finding no error in ALJ’s assessment of nurse practitioner’s opinion where the severe limitations set forth therein were inconstant with examination findings
How later courts described this case
- finding no error in ALJ’s assessment of nurse practitioner’s opinion where the severe limitations set forth therein were inconstant with examination findings
- holding that review of the Secretary’s decision is not de novo and that the Secretary’s findings are conclusive if supported by substantial evidence
- alteration omitted and quoting Wider v. Colvin, 245 F. Supp. 3d 381, 389 (E.D.N.Y. 2017)
- limitation to simple, routine, and repetitive tasks accounted for the plaintiff’s “mild restrictions in . . . social functioning.”
Written by the judges who cited it.
The opinion
UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF NEW YORK
___________________________________
COLLEEN K.,
Plaintiff, DECISION AND ORDER
v.
1:19-CV-01224 EAW
COMMISSIONER OF SOCIAL SECURITY,
Defendant.
____________________________________
INTRODUCTION
Represented by counsel, Plaintiff Colleen K. (“Plaintiff”) brings this action pursuant
to Title XVI of the Social Security Act (the “Act”), seeking review of the final decision of
the Commissioner of Social Security (the “Commissioner” or “Defendant”) denying her
application for supplemental security income (“SSI”). (Dkt. 1). This Court has jurisdiction
over the matter pursuant to 42 U.S.C. § 405(g). Presently before the Court are the parties’
cross-motions for judgment on the pleadings pursuant to Rule 12(c) of the Federal Rules
of Civil Procedure (Dkt. 10; Dkt. 11), and Plaintiff’s reply (Dkt. 12). For the reasons
discussed below, the Commissioner’s motion (Dkt. 11) is granted and Plaintiff’s motion
(Dkt. 10) is denied.
BACKGROUND
Plaintiff protectively filed her application for SSI on October 20, 2015. (Dkt. 6 at
22, 80).1 In her application, Plaintiff alleged disability beginning November 1, 2014, due
to the following impairments: post-traumatic stress disorder; anxiety; fibromyalgia;
asthma; migraines; inability to use right hand or arm. (Id. at 22, 219, 254). Plaintiff’s
application was initially denied on March 4, 2016. (Id. at 22, 83-86). At Plaintiff’s request,
a hearing was held before administrative law judge (“ALJ”) Stephan Bell in Buffalo, New
York, on August 30, 2018. (Id. at 22, 43-70). On September 21, 2018, the ALJ issued an
unfavorable decision. (Id. at 19-42). Plaintiff requested Appeals Council review; her
request was denied on July 18, 2019, making the ALJ’s determination the Commissioner’s
final decision. (Id. at 8-13). This action followed.
LEGAL STANDARD
I. District Court Review
“In reviewing a final decision of the [Social Security Administration (“SSA”)], this
Court is limited to determining whether the SSA’s conclusions were supported by
substantial evidence in the record and were based on a correct legal standard.” Talavera
v. Astrue, 697 F.3d 145, 151 (2d Cir. 2012) (quotation omitted); see also 42 U.S.C.
§ 405(g). The Act holds that a decision by the Commissioner is “conclusive” if it is
supported by substantial evidence. 42 U.S.C. § 405(g). “Substantial evidence means more
1 When referencing the page number(s) of docket citations in this Decision and Order,
the Court will cite to the CM/ECF-generated page numbers that appear in the upper
righthand corner of each document.
than a mere scintilla. It means such relevant evidence as a reasonable mind might accept
as adequate to support a conclusion.” Moran v. Astrue, 569 F.3d 108, 112 (2d Cir. 2009)
(quotation omitted). It is not the Court’s function to “determine de novo whether [the
claimant] is disabled.” Schaal v. Apfel, 134 F.3d 496, 501 (2d Cir. 1998) (quotation
omitted); see also Wagner v. Sec’y of Health & Human Servs., 906 F.2d 856, 860 (2d Cir.
1990) (holding that review of the Secretary’s decision is not de novo and that the
Secretary’s findings are conclusive if supported by substantial evidence). However, “[t]he
deferential standard of review for substantial evidence does not apply to the
Commissioner’s conclusions of law.” Byam v. Barnhart, 336 F.3d 172, 179 (2d Cir. 2003)
(citing Townley v. Heckler, 748 F.2d 109, 112 (2d Cir. 1984)).
II. Disability Determination
An ALJ follows a five-step sequential evaluation to determine whether a claimant
is disabled within the meaning of the Act. See Parker v. City of New York, 476 U.S. 467,
470-71 (1986). At step one, the ALJ determines whether the claimant is engaged in
substantial gainful work activity. See 20 C.F.R. § 416.920(b). If so, the claimant is not
disabled. If not, the ALJ proceeds to step two and determines whether the claimant has an
impairment, or combination of impairments, that is “severe” within the meaning of the Act,
in that it imposes significant restrictions on the claimant’s ability to perform basic work
activities. Id. § 416.920(c). If the claimant does not have a severe impairment or
combination of impairments, the analysis concludes with a finding of “not disabled.” If
the claimant does have at least one severe impairment, the ALJ continues to step three.
At step three, the ALJ examines whether a claimant’s impairment meets or
medically equals the criteria of a listed impairment in Appendix 1 of Subpart P of
Regulation No. 4 (the “Listings”). Id. § 416.920(d). If the impairment meets or medically
equals the criteria of a Listing and meets the durational requirement (id. § 416.909), the
claimant is disabled. If not, the ALJ determines the claimant’s residual functional capacity
(“RFC”), which is the ability to perform physical or mental work activities on a sustained
basis, notwithstanding limitations for the collective impairments. See id. § 416.920(e).
The ALJ then proceeds to step four and determines whether the claimant’s RFC
permits the claimant to perform the requirements of his or her past relevant work. Id.
§ 416.920(f). If the claimant can perform such requirements, then he or she is not disabled.
If he or she cannot, the analysis proceeds to the fifth and final step, wherein the burden
shifts to the Commissioner to show that the claimant is not disabled. Id. § 416.920(g). To
do so, the Commissioner must present evidence to demonstrate that the claimant “retains a
residual functional capacity to perform alternative substantial gainful work which exists in
the national economy” in light of the claimant’s age, education, and work experience. Rosa
v. Callahan, 168 F.3d 72, 77 (2d Cir. 1999) (quotation omitted).
DISCUSSION
I. The ALJ’s Decision
In determining whether Plaintiff was disabled, the ALJ applied the five-step
sequential evaluation set forth in 20 C.F.R. § 416.920. At step one, the ALJ determined
that Plaintiff had not engaged in substantial gainful work activity since October 20, 2015,
the application date. (Dkt. 6 at 25).
At step two, the ALJ found that Plaintiff suffered from the severe impairments of:
polyneuropathy; history of rectal prolapse; depressive disorder; and anxiety disorder. (Id.).
The ALJ further found that Plaintiff’s medically determinable impairments of carpal tunnel
syndrome, right wrist contusion, history of right distal radius fracture, “status post June
2014 right wrist open reduction, internal fixation,” fibromyalgia, myalgia, cervicalgia, joint
pain, mild obesity, abdominal pain, constipation, headaches, dermatitis, sinusitis, dyspnea,
asthma, tobacco use disorder, tachycardia, sleep disturbance, insomnia, fatigue, malaise,
and vitamin deficiencies were non-severe. (Id.).
At step three, the ALJ found that Plaintiff did not have an impairment or
combination of impairments that met or medically equaled the severity of any Listing. (Id.
at 26). The ALJ particularly considered the criteria of Listings 11.14, 12.04, and 12.06 in
reaching his conclusion. (Id. at 22-23).
Before proceeding to step four, the ALJ determined that Plaintiff retained the RFC
to perform sedentary work as defined in 20 C.F.R. § 416.967(a), but with the following
additional limitations:
[Plaintiff] is able to lift and/or carry ten pounds occasionally and less than
ten pounds frequently, stand and/or walk for two hours in an eight-hour
workday, and sit for six hours in an eight-hour workday. Although [Plaintiff]
is unable to climb ladders, ropes, and scaffolds, she is able to frequently
balance, stoop, kneel, crouch, crawl, and climb ramps and stairs. [Plaintiff]
is able to use her bilateral hands to frequently finger. [Plaintiff] is
occasionally able to work at unprotected heights and around moving
mechanical parts, and she is occasionally able to operate a motor vehicle, but
she is unable to work around vibration. In addition, [Plaintiff] is able to
perform simple, routine, and repetitive tasks and make simple work-related
decisions.
(Id. at 28). At step four, the ALJ found that Plaintiff had no past relevant work. (Id. at 33).
At step five, the ALJ relied on the testimony of a vocational expert (“VE”) to
conclude that, considering Plaintiff’s age, education, work experience, and RFC, there
were jobs that exist in significant numbers in the national economy that Plaintiff could
perform, including the representative occupations of order clerk, optical assembler, and
charge account clerk. (Id. at 33-34). Accordingly, the ALJ found that Plaintiff was not
disabled as defined in the Act. (Id. at 34).
II. The Commissioner’s Determination is Supported by Substantial Evidence and
Free from Reversible Error
Plaintiff asks the Court to either reverse or remand this matter to the Commissioner
for further administrative proceedings, arguing that the ALJ’s physical and mental RFC
findings are unsupported by substantial evidence and that the ALJ erred in weighing the
medical opinions of record. For the reasons set forth below, the Court finds that neither
reversal nor remand are warranted.
A. Physical RFC Finding
In deciding a disability claim, an ALJ is tasked with “weigh[ing] all of the evidence
available to make an RFC finding that [is] consistent with the record as a whole.” Matta
v. Astrue, 508 F. App'x 53, 56 (2d Cir. 2013). An ALJ’s conclusion need not “perfectly
correspond with any of the opinions of medical sources cited in his decision.” Id.
However, an ALJ is not a medical professional, and “is not qualified to assess a claimant’s
RFC on the basis of bare medical findings.” Ortiz v. Colvin, 298 F. Supp. 3d 581, 586
(W.D.N.Y. 2018) (quotation omitted). “[A]s a result[,] an ALJ’s determination of RFC
without a medical advisor’s assessment is not supported by substantial evidence.” Dennis
v. Colvin, 195 F. Supp. 3d 469, 474 (W.D.N.Y. 2016) (quotation omitted).
Here, the ALJ formulated his physical RFC finding by relying on the medical
opinion of consultative examiner Dr. Donna Miller, along with Plaintiff’s treatment records
and testimony. Dr. Miller performed a physical examination of Plaintiff on February 4,
2016, and assessed no limitations in sitting, standing, walking, or use of extremities, but
opined that Plaintiff should avoid dust, irritants, and tobacco exposure. (Dkt. 6-1 at 127-
29).
The ALJ gave “reduced weight” to Dr. Miller’s opinion in assessing Plaintiff’s
physical RFC. (Dkt. 6 at 31). In particular, the ALJ explained that the medical evidence
of record did not support the conclusion that Plaintiff needed to avoid respiratory irritants,
because her asthma was well-controlled when she was compliant with her treatment. (Id.).
The ALJ further explained that some limitation in Plaintiff’s ability to “lift, carry, stand,
walk, sit, and engage in postural activities” was appropriate in light of her “ongoing
conservative treatment for polyneuropathy[.]” (Id.). The ALJ noted that Plaintiff had
undergone an open reduction, internal fixation surgical procedure due to a right wrist
fracture in June 2014—prior to both the alleged onset date and the application date—and
that her associated pain and symptoms had “responded well to conservative treatment
modalities” such as “medication management, activity modification, home exercises, the
use of wrist splints, and specialist treatment with orthopedists.” (Id. at 30). The ALJ
further noted that at the consultative examination in February 2016, Plaintiff denied having
any issues with her hands and was observed to have “intact hand and finger dexterity with
full bilateral grip strength.” (Id.). The ALJ also considered Plaintiff’s testimony regarding
her abilities, including her testimony that she “experiences a faint feeling in her fingertips
after several hours,” that standing upright can trigger pain, that she has difficulty sitting,
and that she “has difficulty bending and picking up objects.” (Id. at 29). The ALJ
determined that Plaintiff’s claims regarding her symptoms were not fully credible. (Id. at
30). Based on his assessment of all the evidence of record, the ALJ reached the RFC
determination set forth above.
The Court finds no reversible error in the ALJ’s assessment of Plaintiff’s physical
RFC. The ALJ’s conclusion that Plaintiff is capable of a limited range of sedentary work
is amply supported by Dr. Miller’s unremarkable physical examination and associated
medical opinion, as well as Plaintiff’s treatment records, which generally reflect normal
musculoskeletal examinations, including normal upper and lower extremities. (See, e.g.,
Dkt. 6-1 at 146, 159-60, 165, 184; Dkt. 6-2 at 125, 131, 138, 145, 156, 160, 190, 202, 205).
The fact that the ALJ partially credited Plaintiff’s testimony regarding her physical abilities
and accordingly incorporated exertional and postural limitations into the RFC beyond those
identified by Dr. Miller is not a basis for remand. See Beckles v. Comm’r of Soc. Sec., No.
18-CV-321P, 2019 WL 4140936, at *5 (W.D.N.Y. Aug. 30, 2019) (“The ALJ did not err
. . . by including greater limitations in her RFC determination than those opined by [Dr.]
Miller.”).
Plaintiff argues that the ALJ failed to properly consider the opinions of orthopedic
surgeon Dr. Lindsay Clark and Nurse Practitioner (“NP”) Mary Ellen Brown in assessing
her ability to lift and use her hands. The Court finds this argument without merit. As to
Dr. Clark’s opinions, as the ALJ explained, they were issued in September 2014, prior to
the alleged onset date and more than a year before the application date. (Dkt. 6 at 32; see
Dkt. 6-1 at 69, 262-63). Moreover, Dr. Clark expressly opined that the limitations she had
identified were expected to last for only “1-3 months.” (Dkt. 6-1 at 263). The ALJ did not
err in concluding that Dr. Clark’s opinions were not relevant to Plaintiff’s functioning
during the time period at issue.
As to NP Brown’s opinions, under the regulations applicable to Plaintiff’s claims,
“nurse practitioners are not considered ‘acceptable medical sources,’ and their opinions are
therefore not ‘entitled to any particular weight.’” Coger v. Comm’r of Soc. Sec., 335 F.
Supp. 3d 427, 432 (W.D.N.Y. 2018) (alteration omitted and quoting Wider v. Colvin, 245
F. Supp. 3d 381, 389 (E.D.N.Y. 2017)). Accordingly, while the ALJ was required to
consider NP Brown’s opinions, he was free to discount them to the extent he determined
they were inconsistent with the other evidence of record. Here, the ALJ took into account
NP Brown’s treating relationship with Plaintiff, but nonetheless afforded little weight to
her various opinions because the “extreme limitations” set forth therein were unsupported
by the objective medical evidence. (Dkt. 6 at 32). The Court finds no error in this
conclusion. See Coger, 335 F. Supp. 3d at 434 (finding no error in ALJ’s assessment of
nurse practitioner’s opinion where the severe limitations set forth therein were inconstant
with examination findings). As set forth above, Plaintiff’s medical records consistently
reflect normal musculoskeletal examinations. There is no support in the record for, for
example, NP Brown’s opinion that Plaintiff would need to use a cane or to elevate her legs
for 100% of the day and is unable to sit for longer than ten minutes or walk more than 30
feet. To the contrary, NP Brown herself recommended that Plaintiff exercise for 30
minutes per day. (Dkt. 6-2 at 352).
The Court further is not persuaded by Plaintiff’s contention that the ALJ failed to
explain why he discounted Dr. Miller’s opinion that Plaintiff should avoid respiratory
irritants. As noted above, the ALJ explained that he found this portion of Dr. Miller’s
opinion inconsistent with the evidence of record demonstrating that Plaintiff’s asthma was
well-controlled with treatment. (Dkt. 6 at 31). Moreover, even if the ALJ should have
credited this aspect of Dr. Miller’s opinion, any error in this regard was harmless, because
none of the representative occupations identified by the VE require exposure to respiratory
irritants. See Dictionary of Occupational Titles 209.567-014, 1991 WL 671794 (order
clerk); id. 713.687-018, 1991 WL 679271 (optical assembler); id. 205.367-014, 1991 WL
671715 (charge account clerk); see also Poles v. Berryhill, No. 17CV6189(MAT), 2018
WL 1471884, at *4 (W.D.N.Y. Mar. 26, 2018) (finding purported error in assessing RFC
harmless where it did not impact conclusion that the plaintiff was capable of performing
representative occupations identified by VE).
For all these reasons, the Court rejects Plaintiff’s argument that the ALJ committed
reversible error in assessing her physical RFC.
B. Mental RFC Finding
The Court further finds no error by the ALJ in assessing Plaintiff’s mental RFC. In
reaching his determination as to Plaintiff’s mental RFC, the ALJ afforded “very significant
weight” to the opinion of consultative examiner Dr. Gregory Fabiano. (Dkt. 6 at 31). Dr.
Fabiano examined Plaintiff on February 4, 2016. (Dkt. 6-1 at 122). He assessed Plaintiff
with “[u]nspecified anxiety disorder” and “[o]pioid substance use disorder, in early full
remission,” and opined that she had “moderate limitations in the ability to maintain
attention and concentration and appropriately deal with stress,” “some mild limitations in
her ability to relate adequately with others,” and no limitations in “the ability to follow and
understand simple directions and instructions, perform simple tasks independently,
maintain a regular schedule, learn new tasks, perform complex tasks independently, or
make appropriate decisions.” (Id. at 125).
Plaintiff contends that in fashioning his mental RFC finding, the ALJ failed to
account for Dr. Fabiano’s opinion that she had mild limitations in social functioning and
moderate limitations in the ability to maintain attention and concentration and
appropriately deal with stress. This argument is without merit. Dr. Fabiano also concluded
that these limitations would not prevent Plaintiff from following and understanding simple
directions and instructions, learning new tasks, performing both simple and complex tasks
independently, and making appropriate decisions. (Id.). Accordingly, the ALJ’s
conclusion that Plaintiff could perform “simple, routine, and repetitive tasks and make
simple work-related decisions” is fully consistent with Dr. Fabiano’s opinion. See, e.g.,
Blocker v. Saul, No. 18-CV-6788F, 2020 WL 1047737, at *6 (W.D.N.Y. Mar. 4, 2020)
(finding RFC limiting plaintiff to simple, routine and repetitive tasks in a work
environment free of fast-paced production requirements sufficient to account for marked
limitation in dealing with stress); Broadbent v. Saul, No. 3:18-cv-02127(WIG), 2019 WL
4295328, at *5 (D. Conn. Sept. 11, 2019) (explaining that “courts routinely find that a
claimant who has moderate limitations in memory and concentration can perform simple
routine, tasks”); Williams v. Colvin, 98 F. Supp. 3d 614, 633 (W.D.N.Y. 2015) (“[T]he
ALJ’s finding that Plaintiff can engage in simple tasks is consistent with the opinions of
Dr. Jones and Dr. Altmansberger, who determined that although Plaintiff had mild to
moderate difficulties with regard to concentration, persistence, or pace, she was capable of
performing unskilled work.”); Diakogiannis v. Astrue, 975 F. Supp. 2d 299, 315
(W.D.N.Y. 2013) (limitation to simple, routine, and repetitive tasks accounted for the
plaintiff’s “mild restrictions in . . . social functioning.”).
The Court further finds that the ALJ did not err in affording little weight to NP
Brown’s opinions regarding Plaintiff’s mental impairments. The ALJ again appropriately
found that NP Brown had assessed extreme limitations inconsistent with the evidence of
record. (Dkt. 6 at 32). For example, NP Brown opined that Plaintiff was “completely
agoraphobic” and unable to engage in any social interaction. (See id.). However, Plaintiff
herself testified that she had a boyfriend, that she periodically attended a “self-help group”
with a friend, and that she would go shopping with her boyfriend. (Id. at 49, 57). The ALJ
was within his discretion to conclude that Dr. Fabiano’s opinion provided a more accurate
assessment of Plaintiff’s mental functioning than NP Brown’s opinions.
CONCLUSION
For the foregoing reasons, the Commissioner’s motion for judgment on the
pleadings (Dkt. 11) is granted, and Plaintiff’s motion for judgment on the pleadings (Dkt.
10) is denied. The Clerk of Court is directed to enter judgment and close this case.
SO ORDERED.
________________________________
ELIZABETH A. WOLFORD
United States District Judge
Dated: January 13, 2021
Rochester, New York