campbell was unable to attend recent telehealth appointments with her therapist due to
exhaustion and her episodes. R. 56.
Campbell lives with her husband in a mobile home and is unable to drive. R. 57-58.
After the disability onset date, Campbell travelled to Disney World with her family for six days.
R. 58. She went to the park but was not able to walk for long periods of time and spent 30-40%
of the trip in her room. R. 58; 67. She remains at home alone three or four days per week, but
occasionally her mother-in-law or sister visit. R. 60. Campbell testified that most days she is in
bed or on the couch, but on a “good day” she can do small housework tasks like sweeping or
cleaning up after her cats. Id. She testified that beginning in May or June 2020, after waking up
from an episode she is in a “fight or flight response” and cannot remember what happened during
the episode. R. 65. Campbell also experiences night terrors. Id. She cannot bathe alone, and
her husband must supervise her in case of a syncopal episode. R. 66. She stopped attending
college because she could not concentrate on reading and would pass out. R. 67-68. While
Campbell worked as a cashier in 2019, her employer allowed her to call out of work two to three
times per month and tried creating a safer work environment by installing cameras to check on
her while working. R. 69-70.
Spencer Campbell, Campbell’s husband, completed a Third-Party Function Report in
October 2019. R. 315. He claimed that his wife passes out multiple times per day and after is
fatigued and confused. Id. He also stated she cannot work alone or drive, cannot bathe alone,
9

and sometimes struggles dressing herself. R. 316. Campbell can feed the cats, change the litter
box sometimes, and do the dishes and laundry, but these chores take her longer than average. R.
316-17. She also can play video games and hang out with friends or family once or twice a week
as long as she does not get fatigued. R. 319. Mr. Campbell’s December 2020 statement reports
that Campbell has passed out unpredictably for the last three years. R. 367. On average, her
syncopal episodes are two to five minutes and occur twice daily. Id. However, on “bad days,”
she could pass out up to ten times daily. Id. She is unable to do chores that require her to stand
and has been unable to keep a job. Id. She has suffered anxiety attacks, memory problems, and
has difficulty focusing. Id. He mentioned that she dropped out of college because of these
issues. Id.
Campbell’s former employer, Kirstin Nice, owner of M&J Gourmet, also submitted a
letter in October 2020. R. 346. Ms. Nice stated that she was aware of Campbell’s limitations
when she hired her in January 2019 and worked to ensure her safety. Id. She reported that
Campbell lost consciousness while working several times and that her illness prevented her from
performing the job safely. Id. She noted that Campbell was “upstanding, honest, and [a] hard
worker.” Id. Campbell quit her job with M&J Gourmet due to her symptoms. R. 27; 643; 969.
V.

DISCUSSION
A. The ALJ properly evaluated and considered the opinion of Campbell’s treating
psychologist, Dr. Beaumont, and the decision is supported by substantial
evidence.
Campbell’s first general claim is that the ALJ erroneously rejected the opinion of Dr.

Beaumont as unsupported by objective medical evidence and inconsistent with the record. Doc.
10, at 9-10.
10

When considering medical evidence, the ALJ will not “defer or give any specific
evidentiary weight, including controlling weight, to any medical opinion(s) or prior
administrative medical finding(s), including those from [claimant’s] medical sources.” 20 C.F.R.
§§ 404.1520c(a); 416.920c(a). The ALJ instead assesses the persuasiveness of a medical opinion
by evaluating several factors including supportability, consistency, the medical source’s
relationship with the claimant, the source’s specialization, and the source’s familiarity with other
evidence in the claim or understanding of the disability program’s policies and evidentiary
requirements. Id. When determining whether a medical opinion is persuasive, the most
important factors are supportability and consistency. 20 C.F.R. §§ 404.1520c(a); 404.1520c(c);
416.920c(a); 416.920c(a).
The ALJ is not required to explain all factors, but the ALJ must explain how she
considered supportability and consistency. 20 C.F.R. §§ 404.1520c(b)(2); 416.920c(b)(2).
Supportability considers how relevant “the objective medical evidence and supporting
explanations presented by a medical source are to support his or her medical opinion(s).” 20
C.F.R. §§ 404.1520c(c)(1); 416.920c(c)(1). Consistency is the measure of how consistent “a
medical opinion(s) or prior administrative medical finding(s) is with the evidence from other
medical sources and nonmedical sources in the claim.” 20 C.F.R. §§ 404.1520c(c)(2);
416.920c(c)(2). The ALJ may choose which opinions 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). In
rejecting a medical opinion, the ALJ must describe why the evidence was rejected and “explain
[any] conciliations and rejections.” Burnett, 220 F.3d at 122.

11

Here, the ALJ found the opinion of Campbell’s treating psychologist, Dr. Beaumont, was
unpersuasive. R. 34. The ALJ discussed Dr. Beaumont’s November 2019 and July 2020
reports:
Dr. Beaumont’s description of the claimant’s limitations is not
supported by her own treatment records. She has not reported on any
observed episodes of lost consciousness and has treated the claimant
with conservative psychotherapy. She has not reported any observed
episodes of agitation or panic. Her observations of the claimant only
mention disturbances in mood and affect and note she was “variably
impaired” in functional status; however, she also notes the claimant
is oriented, alert, and interactive and does not explain her finding of
functional status. Treatment notes also indicate the claimant was
capable of traveling, of functioning alone prior to June 2020, and of
maintaining a relationship. Treatment notes further show the
claimant reported recognizing some patterns to her episodes that are
not described in Dr. Beaumont’s report. Additionally, the
longitudinal evidence supports only conservative medical care since
the amended onset date, with no neurological, psychiatric, or
neuropsychiatric follow up despite recommendations to engage in
such care.
R. 32 (internal citations omitted). The ALJ decision also addresses Dr. Beaumont’s December
2020 MSS, providing:
Dr. Beaumont’s limitations are unsupported by the claimant’s
mental status examination, which showed good attention and
concentration and appropriate interview behavior; none of her
subsequent progress notes show objective abnormalities to support
such severe limitations. The limitations are similarly inconsistent
with the evidence of record; the claimant remained capable of
engaging in part-time work through July 2019, at which point she
quit. This suggests she was capable, even if limited, of performing
work-related activities. Additionally, Dr. Beaumont’s reports on the
claimant’s episodes are not supported by observation; she has not
reported direct observation of the claimant’s symptoms during
appointments in 2019 or 2020. This suggests the limitations assessed
are heavily based on self-report.
R. 34 (internal citations omitted).
12

Campbell first claims that the ALJ erred when she found Dr. Beaumont’s opinion
unsupported by objective medical evidence. To this point, Campbell argues that Dr. Beaumont
“specifically supported her opinions with detailed explanations, and made objective clinical
findings of anxious mood and labile affect based on her observations at multiple therapy
sessions.” Doc. 10, at 9-10. Campbell also argues that the ALJ improperly characterized
Campbell’s treatment as conservative when she dismissed Dr. Beaumont’s opinion as
unsupported. Doc. 17, at 3.
Here, the ALJ analyzed Dr. Beaumont’s treatment records and the supportability of those
records. Specifically, the ALJ considered that Dr. Beaumont herself had never witnessed an
episode of syncope, panic, or agitation. R. 32; 932-53; 967-1044. While true that Dr. Beaumont
repeatedly recorded Campbell’s complaints regarding syncopal episodes within her treatment
notes, recording a claimant’s subjective complaints within a medical report does not transform a
claimant’s symptom into a supported opinion. See Lisowicz v. Barnhart, 47 F. App’x. 629, 632
(3d Cir. 2002) (“the ALJ is not required to give Plaintiff’s self-reported symptoms controlling
weight simply by virtue of their reproduction in her treating physician’s report”). This remains
true even where—as here—there are a substantial number of such complaints. Rodriguez v.
Barnhart, No. 04-5375, 2005 U.S. Dist. LEXIS 20166, at *25 (E.D. Pa. Sep. 14, 2005) (finding
that “sheer quantity” of subjective complaints does not change their character). Because Dr.
Beaumont never directly observed any of Campbell’s syncopal episodes, but instead relied on
Campbell’s subjective reports, her opinion does not constitute a supported medical opinion
entitled to controlling weight. Lisowicz, 47 F. App’x. at 632. The ALJ also considered that Dr.
Beaumont’s treatment records repeatedly indicated that Campell was “variably impaired” in
13

functional status, while also consistently describing Campbell as “fully oriented, alert, and
interactive.” R. 32; 34; 932-1042. Dr. Beaumont does not explain Campbell’s functional status
or this discrepancy, making her opinion unsupported. R. 32; See Salles v. Commr. Of Soc. Sec.,
229 F. App’x. 140, 148 (3d Cir. 2007) (“A lack of evidentiary support in the medical record is a
legitimate reason for excluding claimed limitations from the RFC.”) Therefore, the ALJ
properly discounted Dr. Beaumont’s opinion on that ground.
The ALJ also noted Campbell’s conservative psychotherapy treatment did not support Dr.
Beaumont’s opinion of Campbell’s debilitating limitations. R. 32; 932-53; 967-1044. When
present, conservative treatment tends to “‘discredit[ ]’ the severity of the claimant’s ‘subjective
symptoms.’” Becker v. Kijakazi, No. 20-cv-5806, 2022 U.S. Dist. LEXIS 69705, at *n.5 (E.D.
Pa. Apr. 14, 2022) (citing Morales v. Comm’r of Soc. Sec., 799 F. App’x 672, 676-77 (11th Cir.
2020). “[T]here is no bright-line rule for what constitutes ‘conservative’ versus ‘radical’
treatment,” and courts within this Circuit have allowed ALJs to make this determination if
accompanied by adequate explanation. Robert M. v. Kijakazi, No. 22-cv-1476, 2023 WL
5839299, at *9 (M.D. Pa. Aug. 7, 2023), approved and adopted, No. 22-cv-1476, 2023 WL
5628604 (M.D. Pa. Aug. 31, 2023); see, e.g., Christina L. v. Kijakazi, No. 22-cv-521, 2023 U.S.
Dist. LEXIS 156341, at *18-19 (M.D. Pa. July 24, 2023) (finding that ALJ’s characterization of
conservative treatment was not supported because ALJ failed to discuss and analyze treatment
modalities that Plaintiff pursued); Gonzalez v. Saul, No. 18-8937, 2019 U.S. Dist. LEXIS
223585, at *19 (D.N.J. Nov. 13, 2019) (finding ALJ properly labeled claimant’s treatment
history conservative because ALJ discussed claimant’s psychotherapy treatment and medication
management).
14

Here, Campbell’s treatment consisted of weekly therapy sessions focused on identifying
signs of increasing anxiety and de-escalation skills to prevent panic attacks and prescriptions for
Buspar or Lexapro and Hydroxyzine. R. 32, 932-53, 967-1044. This treatment can reasonably
be described as conservative. See Gonzalez v. Saul, No. 18-8937, 2019 U.S. Dist. LEXIS
223585, at *19 (D.N.J. Nov. 13, 2019) (acknowledging that twice monthly psychotherapy and
monthly medication management “can reasonably be described as [conservative]”); see also
Rivera v. Berryhill, No. 16-4106, 2017 U.S. Dist. LEXIS 170752, at *16-17 (D.N.J. Oct. 13,
2017) (finding that treatment with medication and monthly psychotherapy was “conservative”
treatment). Therefore, the ALJ properly classified and considered Campbell’s conservative
treatment when determining that Dr. Beaumont’s opinion is unsupported by objective medical
evidence.
Next, Campbell claims that the ALJ erred when she found Dr. Beaumont’s opinion
inconsistent with the record. Campbell argues that she quit her part-time job because she was
unable to perform it safely due to syncopal episodes, which is entirely consistent with Dr.
Beaumont’s limitations. Doc. 10, at 10-11; R. 346. In support of this argument, Campbell
asserts that “even if Plaintiff had successfully performed this part-time job, it would not be
dispositive of her ability to perform a job on a full-time, regular and continuing basis, which is
the regulatory standard for disability at Step Five of the sequential evaluation.” Doc. 17, at 2.
Campbell is correct that part-time work is not definitive proof of the ability to work full
time. But the ALJ did not cite Campbell’s part-time work as evidence that she is able to work

15

full-time or as evidence of her abilities when determining her RFC. 7 Instead, the ALJ considered
Campbell’s part-time work as a factor when she evaluated Dr. Beaumont’s opinion. See
Leventhal v. Kijakazi, No. 20-cv-3157, 2021 WL 5163202, at *9 (E.D. Pa. Nov. 5, 2021)
(permitting ALJ to consider Plaintiff’s ability to engage in childcare and part-time work as
evidence inconsistent with restrictive limitations provided by Plaintiff’s physician, but not as
evidence of Plaintiff’s ability to work full-time). Campbell’s ability to engage in any consistent
work (even though it is accommodated) is inconsistent with Dr. Beaumont’s opinion that
Campbell has severe limitations.
The ALJ also found that Dr. Beaumont’s proposed restrictions were inconsistent with
Campbell’s daily activities. While the ALJ included this reasoning in her supportability analysis,
it also concerns the consistency of Dr. Beaumont’s opinion with non-medical sources in the
record, specifically Campbell’s self-reported activities. Although helpful to the Court’s review,
the ALJ is not required to explicitly mention supportability and consistency when analyzing
these factors. See Kaschak v. Kijakazi, No. 21-354-E, 2023 U.S. Dist. LEXIS 36326, at *n.2
(W.D. Pa. Mar. 3, 2023) (noting “there are no ‘magic words’ an ALJ must use to articulate his or
her consideration of supportability and consistency”) (citing Cooper v. Comm’r of Soc. Sec., 563

7

The ALJ may consider evidence before the Plaintiff’s onset disability date when Plaintiff’s
reported symptoms appear similar in severity during this time. See Payne v. Kijakazi, No. 21cv-5635, 2023 U.S. Dist. LEXIS 105975, at *n.2 (E.D. Pa. June 20, 2023) (permitting ALJ to
consider Plaintiff’s ability to work until onset disability date when assessing consistency of
physician’s opinion where “Plaintiff [does not] alleg[e] disability based on an injury that
occurred on a particular date”); see also Cassler v. Colvin, No. 12-5015, 2014 U.S. Dist. LEXIS
121147, at *3 n.5 (E.D. Pa. May 14, 2014) (denying Commissioner’s argument that “any
evidence pertaining to the period of time before the alleged onset date…is irrelevant” because
Plaintiff “has not alleged disability based on an injury that occurred on a particular date”).
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F. App’x. 904, 911 (3d Cir. 2014)). In this vein, discussing this evidence within the context of
supportability does not preclude considering it as evidence of inconsistency.
During the time Dr. Beaumont alleged Campbell experienced extreme limitations, after
her disability on set date, Campbell travelled to Disney for six days with her family. R. 32; 58;
941. Campbell reported that she was able to cook, prepare food, clean, do laundry, and go
shopping if accompanied. R. 32; 304-07. Campbell also appeared to spend much of her time
alone until she decided in June 2020 that she wanted someone with her 24 hours a day. R. 32;
1036. Campbell’s actions are inconsistent with Dr. Beaumont’s opinion that Campbell’s
symptoms “significantly impacted her ability to engage in typical daily life activities” because
Campbell was not as limited as Dr. Beaumont suggested. R. 31; 661. The ALJ sufficiently
explained why she discounted Dr. Beaumont’s opinion on this basis, and her decision is
supported by substantial evidence. Campbell’s first claim regarding Dr. Beaumont fails.
B. Substantial Evidence Supports the ALJ’s Assessment of the Severity of
Campbell’s Syncope in her RFC.
Campbell next maintains that the ALJ did not have substantial evidence to discount the
severity of Campbell’s syncope symptoms in her RFC. Doc. 10, at 13-16.
A two-step process is used to evaluate a claimant’s symptoms in disability claims. Social
Security Ruling 16-3P: Titles II & XVI: Evaluation of Symptoms in Disability Claims, SSR 163P, 2016 WL 1119029, at *3, *4 (S.S.A. Mar. 16, 2016). First, it is determined whether a
claimant has “a medically determinable impairment that could reasonably be expected to produce
the individual’s alleged symptoms.” Id. at *3. Second, the ALJ evaluates the intensity and
persistence of an individual’s symptoms such as pain and determines the extent to which the
symptoms limit the claimant’s ability to perform work-related activities. Id. at *4-5. At the
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second step, in addition to the objective medical evidence in the record, the ALJ considers
factors relevant to the claimant’s symptoms including (1) daily activities; (2) location, duration,
and frequency of pain and other symptoms; (3) precipitating and aggravating factors; (4) type,
dosage, effectiveness and side effects of medication; (5) treatment, other than medication; (6)
other measures taken to relieve pain; and (7) other factors. See 20 C.F.R. § 404.1529I(3)(i)–
(vii).
It is true that the ALJ is required to give “serious consideration to a claimant’s subjective
complaints of pain [or other symptoms], even where those complaints are not supported by
objective evidence.’” Mason v. Shalala, 994 F.2d 1058, 1067 (3d Cir. 1993) (citing Ferguson v.
Schweiker, 765 F.2d 31, 37 (3d Cir. 1985)). Nevertheless, subjective complaints alone are not
sufficient to establish a claimant’s disability. See 20 C.F.R. §§ 404.1529(a); 416.929(a). When
considering the credibility of the complaints in light of the objective medical evidence, the ALJ
may partially or entirely reject complaints that are inconsistent with the evidence. Id.; see also
Weber v. Massanari, 156 F. Supp. 2d 475, 485 (E.D. Pa. 2001). Moreover, when a claimant’s
daily activities are inconsistent, an ALJ may “conclude that some or all of the claimant’s
testimony about her limitations or symptoms is less than fully credible.” Burns, 312 F.3d at
129–30 (3d Cir. 2002). An ALJ’s conclusion regarding a claimant’s subjective complaints of
pain is entitled to great deference, and the decision will be upheld as long as substantial evidence
supports the conclusion. See Biestek, 139 S. Ct. at 1157; Horodenski v. Comm’r of Soc. Sec.,
215 F. App’x 183, 189 (3d Cir. 2007); see also Cosme v. Comm’r of Soc. Sec., 845 F. App’x
128, 133-34 (3d Cir. 2021) (holding substantial evidence, including opinions of medical doctors,
supported ALJ’s decision to discount claimant’s subjective complaints).
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An RFC assessment is the most a claimant can do in a work setting despite the limitations
caused by his or her impairments. 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). An ALJ is
required to include in the RFC any credibly established limitations supported by the record.
Salles v. Comm’r of Soc. Sec., 229 F. App’x 140, 147 (3d Cir. 2007). The ALJ’s RFC
assessment must be “‘accompanied by a clear and satisfactory explication of the basis on which
it rests.’” Fargnoli v. Massanari, 247 F.3d 34, 41 (3d Cir. 2001) (quoting Cotter v. Harris, 642
F.2d 700, 704 (3d Cir. 1981)). Once an ALJ has made an RFC determination, the 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).
The ALJ considered Campbell’s statements about the intensity, persistence and limiting
effects of her symptoms and their impact on Campbell’s ability to perform work-related
activities, finding them inconsistent with the record evidence. R. 29-30. The ALJ noted various
inconsistencies between Campbell’s testimony and the record:
The claimant’s specialist testing predates her amended onset date;
she saw neurology and cardiology in 2017 and 2018 but did not
engage in follow up after initial testing was generally negative.
Despite neurology advising her to follow up both with
neuropsychiatry and with neurology after April 2018, records show
no engagement with a neuropsychiatrist and no neurology follow up
since her amended onset date. Records indicate she lost her
insurance and was unable to follow up with neuropsychiatry in early
2020, but later records only mention concerns about being
evaluated. Regardless, the claimant has not undergone formal
evaluations with autonomic or neuropsychiatric specialists, despite
recommendations to engage. The claimant was also resistant to
using medication, though it was recommended; the claimant’s
primary care provider indicated she should restart Paxil, but she was
hesitant. Again in March 2020, she told another primary care
provider she was unwilling to go back on anti-depressants.
Additionally, the claimant’s reports of her episodes vary during her
alleged disability period. She testified she passes out two to five
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times a day during her December 2020 hearing, but she reported in
her Statement it was an average of twice per day. In October 2019,
she told one provider it had improved from occurring once to three
times per day to only occurring once; she told another provider in
March 2020 it was occurring multiple times per day. Though she
reported in her Statement and testimony there were no known
triggers or times of day, she reported to her psychologist the
episodes generally happened in the late afternoons and in the
evenings; she also mentioned exercise or her menstrual cycles were
triggers; and she repeatedly acknowledged the episodes were related
to increased anxiety. The claimant alleged she felt unsafe because
of the episodes and could not be alone; however, the evidence
suggests she spent much of her time alone until she indicated she
wanted someone with her 24 hours a day in June 2020. She reported
she had been to the emergency room because of symptoms, but there
are no emergency room visits since April 2019. There is also no
indication the claimant suffered any injuries as a result of losing
consciousness; she has not reported falls, and she acknowledged the
syncope generally affected her while sitting and lying down.
Records also suggest she had been advised of a vascular technique
to stop the cycle of passing out; however, she told her
psychotherapist in August 2020 she had not tried the technique. The
claimant also reported variably on activities of daily living; she told
Dr. Mashberg she could cook, do cleaning and laundry, and shop
with someone else. During testimony, however, she noted she could
only tidy or sweep on a good day and otherwise was in bed or on the
couch. These inconsistencies suggest the information provided by
the claimant may not be entirely reliable.
Id. (internal citations omitted). The ALJ also found that Campbell’s statements about the
severity of her symptoms were inconsistent with the medical evidence, which showed
conservative treatment and few objective signs of limitations:
Mental status examinations have observed anxious mood and
anxious or labile affect. Her therapist noted she was “variably
impaired” in functional status; however, she repeatedly noted the
claimant was oriented, alert, and interactive via telehealth
appointments. The claimant has also demonstrated intact cognition,
memory, attention and concentration. The undersigned recognizes
the claimant’s stress and anxiety affect her physical symptoms, but
both her medical and mental health care since her amended onset
date have been conservative. She has declined psychiatric
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medication, psychiatric care, and neuropsychiatric care. Her
physical and mental examinations have been generally benign
except for changes in mood and affect. She has reported symptoms
of depression to her therapist that she has otherwise denied to other
providers, but she has not been referred to a higher level of care. She
has also retained the abilities to engage in activities of daily living
including traveling, socializing, using online social media, preparing
meals, engaging in hobbies, exercising, and maintaining a
relationship despite her limitations. She told a provider in late 2020
she was engaging in work involving more time standing; even
though she clarified this was housework at the hearing, she did not
mention episodes of syncope during September or October 2020
primary care appointments.
R. 29-30.
Campbell argues that the ALJ violated the Social Security regulations by rejecting the
severity of her symptoms detailed at the hearing and in her husband’s written statements. Doc.
10, at 14. She also argues that the ALJ did not consider all of the objective medical evidence,
namely medical opinions from Joseph Perez, D.O., and Tina Myers, D.O. Id. at 15.
The ALJ properly considered Campbell’s subjective complaints. The ALJ followed the
two-step process and determined that Campbell’s medically determinable impairments could
reasonably be expected to cause Campbell’s alleged symptoms. R. 26. Contrary to Campbell’s
argument, lack of objective evidence was not the only factor the ALJ considered in assessing
Campbell’s subjective reports. Doc. 10, at 14; R. 26-28. Instead, the ALJ correctly discredited
Campbell’s testimony given the inconsistencies in her activities of daily living with the reported
severity of her symptoms. R. 30. Specifically, Campbell said that she was able to cook, clean,
do laundry, shop if accompanied, and socialize with friends and family. R. 30; 666. During
testimony, however, she said that she was typically confined to her bed or the couch. R. 60.
Moreover, although additional treatment was recommended to Campbell, she chose not to pursue
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such treatment. 8 The ALJ explained that since her onset date, Campbell has been treated via
psychotherapy and medication, but she has not pursued “neurological, psychiatric, or
neuropsychiatric follow up despite recommendations to engage in such care.” R. 32; 464; 638;
640-41; 644-45. The ALJ considered this evidence, and reasonably concluded that Campbell’s
syncope was not as severe as Campbell represented. R. 27.
Campbell’s argument that the ALJ erred by failing to consider objective evidence
corroborating the severity of her symptoms also fails. Campbell cites to a diagnosis by Dr. Perez
of “syncope with differential including vasovagal episode versus psychogenic or cardiac
dysrhythmia versus seizure,” and an opinion from Dr. Myers that Campbell’s syncope was due to
episodic atrioventricular junctional rhythm. Doc. 10, at 14-15; R. 494-504. As the
Commissioner notes, however, Dr. Perez’s initial diagnosis and Dr. Myers’s assessment well
predate the onset date. Doc. 11, at 14. Additionally, Dr. Perez’s diagnosis was a differential
diagnosis that required numerous follow-up tests, which ultimately ruled out a physical cause for
her syncope. Id. at 14-15; R. 464; 503. Similarly, Dr. Myers acknowledged that Campbell’s
syncopal episodes were anxiety-related and referred her to neuropsychiatry. R. 27; 464. The
ALJ considered this evidence, and reasonably concluded that Campbell’s syncope was anxietyrelated and not as severe as Campbell represented. R. 27.
Despite the ALJ’s finding that Campbell’s symptoms were not as severe as she alleged,
the ALJ accounted for Campbell’s syncope symptoms in her RFC. R. 32-35. The ALJ included

8

Failure to follow physician’s recommendations may suggest that the symptoms are not as
severe as a claimant maintains. See Robinson v. Berryhill, No. 14-1916, 2018 U.S. Dist. LEXIS
225242, at *13 (E.D. Pa. Oct. 23, 2018) (“[L]ack of follow up in general to her physicians'
recommendations is notable as reflective of a failure to follow prescribed treatment and suggests
that the symptoms are not as persistent as represented.”).
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Campbell’s risk of syncope and collapse in her physical limitations by restricting Campbell to
“occasional climbing of ramps and stairs; never climb ladders, ropes, or scaffolds; and should
have no exposure to driving vehicles, unprotected heights and moving machinery.” R. 33.
Because Campbell’s syncope is exacerbated by stress, the ALJ also restricted Campbell to
unskilled work with reduced interaction, only occasional decision-making and occasional
changes, and tasks performed at a consistent but not production pace. R. 32. For these reasons,
the ALJ’s RFC determination is supported by substantial evidence in the record.
C. The ALJ did not err in her hypothetical questions to the VE.
Finally, Campbell argues that the ALJ failed to include all of her credibly established
limitations regarding her syncopal episodes in her RFC and hypothetical questions to the VE.
Doc. 10, at 17. She points out that when such limitations were included in an alternative
hypothetical, the VE testified that no work could be performed. Id.
Here, as previously noted, the ALJ did not adopt Dr. Beaumont’s limitations related to
her syncopal episodes because the ALJ determined that Dr. Beaumont’s opinion was not
supported nor consistent with the record. R. 32, 34. Because the ALJ rejected Dr. Beaumont’s
limitations as unpersuasive, the ALJ was permitted to exclude those limitations from the RFC
and in the hypothetical questions to the VE. See Salles, 229 F. App’x at 148 (“A lack of
evidentiary support in the medical record is a legitimate reason for excluding claimed limitations
from the RFC.”) The ALJ crafted an appropriate RFC based on the medical evidence and
determined Campbell was not disabled. Therefore, Campbell’s argument that the ALJ erred as to
the hypothetical questions to the VE lacks merit.

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VI.

CONCLUSION
Substantial evidence supports the ALJ’s decision to reject Dr. Beaumont’s opinion. The

ALJ’s decision discounting the severity of Campbell’s syncope is also supported by substantial
evidence. Finally, the ALJ did not err by excluding Dr. Beaumont’s limitations from Campbell’s
RFC and in the hypothetical questions posed to the VE. Accordingly, Campbell’s request for
review (Doc. 1) is DENIED. The final decision of the Commissioner of Social Security is
AFFIRMED.
An appropriate order follows.
BY THE COURT:
/s/ Craig M. Straw
CRAIG M. STRAW
U.S. Magistrate Judge

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