Long v. Colvin
Filing
19
MEMORANDUM OPINION - Based on the foregoing, the Commissioners decision shall be AFFIRMED, and Ms. Longs requests for relief shall be DENIED. Signed by Magistrate Judge Martin C. Carlson on April 5, 2016. (kjn)
UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
DOROTHY LONG,
Plaintiff,
v.
CAROLYN W. COLVIN,
Acting Commissioner of
Social Security
Defendant.
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Civil No. 1:14-CV-2192
(Magistrate Judge Carlson)1
MEMORANDUM OPINION
I.
INTRODUCTION
This is an action brought by Plaintiff, Dorothy Long, an adult individual who
resides in the Middle District of Pennsylvania, under 42 U.S.C. §405(g) seeking
judicial review of the final decision of the Commissioner of Social Security
(“Commissioner”) denying her application for disability insurance benefits. In this
social security appeal Ms. Long alleges that the Administrative Law Judge (ALJ)
erred on three scores by: (1) discounting the opinion of a treating source that Ms.
Long had “marked” limitations in work-related decision-making; (2) giving
insufficient weight to the opinion of a physician assistant regarding her physical
1
This matter has been assigned to the undersigned United States Magistrate
Judge on consent of the parties, pursuant to the provisions of 28 U.S.C. § 636(c) and
Rule 73 of the Federal Rules of Civil Procedure.
limitations; and (3) failing to give sufficient weight to the plaintiff’s subjective
complaints of disabling pain. (Doc. 12.) Our review of the record, however, reveals
that there was substantial record evidence supporting each of these findings and
conclusions of the ALJ. Moreover, we find that the rationale for the ALJ’s decision
was fully and adequately set forth in the decision denying Ms. Long’s claim.
Therefore, given the deferential standard of review which applies to such claims and
cases, for the reasons set forth below, the Commissioner’s decision is AFFIRMED, and
Ms. Long’s request for relief is DENIED.
II.
BACKGROUND AND PROCEDURAL HISTORY
The plaintiff, Dorothy Long, was born in on April 10,1976, and was 40 years
old at the time of her initial application for disability benefits on August 1, 2006. (Tr.
219, 226.) By the time of her ALJ hearing in this matter on November 21, 2012, Long
was approximately 46 years old.2 In her application, Long sought disability benefits
due to the combined effects of the following physical and emotional impairments: disc
disease, lumbago, fibromyalgia, arthritis, insomnia, allergies, iron deficiency, muscle
spasms, depression, anxiety, adjustive and post-traumatic stress disorders. (Tr. 11.)
2
We note that there have been protracted administrative proceedings on this
application, (Tr. 95 and 149), resulting in part from the plaintiff’s failure to attend an
initial ALJ hearing scheduled in her case. While these delays account for the
prolonged nature of these proceedings, which spanned six years, no party has raised
the delay as an issue in this litigation.
2
With respect to this array of medical and emotional impairments the administrative
records contained extensive treatment notes, records, and evaluations by multiple
medical sources spanning a number of years. Many of these treatment records
suggested that Long, who was working intermittently at a sheltered workshop at the
time of the ALJ hearing, (Tr. 45), suffered from only a moderate degree of
impairment.
A.
LONG’S MEDICAL IMPAIRMENTS
For example, between 2004 and 2012, Long received medical care from a half
dozen doctors and health care providers. (Tr. 16-19.) The tests, treatment and
examinations conducted by these health care professionals consistently documented
subjective complaints of pain by Ms. Long, but revealed little objective evidence of
physical impairment by the plaintiff. Consequently, the course of treatment typically
prescribe for Ms. Long was conservative in nature, and frequently entailed little more
than regular office visits and physical therapy. Ms. Long’s medical history further
revealed that she was not consistently compliant with this conservative treatment
course and often neglected to attend or complete programs of physical therapy which
were prescribed or recommended for her. (Id.) Given the lack of clinical findings
supporting Ms. Long’s claims of physical disability, and her non-compliance with the
conservative treatment regime prescribe for her by a number of doctors, in 2009 a
3
state agency medical consultant opined that Long retained the ability to perform light
work. (Tr. 16-17.)
Arrayed against this body of medical evidence was one report cited by Long
which indicated that she was physically disabled. This report was a checkbox form
completed by a physician assistant in June of 2012. (Tr. 717-719.) In this form, the
physician assistant identified in a summary fashion a series of physical limitations on
Ms. Long’s ability to work, limitations which would have precluded Long from
holding substantial employment.
B.
LONG’S EMOTIONAL TREATMENT HISTORY
With respect to any emotional impairments experienced by Long, her medical
history was similarly extensive, but inconclusive. Like her medical history, Long’s
emotional treatment history was marked by reports and evaluations from numerous
medical sources. (Tr. 18-22.) These treating sources provided Long with Global
Assessment of Functioning or GAF scores which ranged between 50 and 60 over
some three years between 2009 and 2012. These GAF scores were consistent with
only a moderate level of emotional or mental impairment. Moreover as a general
matter, Long received only routine and conservative treatment consisting of
medication and therapy for her adjustment disorder with depressed mood during this
period. (Tr. 20, 708, 862, 1595.) The medical records also reflected that Long’s
4
symptoms were largely controlled with medication (Tr. 708, 710, 871, 1519). Indeed,
Long reported that her depression was well controlled with medication, including
Trazodone, Zoloft, and sertraline. (Tr. 708, 710, 871, 1243, 1262, 1599).
Long also provided positive mental health assessments to her care-givers over
time. For example, in March 2011, Long stated that she was not as emotional; was not
“freaking out” as much; and that others had noticed a difference in her (Tr. 871); in
September 2012, Long denied experiencing any depression, anxiety or psychosis (Tr.
914); and throughout the Fall of 2012, Long reported that she was only experiencing
situational stress because she was waiting to hear about her claim for social security
benefits and her partner had left her. (Tr. 1595).
In addition, Long’s description of her own activities of daily living in many
respects did not support her claims of wholly debilitating physical and emotional
limitations. According to Long, she cared for a pet; assisted her mother by driving her
to appointments and helping her with whatever she needs; and helped her girlfriend
with the household chores and her children. (Tr. 278, 419, 422). Long also reported
that she went grocery shopping and cooked (Tr. 279, 367, 422); socialized with her
family (Tr. 282); walked her dog (Tr. 421); spent time with others listening to music,
playing cards, and talking (Tr. 424); and attended church on a regular basis. (Tr. 424).
It was against the backdrop of this mental health treatment history that three
5
medical sources opined at various times that Long’s emotional impairments were not
disabling. Thus, in 2006, a state agency psychologist, Richard A. Heil, Ph.D.,
reviewed Long’s record and found that Plaintiff’s mental impairments were not severe
(Tr. 611-623). In reaching this conclusion, Dr. Heil noted that Long had at that time
only sought treatment from her primary care physician for her depression and reported
that medication he prescribed (Trazadone) helped her symptoms (Tr. 623); and had
not at that time asserted that she was functionally limited as a result of her depression.
(Tr. 623.).
Three years later, in January of 2009, a second consultative examiner, Dana R.
Irwin, Ph.D., found that Long had only minimal limitations as a result of her mental
health (Tr. 19, 655). On mental status examination, Long’s demeanor was reported
as pragmatic, “somewhat abrupt,” and “free of undue anxiety” (Tr. 656); she was alert,
oriented, and possessed adequate recall; her speech was comprehensible and logical
without bizarre thought content or process; her mood was euthymic with humor; and
she endorsed depressive symptomatology at a negligible intensity. (Tr. 656). Long
indicated she was only slightly irritable due to her family relational problems and she
denied guilt or self-concept declines, homicidal or suicidal ideations, anhedonia or
social declines and symptoms related to manic, hypomanic, or cyclothymic mood.
(Tr. 656). Long also demonstrated intact immediate and remote recall; demonstrated
6
average performance on various measures of her knowledge (Tr. 656); and displayed
moderate self-awareness and psychological insight. (Tr. 657). Given these findings
Dr. Irwin diagnosed Long with family relational problems and assessed her GAF score
at 60. (Tr. 657). Dr. Irwin also concluded that Long’s activities of daily living were
intact; her social functions were active and varied with peers and family; her
concentration and persistence were not impaired; and she was capable of negotiating
a variety of novel settings and acquaintances (Tr. 657).
Likewise, on January 16, 2009, state agency psychologist, Kerry Brace, Psy.D.,
concluded that Long’s mental impairments were not severe (Tr. 19, 662-74). Dr. Brace
opined that Long had no restrictions in her activities of daily living, no difficulties in
maintaining social functioning, no difficulties in maintaining concentration,
persistence, or pace, and had not experienced repeated episodes of decompensation
of extended duration (Tr. 672).
In contrast to these medical opinions and findings, on June 14, 2012, one of
Long’s care-givers, Dr. Komarneni completed a Medical Source Statement of Ability
to Do Work-Related Activities (Mental) on behalf of Long. (Tr. 720-22). Dr.
Komarneni found that Long had moderate limitations in her ability to understand,
remember, and carry out short, simple instructions. (Tr. 720). He opined that Long had
marked limitation in her ability to understand, remember, and carry out detailed
7
instructions; and in her ability to make judgments on simple work-related decisions.
(Tr. 720). Dr. Komarneni further concluded that Long’s abilities to respond
appropriately to supervision, co-workers, and work pressures in a work setting were
not affected at all by her impairment. (Tr. 721-22.)
C.
THE ALJ’S DECISION
It is against this medical background, a medical history marked by contradictory
evidence much of which suggested that Long retained the ability to work, that the
ALJ conducted a hearing in Long’s case on November 21, 2012. (Tr. 39-70.) At this
hearing Long and a Vocational Expert appeared and testified. (Id.)
On January 30, 2013, the ALJ issued an opinion denying Long’s application for
benefits. (Tr. 9-26.) In this decision denying Ms. Long’s claims, the ALJ found that
Ms. Long met the insured status requirement of Title II of the Social Security Act
through September of 2009. (Tr. 11). At step one, the ALJ found that Ms. Long did
not engage in substantial gainful activity at any point during the relevant period after
August 1, 2006. Id. At step two, the ALJ found that, through her date last insured,
Ms. Long had medically determinable severe impairments, including: disc disease,
lumbago, fibromyalgia, arthritis, insomnia, allergies, iron deficiency, muscle spasms,
depression, anxiety, adjustive and post-traumatic stress disorders. (Tr. 11.) At step
three the ALJ concluded that during the relevant period Ms. Long did not have an
8
impairment or combination of impairments that met or medically equaled the severity
of one of the impairments listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr.
12).
Between steps three and four of the sequential evaluation process, the ALJ
assessed Ms. Long’s residual functional capacity, or RFC, finding that:
The claimant has the residual functional capacity to perform sedentary
work as defined in 20 CFR 404.1567(a) and 416.967(a), except the
claimant is limited to occasional balancing, stooping, kneeling,
crouching, crawling, and climbing ramps and stairs. The claimant must
avoid climbing ladders, ropes, and scaffolds, exposure to weather,
extreme heat or cold, wetness, humidity, vibration, chemicals, or
atmospheric conditions such as smoke, fumes, odors, dusts, poor
ventilation, and gases. The claimant can occasionally reach overhead and
the need to change positions can be accommodated by the normal
morning, lunch, and afternoon breaks. The claimant is limited to simple,
routine, and repetitive tasks and simple work related decisions with
infrequent changes in the work setting defined as no more than 1 per day.
The claimant must avoid fast-paced production requirements as seen in
assembly line work and she can tolerate only occasional interaction with
co-workers, supervisors, and the general public.
(Tr. 14-15.)
In reaching this determination, the ALJ carefully considered all of the medical
and psychological evidence amassed in the case, and specifically addressed the
opinion of Dr. Komarneni, one of Long’s health care-givers. On this score, the ALJ
accorded significant weight to many of Dr. Komarneni’s assessments, but concluded
that the doctor’s opinion that Long had “marked limitations in making judgments on
9
simple, work related decisions” warranted “only minimal weight, as it is not
accompanied by any clinical or objective findings, it is inconsistent with Dr.
Komarneni’s consistent Global Assessment of Functioning of 55 in September,
October, and November, 2012, and [was] inconsistent with the majority of the [other]
evidence.” (Tr. 22.)
Likewise, the ALJ’s assessment of Long’s physical limitations rested upon a
comprehensive analysis of records and opinions from numerous treating and
consulting sources, and included a specific, detailed analysis of the 2012 checkbox
form completed by a physician assistant which found that Long was physically
disabled. The ALJ rejected this summary opinion as an outlier which was inconsistent
with the treatment records and opinions of eight other doctors. (Tr. 21.) The ALJ also
observed that this opinion was not borne out by objective medical testing, and clinical
findings. (Id.) Further, the ALJ noted that a physician assistant is not an acceptable
medical source under social security regulations whose opinion is entitled to great
weight. Taking all of these factors into account, the ALJ largely discounted this
opinion. (Id.)
The ALJ then concluded at Step 4 that Ms. Long could no longer do her prior
work, (Tr. 22), but found consistent with the testimony of the Vocational Expert at
step five that Ms. Long could adjust to other work that exists in significant numbers
10
in the national economy despite her impairments. (Tr. 23.)
Having exhausting her administrative remedies with respect to this adverse
decision, Long filed the instant appeal. (Doc. 1.) This matter is fully briefed by the
parties, and is now ripe for resolution.
III.
DISCUSSION
A.
SUBSTANTIAL EVIDENCE REVIEW – THE ROLE OF THIS COURT
When reviewing the Commissioner’s final decision denying a Social Security
claimant’s application for benefits, this Court’s review is limited to the question of
whether the findings of the final decision-maker are supported by substantial evidence
in the record. See 42 U.S.C. § 405(g); Johnson v. Comm’r of Soc. Sec., 529 F.3d 198,
200(3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536(M.D.Pa. 2012).
Substantial evidence “does not mean a large or considerable amount of evidence, but
rather such relevant evidence as a reasonable mind might accept as adequate to
support a conclusion.” Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial
evidence is less than a preponderance of the evidence but more than a mere scintilla.
Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not
substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a
conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir.
1993). But in an adequately developed factual record, substantial evidence may be
11
“something less than the weight of the evidence, and the possibility of drawing two
inconsistent conclusions from the evidence does not prevent [the ALJ’s decision] from
being supported by substantial evidence.” Consolo v. Fed. Maritime Comm’n, 383
U.S. 607, 620 (1966). “In determining if the Commissioner’s decision is supported
by substantial evidence the court must scrutinize the record as a whole.” Leslie v.
Barnhart, 304 F.Supp.2d 623, 627 (M.D.Pa. 2003). The question before this Court,
therefore, is not whether Ms. Long is disabled, but whether the Commissioner’s
finding that she is not disabled is supported by substantial evidence and was reached
based upon a correct application of the relevant law. See Arnold v. Colvin, No. 3:12CV-02417, 2014 WL 940205, at *1 (M.D.Pa. Mar. 11, 2014)(“[I]t has been held that
an ALJ’s errors of law denote a lack of substantial evidence.”)(alterations omitted);
Burton v. Schweiker, 512 F.Supp. 913, 914 (W.D.Pa. 1981)(“The Secretary’s
determination as to the status of a claim requires the correct application of the law to
the facts.”); see also Wright v. Sullivan, 900 F.2d 675, 678 (3d Cir. 1990)(noting that
the scope of review on legal matters is plenary); Ficca, 901 F.Supp.2d at 536 (“[T]he
court has plenary review of all legal issues . . . .”).
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B.
INITIAL BURDENS OF PROOF , PERSUASION AND ARTICULATION
FOR THE ALJ
To receive benefits under the Social Security Act by reason of 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 can be
expected to result in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months.” 42 U.S.C. §423(d)(1)(A); see also 20
C.F.R. §404.1505(a). To satisfy this requirement, a claimant must have a severe
physical or mental impairment that makes it impossible to do his or her previous work
or any other substantial gainful activity that exists in the national economy. 42 U.S.C.
§423(d)(2)(A); 20 C.F.R. §404.1505(a). To receive benefits under Title II of the
Social Security Act, a claimant must also show that he or she contributed to the
insurance program, is under retirement age, and became disabled prior to the date on
which he or she was last insured. 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
In making this determination at the administrative level, the ALJ follows a fivestep sequential evaluation process. 20 C.F.R. §404.1520(a). Under this process, the
ALJ must sequentially determine: (1) whether the claimant is engaged in substantial
gainful activity; (2) whether the claimant has a severe impairment; (3) whether the
claimant’s impairment meets or equals a listed impairment; (4) whether the claimant
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is able to do his or her past relevant work; and (5) whether the claimant is able to do
any other work, considering his or her age, education, work experience and residual
functional capacity (“RFC”). 20 C.F.R. §404.1520(a)(4).
Between steps three and four, the ALJ must also assess a claimant’s RFC. RFC
is defined as “that which an individual is still able to do despite the limitations caused
by his or her impairment(s).” Burnett v. Comm’r of Soc. Sec., 220 F.3d 112, 121 (3d
Cir. 2000) (citations omitted); see also 20 C.F.R. §§404.1520(e), 404.1545(a)(1). In
making this assessment, the ALJ considers all of the claimant’s medically
determinable impairments, including any non-severe impairments identified by the
ALJ at step two of his or her analysis. 20 C.F.R. §404.1545(a)(2).
At steps one through four, the claimant bears the initial burden of demonstrating
the existence of a medically determinable impairment that prevents him or her in
engaging in any of his or her past relevant work. 42 U.S.C. §423(d)(5); 20 C.F.R.
§404.1512; Mason, 994 F.2d at 1064.
Once this burden has been met by the claimant, it shifts to the Commissioner
at step five to show that jobs exist in significant number in the national economy that
the claimant could perform that are consistent with the claimant’s age, education,
work experience and RFC. 20 C.F.R. §404.1512(f); Mason, 994 F.2d at 1064.
14
The ALJ’s disability determination must also meet certain basic procedural and
substantive requisites. Most significant among these legal benchmarks is a
requirement that the ALJ adequately explain the legal and factual basis for this
disability determination. Thus, in order to facilitate review of the decision under the
substantial evidence standard, the ALJ's decision must be accompanied by "a clear and
satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700,
704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must
indicate which evidence was accepted, which evidence was rejected, and the reasons
for rejecting certain evidence. Id. at 706-07. In addition, “[t]he ALJ must indicate in
his decision which evidence he has rejected and which he is relying on as the basis for
his finding.” Schaudeck v. Comm’r of Soc. Sec., 181 F. 3d 429, 433 (3d Cir. 1999).
C.
GUIDELINES FOR THE ASSESSMENT OF THE CREDIBILITY OF A
CLAIMANT’S ALLEGATIONS ABOUT HER SYMPTOMS AND
LIMITATIONS
Furthermore, with respect to assessments of a claimant’s credibility, the
regulations describe a two-step process. 20 C.F.R. §404.1529. First, the ALJ must
consider whether the claimant has met his or her burden of showing that he or she has
a medically determinable physical or mental impairment that could reasonably be
expected to produce the symptoms alleged. Once an underlying impairment has been
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shown, the ALJ reaches the second step of this process. At the second step the ALJ
must “evaluate the intensity, persistence, and limiting effects of the individual’s
symptoms to determine the extent to which the symptoms limit the individual’s ability
to do basic work activities.” SSR 96-7p, 1996 WL 374186 at *2. “Whenever the
individual’s statements abut the intensity, persistence, or functionally limiting effects
of pain or other symptoms are not substantiated by objective medical evidence, the
adjudicator must make a finding on the credibility of the individual’s statements based
on the consideration of the entire case record.” Id. In doing so, the ALJ must
consider the following seven factors outlined in 20 C.F.R. §404.1529(c)(3): (1) the
claimant’s daily activities; (2) the location, duration, frequency, and intensity of the
claimant’s pain or symptoms; (3) precipitating or aggravating factors; (4) the type,
dosage, effectiveness, and side effects of any medication the claimant takes or has
taken to alleviate pain or other symptoms; (5) treatment, other than medication, the
claimant receives or has received for relief of pain or other symptoms; (6) any
measures the claimant uses or has used to relieve pain or other symptoms; and (7) any
other factors concerning the claimant’s functional limitations and restrictions due to
pain or other symptoms that are brought to the ALJ’s attention.
404.1529(c)(3); SSR 96-7p, 1996 WL 374186 at*3.
16
20 C.F.R.
In making a finding about the credibility of a claimant’s statements, the ALJ
need not totally accept or totally reject the individual’s statements. SSR 96-7p, 1996
WL 374186. The ALJ may find all, some, or none of the claimant’s allegations to be
credible, or may find a claimant’s statements about the extent of his or her functional
limitations to be credible but not to the degree alleged. Id. Further, an ALJ’s findings
based on the credibility of a claimant are to be accorded great weight and deference,
since an ALJ is charged with the duty of observing a witness’ demeanor and
credibility. Frazier v. Apfel, No. 99-CV-715, 2000 WL 288246, at *9(E.D. Pa. Mar.
7, 2000)(quoting Walters v. Comm’r of Soc. Sec., 127 F.3d 525, 531(6th Cir. 1997)).
D.
LEGAL BENCHMARKS FOR THE ALJ’S ASSESSMENT
MEDICAL OPINION EVIDENCE
OF
Finally an ALJ’s assessment of medical opinion evidence must also satisfy
certain legal benchmarks. The Commissioner’s regulations define medical opinions
as “statements from physicians and psychologists or other acceptable medical sources
that reflect judgments about the nature and severity of [a claimant’s] impairment(s),
including [a claimant’s] symptoms, diagnosis and prognosis, what [a claimant] can
still do despite impairments(s), and [a claimant’s] physical or mental restrictions. 20
17
C.F.R. §404.1527(a)(2).3 Regardless of its source, the ALJ is required to evaluate
every medical opinion received. 20 C.F.R. §404.1527(c).
In deciding what weight to accord to competing medical opinions, the ALJ is
guided by factors outlined in 20 C.F.R. §404.1527(c). “The regulations provide
progressively more rigorous tests for weighing opinions as the ties between the source
of the opinion and the individual become weaker.” SSR 96-6p, 1996 WL 374180 at
*2. Treating sources have the closest ties to the claimant, and therefore their opinions
generally entitled to more weight. See 20 C.F.R. §404.1527(c)(2)(“Generally, we give
more weight to opinions from your treating sources...”); 20 C.F.R. §404.1502
(defining treating source). Under some circumstances, the medical opinion of a
treating source may even be entitled to controlling weight.
20 C.F.R.
§§04.1527(c)(2); see also SSR 96-2p, 1996 WL 374188 (explaining that controlling
3
Medical source opinions on issues that are dispositive of a case, e.g., whether
a claimant is disabled, are reserved to the Commissioner and do not constitute medical
opinions defined by 20 C.F.R. §404.1527(a)(2). 20 C.F.R. §404.1527(d).
Furthermore, where a medical source opines that an individual is limited to
“sedentary” work, or makes similar statements that appear to use terms set out in the
Commissioner’s regulations, the adjudicator must not assume that the medical source
using the terms “sedentary” and “light” is aware of the Commissioner’s definitions.
SSR 96-5p, 1996 WL 374183 at *5. Such opinions must never be ignored, and must
be considered based on the applicable factors in 20 C.F.R. §404.1527(c). SSR 96-5p,
1996 WL 374183 at *3. However, medical opinions on case dispositive issues like
these are never entitled to controlling weight under 20 C.F.R. §404.1527(c)(2). See
20 C.F.R. §404.1527(d)(3); SSR 96-5p, 1996 WL 374183 at *2.
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weight may be given to a treating source’s medical opinion only where it is wellsupported by medically acceptable clinical and laboratory diagnostic techniques, and
it is not inconsistent with the other substantial evidence in the case record).
Where no medical source opinion is entitled to controlling weight, the
Commissioner’s regulations direct the ALJ to consider the following factors, where
applicable, in deciding the weight given to any non-controlling medical opinions:
length of the treatment relationship and frequency of examination; nature and extent
of the treatment relationship; the extent to which the source presented relevant
evidence to support his or her medical opinion, and the extent to which the basis for
the source’s conclusions were explained; the extent to which the source’s opinion is
consistent with the record as a whole; whether the source is a specialist; and, any other
factors brought to the ALJ’s attention. 20 C.F.R. §404.1527(c).
At the initial level of administrative review, State agency medical and
psychological consultants may act as adjudicators. See SSR 96-5p, 1996 WL 374183
at *4. As such, they do not express opinions; they make findings of fact that become
part of the determination. Id. However, 20 C.F.R. §404.1527(e) provides that at the
ALJ and Appeals Council levels of the administrative review process, findings by
nonexamining State agency medical and psychological consultants should be
evaluated as medical opinion evidence. As such, ALJs must consider these opinions
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as expert opinion evidence by nonexamining physicians and psychologists and must
address these opinions in their decisions. SSR 96-5p, 1996 WL 374183 at *6.
Opinions by State agency consultants can be given weight “only insofar as they are
supported by evidence in the case record.” SSR 96-6p, 1996 WL 374180 at *2. In
appropriate circumstances, opinions from nonexamining State agency medical or
psychological consultants may be entitled to greater weight than the opinions of
treating or examining sources. Id. at *3.
Furthermore, as discussed above, it is beyond dispute that, in a social security
disability case, the ALJ’s decision must be accompanied by "a clear and satisfactory
explication of the basis on which it rests." Cotter, 642 F.2d at 704. This principle
applies with particular force to the opinion of a treating physician. See 20 C.F.R.
§404.1527(c)(2)(“We will always give good reasons in our notice of determination
or decision for the weight we give your treating source’s opinion.”). “Where a
conflict in the evidence exists, the ALJ may choose whom to credit but ‘cannot reject
evidence for no reason or the wrong reason.’” Plummer v. Apfel, 186 F.3d 422, 429
(3d Cir. 1999)(quoting Mason, 994 F.2d at 1066)); see also Morales v. Apfel, 225
F.3d 310, 317 (3d Cir. 2000).
However, it is also well-settled that acceptable medical sources do not include
physician assistants. Genier v. Astrue, 298 F. App'x 105, 108 (2d Cir.2008). Rather,
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these medical source rules only applies to physicians, and where a disability claimant's
application is supported by statements from physician assistants, this rule does not
apply. Instead, the ALJ should consider the physician assistant's opinion as some
“other source” opinion, which should be assessed, but not given controlling weight.
Applying these legal guideposts, it has been held that an ALJ may properly elect to
follow the consultative opinion of a non-examining physician who reviews a
claimant's medical records over treating physician assistant opinions, provided the
ALJ adequately explains the grounds for this determination. See e.g., Weaver v.
Astrue, 353 F. App'x 151, 152 (10th Cir.2009); Hearn v. Colvin, No. 3:13-CV-1229,
2014 WL 4793954, at *10 11 (M.D. Pa. Sept. 24, 2014); Wade v. Colvin, No.
13–CV–135, 2014 WL 1015719 (D.Co.2014).
E.
SUBSTANTIAL EVIDENCE SUPPORTED THE ALJ’S FINDINGS
In this appeal, Long challenges the ALJ’s decision on three scores, arguing that
the ALJ erred in: (1) discounting the opinion of a treating source that Ms. Long had
“marked” limitations in work-related decision-making; (2) giving insufficient weight
to the opinion of a physician assistant; and (3) failing to give sufficient weight to the
plaintiff’s subjective complaints of disabling pain.
Judged against the deferential standards of review which governs these claims,
we find that each of these assertions fails to undermine the ALJ’s judgment in this
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case. Turning first to Long’s complaint that the ALJ gave insufficient weight to Dr.
Komarneni’s finding that she suffered from a marked limitation in the field of workrelated decision-making, we note at the outset that the ALJ actually gave significant
weight to much of Dr. Komarneni’s opinion, but rejected this specific aspect of the
opinion, noting that it was inconsistent with multiple other findings by various other
medical sources, and was not congruent with the doctor’s own Global Assessment of
Functioning (GAF) score for Long. That GAF score of 55 was consistent with only
a moderate, and not a marked, level of impairment.
In her argument, Long suggests that the ALJ erred in considering any GAF
score when discounting Dr. Komarneni’s opinion, observing that medical science has
recently abandoned the GAF score as a diagnostic tool. We find this argument
unpersuasive. While recent developments in medical science may shed some light on
the weight to be given to GAF scores, the relevant Social Security regulations
mandate, and case law confirms, that an ALJ is required to consider all relevant
evidence in the case record to assess a claimant’s RFC. 20 C.F.R. §404.1545(a)(1).
Further, because during the relevant period the GAF scale was used by mental health
professionals to assess current treatment needs and provide a prognosis, it was clearly
relevant to Long’s claim. Thus, Long’s assertion that – due to its highly subjective
nature – a GAF score should not influence an ALJ’s decision misconstrues the
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regulations. Notwithstanding the fact that, subsequent to the ALJ’s decision, the GAF
score was abandoned as an assessment tool by mental health clinicians, these scores
were properly viewed by the ALJ as pieces of evidence in an otherwise substantial
record. Accordingly, we find that the ALJ properly addressed the GAF scores of
record, concluded that the GAF scores of record were consistent with the overall
objective medical evidence; and found that these GAF scores and other medical
evidence only supported a finding of moderate mental impairment.
In this regard, we note that GAF scores like those frequently found here “in the
51–60 range indicate [only] moderate impairment in social or occupational
functioning.” Cherry v. Barnhart, 29 F. App'x 898, 900 (3d Cir.2002). Thus, these
objective measures actually contradict a finding of total disability and support a
conclusion that Long faced no more than moderate impairment. See Smith v. Comm'r
of Soc. Sec., CIV.A. 10–468 MLC, 2010 WL 4063347 (D.N.J. Oct.15, 2010). Indeed,
the United States Court of Appeals for the Third Circuit has expressly endorsed this
type of fact-finding by ALJs in the past, affirming the denial of benefits in cases in
which claimants presented similar overall GAF scores. See, e.g., Rios v. Comm'r of
Soc. Sec., 444 F. Appx. 532 (3d Cir.2011) (affirming Commissioner where the record
indicated that the plaintiff was assessed three GAF scores at different times of 50, 50,
and 50–55 respectively); Gilroy v. Astrue, 351 F. App'x 714 (3d Cir.2009) (affirming
23
ALJ decision denying disability benefits despite GAF of 45); Glover v. Astrue,
CIV.A. 10–901, 2011 WL 1562267 (E.D.Pa. Mar.31, 2011) report and
recommendation adopted, CIV.A. 10–901, 2011 WL 1597692 (E.D. Pa. Apr. 26,
2011(lowest identified GAF rating was 48). DaVinci v. Astrue, No. 1:11 CV 1470,
2012 WL 6137324, at *10 (M.D. Pa. Sept. 21, 2012) report and recommendation
adopted, No. 1:11 CV 1470, 2012 WL 6136846 (M.D. Pa. Dec. 11, 2012)(GAF
score of 60-65).
In short, there was no error in the ALJ’s treatment of this psychological opinion
evidence, and the ALJ’s findings on this score were supported by substantial evidence
that was thoroughly discussed in the ALJ’s decision. Therefore, this argument
provides no grounds for setting aside the ALJ’s decision.
Likewise, the ALJ properly assessed the opinion of the physician assistant and
discounted that opinion. At the outset, we note that the ALJ correctly concluded that
this isolated opinion was inconsistent with greater weight of the medical and opinion
evidence in this case, evidence which revealed a lesser degree of impairment than that
found by the physician assistant. Further, the format of this report, a check box form,
added little weight to this opinion. Indeed, it is well-settled that: “Form reports in
which a physician [assistant’s] obligation is only to check a box or fill in a blank are
weak evidence at best.” Mason v. Shalala, 994 F.2d 1058, 1065 (3d Cir. 1993).
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Finally, the ALJ aptly found that the physician assistant's opinion, as some “other
source” opinion, should be assessed, but not given controlling weight. Indeed, this
decision was entirely consistent with the approach taken by other courts which have
held that an ALJ may properly elect to follow the consultative opinion of a nonexamining physician who reviews a claimant's medical records over treating physician
assistant opinions, provided the ALJ adequately explains the grounds for this
determination. See e.g., Weaver v. Astrue, 353 F. App'x 151, 152 (10th Cir.2009);
Hearn v. Colvin, No. 3:13-CV-1229, 2014 WL 4793954, at *10 11 (M.D. Pa. Sept.
24, 2014); Wade v. Colvin, No. 13–CV–135, 2014 WL 1015719 (D.Co.2014).
Accordingly, there was no error here in the treatment by the ALJ of this evidence.
Finally, Long argues that the ALJ erred in assessing her subjective complaints
of pain and disability, but we find that this argument is also unavailing. In assessing
a claimant’s allegations of pain, we begin by recognizing that “[t]estimony of
subjective pain and inability to perform even light work is entitled to great weight.”
Dobrowolsky v. Califano, 606 F.2d 403, 409 (3d Cir.1979) Given the “great weight”
which this evidence should receive, an ALJ may only “reject a claim of disabling pain
where he ‘consider[s] the subjective pain and specif[ies] his reasons for rejecting these
claims and support[s] his conclusion with medical evidence in the record.’ Matullo v.
Bowen, 926 F.2d 240, 245 (3d Cir.1990).” Harkins v. Comm'r of Soc. Sec., 399 F.
25
App'x 731, 735 (3d Cir. 2010). Where a disability determination turns on an
assessment of the level of a claimant’s pain, the Social Security Regulations provide
a framework under which a claimant’s subjective complaints are to be considered. 20
C.F.R. § 404.1529. Such cases require the ALJ to “evaluate the intensity and
persistence of the pain or symptom, and the extent to which it affects the individual’s
ability to work.” Hartranft v. Apfel, 181 F.3d 358, 362 (3d Cir. 1999). Cases
involving an assessment of subjective reports of pain “obviously require[ ]” the ALJ
“to determine the extent to which a claimant is accurately stating the degree of pain
or the extent to which he or she is disabled by it.” Id. In making this assessment, the
ALJ is guided both by statute and by regulations. This guidance eschews wholly
subjective assessments of a claimant’s disability. Instead, at the outset, by statute the
ALJ is admonished that an “individual’s statement as to pain or other symptoms shall
not alone be conclusive evidence of disability as defined in this section; there must be
medical signs and findings, established by medically acceptable clinical or laboratory
diagnostic techniques, which show the existence of a medical impairment that results
from anatomical, physiological, or psychological abnormalities which could
reasonably be expected to produce the pain or other symptoms alleged and which,
when considered with all the evidence. . . , would lead to a conclusion that the
individual is under a disability.” 42 U.S.C. § 423(d)(5)(A).
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Here the ALJ’s decision scrupulously followed this legal guidance. While the
ALJ carefully considered this plaintiff’s testimony, that testimony was ultimately
found to be not fully credible due to other substantial countervailing evidence. This
contradictory proof which the ALJ found more persuasive in Long’s case included
repeated objective medical testing, treatment and examination reports; medical
opinion evidence; and Long’s own accounts of her activities of daily living. All of this
evidence provided a more complete picture of Long’s residual functional capacity, and
this evidence fully supported the ALJ’s finding that Long retained the ability to
perform some labor in the regional and national economy.
In sum, while we have great empathy for the medical and emotional challenges
confronting Ms. Long, our responsibility in this setting is to determine whether the
ALJ erred in assessing the evidence under a very deferential standard of review, one
which requires less than a preponderance of the evidence, but more than a scintilla of
proof. When we apply this standard of proof to the instant case, we are constrained
to conclude that the ALJ’s decision satisfied this threshold of proof, and must
therefore be affirmed.
IV.
CONCLUSION
Based on the foregoing, the Commissioner’s decision shall be AFFIRMED, and
Ms. Long’s requests for relief shall be DENIED.
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An appropriate order shall follow.
S/ Martin C. Carlson
Martin C. Carlson
United States Magistrate Judge
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