Bowman v. Commissioner of Social Security

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF PENNSYLVANIA

KETURAH AUDRA BOWMAN, : Civil No. 1:21-cv-751

:

Plaintiff :

:

v. :

: (Magistrate Judge Carlson)

KILOLO KIJAKAZI, :

Acting Commissioner of Social Security1, :

:

Defendant :

MEMORANDUM OPINION

I. Introduction

Social Security appeals often entail legal challenges to an Administrative Law

Judge’s (ALJ) assessment of medical opinion evidence. So it is in the instant case.

In this appeal, the plaintiff, Keturah Bowman advances a single, specific argument,

asserting that the ALJ’s determination that she retained the residual functional

capacity to perform light work was the product of legal error because the ALJ failed

to properly evaluate the opinions of Bowman’s treating physician, Dr. Ann Ramage.

1 Kilolo Kijakazi became the Acting Commissioner of Social Security on

July 9, 2021. Accordingly, pursuant to Rule 25(d) of the Federal Rules of Civil

Procedure and 42 U.S.C. § 405(g) Kilolo Kijakazi is substituted for Andrew

Saul as the defendant in this suit.

1

In the decision denying Bowman’s application for benefits, the ALJ gave Dr.

Ramage’s medical opinion concerning Bowman’s physical limitations “little

weight,” observing that:

[T]he record includes an August 2017 statement from Ann Ramage,

MD, the claimant’s primary care provider. Dr. Ramage stated that the

claimant’s symptoms constantly interfere with her attention and

concentration; she must lie down or recline in excess o[f] normal breaks

during an eight-hour workday; and can walk one block. Dr. Ramage

noted the claimant can sit one hour total and stand/walk no hours in an

eight-hour workday; needs 16 unscheduled half-hour breaks in an

eight-hour workday, can occasionally lift and carry less than ten

pounds, and can handle, finger, and reach ten percent of the time

(B28F/3). Dr. Ramage indicated the claimant will be absent more than

four times a month (B28F/4). In August 2016, Dr. Ramage reported the

claimant “did have FCE and determined she could drive short

distances” (B10F/15). These opinions are unsupported by the

longitudinal treatment notes, which generally show the claimant in no

acute distress with normal gait, normal station, normal range of motion,

full strength, normal pedal pulses, normal sensation, lungs clear to

auscultation and percussion, normal respiration rate, equal and non-

labored breath sounds, no focal deficit, and no edema (B4F; B7F; B8F;

B9F; B10F; B17F; B18F; B23F; B26F; B30F, B32F; B34F; B38F;

B39F; B40F; B44F). These opinions are also unsupported because they

are a checklist and conclusory statement with minimal explanation.

Additionally, these opinions are inconsistent with the claimant’s

activities of daily living, which shows she can perform most personal

care activities, drive short distances, and shop for necessities (B8E).

Further, the record does not document problems with use of the left

upper extremity, the limitation to sitting one hour in an eight-hour

workday, and the claimant utilizes very conservative treatment for her

carpal tunnel syndrome.

(Tr. 18-19).

2

The ALJ also gave little weight to Dr. Ramage’s August 2017 statement,

which opined that the Bowman had moderate limitations in understanding,

remembering, or applying information; extreme limitations in concentrating,

persisting, or maintaining pace; moderate limitations in adapting or managing

herself; and moderate limitations in interacting with others. (Tr. 19-20). According

to the ALJ:

This opinion is unsupported by the progress notes through the date last

insured, which mostly show the claimant was fully oriented and

cooperative with appropriate mood, appropriate affect, normal

languages, appropriate behavior, appropriate dress, organized and

coherent thought process, normal speech, intact immediate memory,

intact recent memory, intact remote memory, intact concentration,

normal sleep, normal appetite, normal attention, normal energy, good

insight, and good judgment (B7F; B10F; B17F; B20F; B23F; B26F;

B30F; B32F; B33F; B34F; B39F; B40F; B44F; B45F; B47F). This

opinion is also unsupported because it is a checklist with minimal

explanation. Further, this opinion is inconsistent with the claimant’s

activities of daily living, which shows she can drive and manage

finances (B8E). Additionally, this opinion is inconsistent with the

claimant’s lack of inpatient mental health treatment or referral to crisis

intervention through the date last insured.

(Id.)

In evaluating the sufficiency of the ALJ’s assessment of this medical opinion,

we are enjoined to apply a deferential standard of review, one which simply calls for

a determination of whether substantial evidence supported the ALJ’s decision.

Mindful of the fact that, in this context, substantial evidence is a term of art which

3

“means only— ‘such relevant evidence as a reasonable mind might accept as

adequate to support a conclusion,’” Biestek v. Berryhill, 139 S. Ct. 1148, 1154

(2019), we find that substantial evidence supported the ALJ’s findings which

afforded little weight to Dr. Ramage’s medical opinions. Therefore, for the reasons

set forth below, we will affirm the decision of the Commissioner denying this claim.

II. Statement of Facts and of the Case

A. Procedural Background

According to the administrative record, this is the plaintiff’s second Social

Security disability application. Ms. Bowman had previously applied for benefits in

November of 2011, but that initial application was denied in August of 2012 and the

ALJ’s decision was upheld by the Appeals Council in 2015. (Tr. 140).

On June 20, 2016, Keturah Bowman applied for benefits under Title II of the

Social Security Act, alleging an onset of disability beginning in September of 2013.

(Tr. 158, 323). Bowman was born in 1974 and was 38 years old at the time of the

alleged onset of her disability. (Tr. 21). Bowman was, therefore, considered a

younger worker under the Commissioner’s regulations. She had two years of college

education, (Tr. 56), and prior employment as a medical secretary, data entry clerk,

and nursery school attendant. (Tr. 89, 59, 372).

4

In her June 2016 disability application, Ms. Bowman reported experiencing a

number of physical and emotional impairments including diabetes, asthma, obesity,

depression, concussion, and post-concussion syndrome status post mild traumatic

brain injury. (Tr. 13). The precipitating event which led to this disability application

was a work-related injury. Ms. Bowman was reportedly kicked in the head by a five-

year-old on September 19, 2013, while working at a daycare center. (Tr. 1188-89).

Following this injury, Bowman had worked part-time at the daycare from January

through August of 2014, (Tr. 104-05), and had received a workers compensation

settlement. (Tr. 118).

Bowman’s date last insured for purposes of Social Security eligibility was

June 30, 2018. (Tr. 12). Thus, the question before the ALJ in the instant case was

whether the evidence demonstrated that Bowman was totally disabled between her

alleged date of onset of disability, September 2013, and her date last insured, June

30, 2018. With the issues framed in this fashion, Bowman’s claim was denied at the

administrative level on October 27, 2016. (Tr. 154). Bowman sought review of this

decision, and following a hearing conducted on February 3, 2018, (Tr. 98-138), an

ALJ entered an initial decision denying her claim on June 11, 2018. (Tr. 158-70).

Upon agency review, the Social Security Appeals Council entered an order on

October 30, 2019 remanding Bowman’s claims for further consideration by an ALJ,

5

(Tr. 177), thus setting the stage for the decision which is now the subject of this

appeal.

B. Bowman’s Treatment History and Medical Opinions

This Social Security appeal presents a singular question for our consideration;

namely, was the ALJ’s determination that Ms. Bowman retained the residual

functional capacity to perform light work the product of legal error because the ALJ

failed to properly evaluate the opinions of Bowman’s treating physician, Dr. Ann

Ramage? (Doc. 20 at 3). As to this issue, the administrative record reveals the

following:

During the pertinent time frame, between September 2013 and June 2018,

Bowman’s primary care physician was Dr. Ann Ramage. For the most part, Ms.

Bowman’s treatment records from this period are remarkably unremarkable. (Tr.

913-1132). Thus, the treatment records consist largely of routine check-ups, coupled

with treatment of various minor medical matters such as allergic reactions to hand

sanitizer. Objective testing yielded few noteworthy results, physical examinations

frequently resulted in normal findings, and Bowman often denied having other

complaints beyond occasional issues with asthma and chronic headaches.

Bowman was seen by Dr. Ramage on October 7, 2013, one month after the

alleged onset of her disability. (Tr. 1017-19). At that time, Bowman complained of

6

a kidney stone. (Id.) While it was noted that Bowman has intermittent headaches,

on October 7 she denied experiencing headaches or any other symptoms unrelated

to her kidney stone. (Tr. 1018). At an October 17, 2013 appointment, Bowman once

again denied any problems beyond a headache and rash. (Tr. 993). A November 25,

2013 routine appointment revealed that her asthma, diabetes, and hypertension were

all under control, and that her post-concussive headache was being managed by

another physician. (Tr. 985).

Similar, and similarly unremarkable, medical findings were made by Dr.

Ramage during routine check-ups in March, April, September, November, and

December of 2014. (Tr. 961-83). In March of 2014, Bowman had a routine follow

up appointment with Dr. Ramage. (Tr. 977-78). At that time she complained of a dry

mouth but exhibited no other acute symptoms. (Tr. 978-83). On April 4, 2014,

Bowman was seen by Dr. Ramage complaining of a clogged left ear for the past six

months. (Tr. 975). Beyond noting some chronic headaches, however, her

examination results and self-reported medical history were unremarkable. (Tr. 977-

78). On September 3, 2014, Bowman was seen for a follow up appointment

regarding her chronic conditions. (Tr. 966). While she continued to describe

headaches and depression, her asthma and diabetes were under control. (Tr. 967).

She denied other problems and her examination results were normal. (Tr. 969-70).

7

Two months later, on November 3, 2014, Bowman had another routine follow

up appointment. (Tr. 961). Once again, except for headaches which were being

treated by a neurologist, the findings from this appointment were benign and not

noteworthy. (Tr. 961-66). A December 1, 2014 appointment yielded similar results.

(Tr. 969-70). Moreover, objective medical testing conducted in 2014 provided scant

support for Bowman’s claims of disability. A January 23, 2014 MRI revealed no

cute intracranial abnormalities. (Tr. 1187). Likewise, a February 8, 2014 x-ray only

disclosed mild degenerative disc disease in the cervical spine. (Tr. 1185).

Bowman’s primary care treatment records from 2015 followed a similar

pattern of routine visits punctuated by largely unremarkable findings. (Tr. 937-54).

During clinical encounters in January, July, and November 2015, Dr. Ramage

documented complaints by Bowman of headaches but noted otherwise normal and

benign findings. (Id.) Bowman consistently denied any other acute medical

problems. (Tr. 946, 954). Furthermore, treatment records from Bowman’s

neurologist, who was taking the lead in addressing her post-concussion headaches,

documented steady improvement in her condition during this time frame. For

example, neurology treatment records reported improvements in her neurological

symptoms in March, May, and September of 2014. (Tr. 1157, 1166, 1172). By May

of 2014, it was noted that Bowman was working two hours on a computer. (Tr.

8

1167). Further, May 5, 2015 neurology records indicated that Bowman continued to

display improvement in her symptoms. (Tr. 1152). On September 10, 2015, it was

reported that Bowman had a functional capacity examination which determined that

she could drive short distances, and she was looking for sedentary, secretarial work.

(Tr. 1148). At this time, according to her neurologist Bowman was experiencing

slow improvement in walking and mild improvement in her headaches. (Tr. 1147).

She also displayed no acute distress. (Tr. 1151).

Ms. Bowman continued to be treated by Dr. Ramage in February, March,

April, August, and September of 2016. (Tr. 913-36, 1021-26, 1261). While she

suffered from some episodes of sinusitis and asthma in February and March (Tr. 925,

932), and continued to complain of headaches in August 2016 (Tr. 914), treatment

records show that Bowman’s diabetes was under control and her examination

findings were largely unchanged. (Tr. 917-18, 930, 936, 1026). Bowman also

described to her caregivers an ability to attend to recreational pursuits. Thus, on April

27, 2016, Bowman reported that she was going on a cruise and was not having any

problems with her asthma. (Tr. 1026).

Bowman reported experiencing a fall during a follow-up appointment with

her family practice in January of 2017. (Tr. 1670). However, records, of her clinical

encounters in March, April, May, July, August, and October of 2017 generally

9

confirmed that her asthma and diabetes were well controlled, and aside from her

headaches and some body aches, Bowman denied any other acute medical problems.

(Tr. 1635-70). Moreover, on May 20, 2017, Bowman was discharged from a

physical therapy program at Wellspan “secondary to good progression.” (Tr. 1369).

In particular, during an August 15, 2017 appointment, Bowman denied any

physical or emotional problems, (Tr. 1644), but a “[l]engthy review of her physical

symptoms were documented for disability.” (Tr. 1641). That “lengthy review” was

later reflected in physical and mental capacity assessments submitted by Dr. Ramage

on August 15, 2017. (Tr. 1452-58). These assessment forms stood in stark contrast

to the doctor’s treatment notes. With respect to Bowman’s physical limitations, on a

check box form Dr. Ramage stated that Bowman’s symptoms constantly interfered

with her attention and concentration; that she would need to lie down or recline in

excess of normal breaks during an eight-hour workday; that she could only walk one

block; that she could sit one hour total during a work day and was unable to stand or

walk at work; that she would need 16 unscheduled half-hour breaks in an eight-hour

workday; that she can only occasionally lift and carry less than ten pounds; that she

can never left of carry weights in excess of ten pounds; that she can handle, finger,

and reach during only ten percent of the time; and that she should be absent from

work more than four times each month. (Tr.1452-53). Thus, Dr. Ramage’s cursory

10

physical assessment form indicated that Bowman’s entire work day would consist

of a series of sixteen unscheduled half hour breaks.

Using a similar check box form, Dr. Ramage opined that the Bowman had

moderate limitations in understanding, remembering, or applying information;

extreme limitations in concentrating, persisting, or maintaining pace; moderate

limitations in adapting or managing herself; and moderate limitations in interacting

with others. (Tr. 1456-58). These conclusions were at odds with the opinions of the

state agency psychologist who found that Bowman had a greater capacity to

undertake the emotional demands of the workplace. (Tr. 139-51).

It was on this record, a record marked by a striking contrast between Dr.

Ramage’s medical opinions and her own clinical treatment records, that Bowman’s

disability application came to be heard by the ALJ.

C. The ALJ’s Hearing and Decision

It is against the backdrop of this evidence that the ALJ conducted a hearing in

Bowman’s case on April 29, 2020. (Tr. 47-97). During this hearing, the ALJ received

testimony from Bowman and a vocational expert. Following these hearings, on May

12, 2020, the ALJ issued a decision denying this application for benefits. (Tr. 7-22).

In that decision, the ALJ first concluded that Bowman met the insured status

requirements of the Social Security Act through June 30, 2018. (Tr. 12). At Step 2

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of the sequential analysis that governs Social Security cases, the ALJ found that

Bowman’s asthma, obesity, depression, concussion, and post-concussion syndrome

status post mild traumatic brain injury were severe impairments (Tr. 13).

At Step 3, the ALJ determined that none of these impairments met or

medically equaled the severity of one of the listed impairments. (Tr. 14-15). Between

Steps 3 and 4, the ALJ concluded that Bowman retained the following residual

functional capacity (“RFC”):

After careful consideration of the entire record, I find that, through the

date last insured, the claimant had the residual functional capacity to

perform light work as defined in 20 CFR 404.1567(b) and she could not

have tolerated concentrated exposure to humidity; poorly ventilated

areas; or irritants, such as fumes, odors, dusts, gases, and chemicals.

She could not have tolerated workplace hazards, such as moving

mechanical parts, and high, exposed places. She had the mental

capacity to tolerate occasional changes in the work setting.

(Tr. 15-16).

In reaching this RFC determination, the ALJ detailed Bowman’s treatment

history at length, noting the numerous instances in which clinical records reflected

relatively benign or unremarkable findings. (Tr. 16-18). The ALJ also evaluated the

medical opinion of Dr. Ramage, the sole medical source who described Bowman as

being totally disabled, examining this opinion in light of this clinical record. On this

score, the ALJ first turned to Dr. Ramage’s physical assessment of the plaintiff. The

12

ALJ gave Dr. Ramage’s medical opinion concerning Bowman’s physical limitations

“little weight,” observing that:

[T]he record includes an August 2017 statement from Ann Ramage,

MD, the claimant’s primary care provider. Dr. Ramage stated that the

claimant’s symptoms constantly interfere with her attention and

concentration; she must lie down or recline in excess o[f] normal breaks

during an eight-hour workday; and can walk one block. Dr. Ramage

noted the claimant can sit one hour total and stand/walk no hours in an

eight-hour workday; needs 16 unscheduled half-hour breaks in an

eight-hour workday, can occasionally lift and carry less than ten

pounds, and can handle, finger, and reach ten percent of the time

(B28F/3). Dr. Ramage indicated the claimant will be absent more than

four times a month (B28F/4). In August 2016, Dr. Ramage reported the

claimant “did have FCE and determined she could drive short

distances” (B10F/15). These opinions are unsupported by the

longitudinal treatment notes, which generally show the claimant in no

acute distress with normal gait, normal station, normal range of motion,

full strength, normal pedal pulses, normal sensation, lungs clear to

auscultation and percussion, normal respiration rate, equal and non-

labored breath sounds, no focal deficit, and no edema (B4F; B7F; B8F;

B9F; B10F; B17F; B18F; B23F; B26F; B30F, B32F; B34F; B38F;

B39F; B40F; B44F). These opinions are also unsupported because they

are a checklist and conclusory statement with minimal explanation.

Additionally, these opinions are inconsistent with the claimant’s

activities of daily living, which shows she can perform most personal

care activities, drive short distances, and shop for necessities (B8E).

Further, the record does not document problems with use of the left

upper extremity, the limitation to sitting one hour in an eight-hour

workday, and the claimant utilizes very conservative treatment for her

carpal tunnel syndrome.

(Tr. 18-19).

Likewise the ALJ afforded little weight to Dr. Ramage’s mental

capacity assessment, stating that:

13

This opinion is unsupported by the progress notes through the date last

insured, which mostly show the claimant was fully oriented and

cooperative with appropriate mood, appropriate affect, normal

languages, appropriate behavior, appropriate dress, organized and

coherent thought process, normal speech, intact immediate memory,

intact recent memory, intact remote memory, intact concentration,

normal sleep, normal appetite, normal attention, normal energy, good

insight, and good judgment (B7F; B10F; B17F; B20F; B23F; B26F;

B30F; B32F; B33F; B34F; B39F; B40F; B44F; B45F; B47F). This

opinion is also unsupported because it is a checklist with minimal

explanation. Further, this opinion is inconsistent with the claimant’s

activities of daily living, which shows she can drive and manage

finances (B8E). Additionally, this opinion is inconsistent with the

claimant’s lack of inpatient mental health treatment or referral to crisis

intervention through the date last insured. Further, I note Dr. Ramage

is not a mental health specialist. Accordingly, I give this opinion little

weight.

(Tr. 19-20).

Instead, the ALJ gave greater weight to the opinions of the state agency expert

who determined that Bowman had a greater capacity to meet the emotional demands

of the workplace. (Tr. 19). Having reached these conclusions regarding the medical

clinical and opinion evidence, the ALJ found that, although Bowman was unable to

return to her past relevant work, she could perform jobs that existed in significant

numbers in the national economy. (Tr. 20-22). Accordingly, the ALJ determined that

Bowman had not met the demanding showing necessary to sustain this claim for

benefits and denied this claim. (Tr. 22).

14

This appeal followed. (Doc. 1). On appeal, Bowman advances a single,

narrowly focused claim, asserting that the ALJ’s determination that she retained the

residual functional capacity to perform light work was the product of legal error

because the ALJ failed to properly evaluate the opinions of Bowman’s treating

physician, Dr. Ann Ramage. This appeal is fully briefed by the parties and is,

therefore, ripe for resolution. As discussed in greater detail below, having considered

the arguments of counsel, carefully reviewed the record, and remaining mindful of

the deferential standard of review which applies here, we conclude that the ALJ’s

decision and evaluation of Dr. Ramage’s medical opinion is supported by substantial

evidence, and thus we will affirm the decision of the Commissioner denying this

claim.

III. Discussion

A. Substantial Evidence Review – the Role of this Court

When reviewing the Commissioner’s final decision denying a 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

15

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

“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 Supreme Court has underscored for us the limited scope of our review in

this field, noting that:

The phrase “substantial evidence” is a “term of art” used throughout

administrative law to describe how courts are to review agency

factfinding. T-Mobile South, LLC v. Roswell, 574 U.S. ––––, ––––,

135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-

evidence standard, a court looks to an existing administrative record

and asks whether it contains “sufficien[t] evidence” to support the

agency's factual determinations. Consolidated Edison Co. v. NLRB,

305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis

16

deleted). And whatever the meaning of “substantial” in other contexts,

the threshold for such evidentiary sufficiency is not high. Substantial

evidence, this Court has said, is “more than a mere scintilla.” Ibid.; see,

e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks

omitted). It means—and means only—“such relevant evidence as a

reasonable mind might accept as adequate to support a conclusion.”

Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v.

Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999)

(comparing the substantial-evidence standard to the deferential clearly-

erroneous standard).

Biestek, 139 S. Ct. at 1154.

The question before this Court, therefore, is not whether the claimant is

disabled, but rather 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. 3:12-CV-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 . . . .”).

Several fundamental legal propositions flow from this deferential standard of

review. First, when conducting this review “we are mindful that we must not

17

substitute our own judgment for that of the fact finder.” Zirnsak v. Colvin, 777 F.3d

607, 611 (3d Cir. 2014) (citing Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir.

2005)). Thus, we are enjoined to refrain from trying to re-weigh the evidence. Rather

our task is to simply determine whether substantial evidence supported the ALJ’s

findings. However, we must also ascertain whether the ALJ’s decision meets the

burden of articulation demanded by the courts to enable informed judicial review.

Simply put, “this Court requires the ALJ to set forth the reasons for his decision.”

Burnett v. Comm'r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000). As the

Court of Appeals has noted on this score:

In Burnett, we held that an ALJ must clearly set forth the reasons for

his decision. 220 F.3d at 119. Conclusory statements . . . are

insufficient. The ALJ must provide a “discussion of the evidence” and

an “explanation of reasoning” for his conclusion sufficient to enable

meaningful judicial review. Id. at 120; see Jones v. Barnhart, 364 F.3d

501, 505 & n. 3 (3d Cir.2004). The ALJ, of course, need not employ

particular “magic” words: “Burnett does not require the ALJ to use

particular language or adhere to a particular format in conducting his

analysis.” Jones, 364 F.3d at 505.

Diaz v. Comm'r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009).

Thus, in practice ours is a twofold task. We must evaluate the substance of the

ALJ’s decision under a deferential standard of review, but we must also give that

decision careful scrutiny to ensure that the rationale for the ALJ’s actions is

sufficiently articulated to permit meaningful judicial review.

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This principle applies with particular force to legal challenges, like the claim

made here, based upon alleged inadequacies in the articulation of a claimant’s

mental RFC. In Hess v. Comm’r Soc. Sec., 931 F.3d 198, 212 (3d Cir. 2019), the

United States Court of Appeals recently addressed the standards of articulation that

apply in this setting. In Hess, the court of appeals considered the question of whether

an RFC, which limited a claimant to simple tasks, adequately addressed moderate

limitations on concentration, persistence, and pace. In addressing the plaintiff’s

argument that the language used by the ALJ to describe the claimant’s mental

limitations was legally insufficient, the court of appeals rejected a per se rule which

would require the ALJ to adhere to a particular format in conducting this analysis.

Instead, framing this issue as a question of adequate articulation of the ALJ’s

rationale, the court held that, “as long as the ALJ offers a ‘valid explanation,’ a

‘simple tasks’ limitation is permitted after a finding that a claimant has ‘moderate’

difficulties in ‘concentration, persistence, or pace.’” Hess v. Comm’r Soc. Sec., 931

F.3d 198, 211 (3d Cir. 2019). On this score, the appellate court indicated that an ALJ

offers a valid explanation a mental RFC when the ALJ highlights factors such as

“mental status examinations and reports that revealed that [the claimant] could

function effectively; opinion evidence showing that [the claimant] could do simple

19

work; and [the claimant]’s activities of daily living, . . . . ” Hess v. Comm’r Soc.

Sec., 931 F.3d 198, 214 (3d Cir. 2019).

In our view, the teachings of the Hess decision are straightforward. In

formulating a mental RFC, the ALJ does not need to rely upon any particular form

of words. Further, the adequacy of the mental RFC is not gauged in the abstract.

Instead, the evaluation of a claimant’s ability to undertake the mental demands of

the workplace will be viewed in the factual context of the case, and a mental RFC is

sufficient if it is supported by a valid explanation grounded in the evidence.

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); 42 U.S.C.

§1382c(a)(3)(A); see also 20 C.F.R. §§404.1505(a), 416.905(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); 42 U.S.C.

§1382c(a)(3)(B); 20 C.F.R. §§404.1505(a), 416.905(a). To receive benefits under

20

Title II of the Social Security Act, a claimant must 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

five-step sequential evaluation process. 20 C.F.R. §§404.1520(a), 416.920(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 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), 416.920(a)(4).

Between Steps 3 and 4, the ALJ must also assess a claimant’s residual

functional capacity (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, 220 F.3d

at 121 (citations omitted); see also 20 C.F.R. §§404.1520(e), 404.1545(a)(1),

416.920(e), 416.945(a)(1). In making this assessment, the ALJ considers all of the

claimant’s medically determinable impairments, including any non-severe

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impairments identified by the ALJ at step two of his or her analysis. 20 C.F.R.

§§404.1545(a)(2), 416.945(a)(2).

Once the ALJ has made this determination, our review of the ALJ's

assessment of the plaintiff's RFC is deferential, and that 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); see also Rathbun v. Berryhill, No. 3:17-CV-00301, 2018 WL

1514383, at *6 (M.D. Pa. Mar. 12, 2018), report and recommendation adopted, No.

3:17-CV-301, 2018 WL 1479366 (M.D. Pa. Mar. 27, 2018); Metzger v. Berryhill,

No. 3:16-CV-1929, 2017 WL 1483328, at *5 (M.D. Pa. Mar. 29, 2017), report and

recommendation adopted sub nom. Metzgar v. Colvin, No. 3:16-CV-1929, 2017 WL

1479426 (M.D. Pa. Apr. 21, 2017)..

At Steps 1 through 4, 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. Mason, 994 F.2d at 1064. Once this

burden has been met by the claimant, it shifts to the Commissioner at Step 5 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), 416.912(f); Mason, 994 F.2d at 1064.

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There is an undeniable medical aspect to an RFC determination, since that

determination entails an assessment of what work the claimant can do given the

physical limitations that the claimant experiences. Yet, when considering the role

and necessity of medical opinion evidence in making this determination, courts have

followed several different paths. Some courts emphasize the importance of medical

opinion support for an RFC determination and state that “[r]arely can a decision be

made regarding a claimant's residual functional capacity without an assessment from

a physician regarding the functional abilities of the claimant.” Biller v. Acting

Comm’r of Soc. Sec., 962 F.Supp.2d 761, 778–79 (W.D. Pa. 2013) (quoting

Gormont v. Astrue, Civ. No. 11–2145, 2013 WL 791455 at *7 (M.D. Pa. Mar. 4,

2013)). In other instances, it has been held that “[t]here is no legal requirement that

a physician have made the particular findings that an ALJ adopts in the course of

determining an RFC.” Titterington v. Barnhart, 174 F. App’x 6, 11 (3d Cir. 2006).

Further, courts have held in cases where there is no evidence of any credible medical

opinion supporting a claimant’s allegations of disability that “the proposition that an

ALJ must always base his RFC on a medical opinion from a physician is misguided.”

Cummings v. Colvin, 129 F.Supp.3d 209, 214–15 (W.D. Pa. 2015).

These seemingly discordant legal propositions can be reconciled by

evaluation of the factual context of these decisions. Those cases which emphasize

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the importance of medical opinion support for an RFC assessment typically arise in

the factual setting, like that presented here, where well-supported medical sources

have opined regarding limitations which would support a disability claim, but an

ALJ has rejected the medical opinion which supported a disability determination

based upon a lay assessment of other evidence. Biller, 962 F.Supp.2d at 778–79. In

this setting, these cases simply restate the commonplace idea that medical opinions

are entitled to careful consideration when making a disability determination,

particularly when those opinions support a finding of disability. In contrast, when

no medical opinion supports a disability finding or when an ALJ is relying upon

other evidence, such as contrasting clinical or opinion evidence or testimony

regarding the claimant’s activities of daily living, to fashion an RFC courts have

adopted a more pragmatic view and have sustained the ALJ’s exercise of

independent judgment based upon all of the facts and evidence. See Titterington,

174 F. App'x 6; Cummings, 129 F.Supp.3d at 214–15. In either event, once the ALJ

has made this determination, our review of the ALJ's assessment of the plaintiff's

RFC is deferential, and that RFC assessment will not be set aside if it is supported

by substantial evidence. Burns, 312 F.3d 113; see also Rathbun, 2018 WL 1514383,

at *6; Metzger, 2017 WL 1483328, at *5.

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The ALJ’s disability determination must also meet certain basic 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 706-707. 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. Standard of Review: Analysis of Medical Opinion Evidence.

The Commissioner’s regulations which were in effect at the time of these

administrative proceedings also set standards for the evaluation of medical evidence,

and 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]

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physical or mental restrictions.” 20 C.F.R. §404.1527(a)(2). 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 afford competing medical opinions and evidence,

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 were 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 weight may be given to a treating source’s

medical opinion only where it is well-supported 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

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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).

In conducting this analysis the ALJ also must consider, and may follow, the

opinions of non-treating sources like state agency experts or outside consultants. 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. At the ALJ and Appeals Council levels of the administrative

review process, however, findings by non-examining state agency medical and

psychological consultants should be evaluated as medical opinion evidence. 20

C.F.R. § 404.1527(e) (effective Aug. 24, 2012, through Mar. 26, 2017). As such,

ALJs must consider these opinions as expert opinion evidence by non-examining

physicians 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

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insofar as they are supported by evidence in the case record.” SSR 96-6p, 1996 WL

374180 at *2. In appropriate circumstances, opinions from non-examining state

agency medical consultants may be entitled to greater weight than

the opinions of treating or examining sources. Id. at *3. See Mack v. Berryhill, No.

3:16-CV-02260, 2018 WL 1123705, at *6 (M.D. Pa. Mar. 1, 2018).

Oftentimes, as in this case, an ALJ must evaluate medical opinions and

records tendered by both treating and non-treating sources. Judicial review of this

aspect of ALJ decision-making is guided by several settled legal tenets. First, when

presented with a disputed factual record, it is well-established that “[t]he ALJ—

not treating or examining physicians or State agency consultants—must make the

ultimate disability and RFC determinations.” Chandler v. Comm'r of Soc. Sec., 667

F.3d 356, 361 (3d Cir. 2011). Thus, “[w]here ... the opinion of a treating physician

conflicts with that of a non-treating, non-examining physician, the ALJ may choose

whom to credit but ‘cannot reject evidence for no reason or for the wrong reason.’

” Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (quoting Plummer, 186 F.3d

at 429). Therefore, provided that the decision is accompanied by an adequate,

articulated rationale, it is the province and the duty of the ALJ to choose which

medical opinions and evidence deserve greater weight.

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Further, when evaluating a treating source opinion, an ALJ may not

unilaterally reject that opinion, and substitute the judge’s own lay judgment for that

medical opinion. However, the ALJ may discount such an opinion when it conflicts

with other objective tests or examination results. Johnson, 529 F.3d at 202–03.

Likewise, an ALJ may conclude that discrepancies between the treating source’s

medical opinion, and the doctor’s actual treatment notes, justifies giving a treating

source opinion little weight in a disability analysis. Torres v. Barnhart, 139 F. App'x

411, 415 (3d Cir. 2005). Finally, “an opinion from a treating source about what a

claimant can still do which would seem to be well-supported by the objective

findings would not be entitled to controlling weight if there was other substantial

evidence that the claimant engaged in activities that were inconsistent with the

opinion.” Tilton v. Colvin, 184 F. Supp. 3d 135, 145 (M.D. Pa. 2016).

Finally, in making this assessment of medical evidence:

An ALJ is [also] entitled generally to credit parts of an opinion without

crediting the entire opinion. See Thackara v. Colvin, No. 1:14–CV–

00158–GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23,

2015); Turner v. Colvin, 964 F.Supp.2d 21, 29 (D.D.C. 2013) (agreeing

that “SSR 96–2p does not prohibit the ALJ from crediting some parts

of a treating source's opinion and rejecting other portions”); Connors

v. Astrue, No. 10–CV–197–PB, 2011 WL 2359055, at *9 (D.N.H. June

10, 2011). It follows that an ALJ can give partial credit to all

medical opinions and can formulate an RFC based on different parts

from the different medical opinions. See e.g., Thackara v. Colvin, No.

1:14–CV–00158–GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23,

2015).

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Durden v. Colvin, 191 F. Supp. 3d 429, 455 (M.D. Pa. 2016).

It is against these legal guideposts that we assess the ALJ’s decision in the

instant case.

D. The Decision of the ALJ Will Be Affirmed.

In this setting, we are mindful that we are not free to substitute our

independent assessment of the evidence for the ALJ’s determinations. Rather, we

must simply ascertain whether the ALJ’s decision is supported by substantial

evidence, a quantum of proof which is less than a preponderance of the evidence but

more than a mere scintilla, Richardson v. Perales, 402 U.S. 389, 401 (1971), and

“does not mean a large or considerable amount of evidence,” Pierce v. Underwood,

487 U.S. 552, 565 (1988), but rather “means—and means only—‘such relevant

evidence as a reasonable mind might accept as adequate to support a conclusion.’ ”

Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019). Judged against these deferential

standards of review, we are constrained to find that substantial evidence supported

the ALJ’s evaluation of the medical opinions proffered by Dr. Ramage.

In reaching this conclusion we note that it is axiomatic that:

The ALJ—not treating or examining physicians or State agency

consultants—must make the ultimate disability

and RFC determinations. See 20 C.F.R. §§ 404.1527(e)(1),

404.1546(c). Although treating and examining physician opinions

often deserve more weight than the opinions of doctors who review

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records, see, e.g., 20 C.F.R. § 404.1527(d)(1)-(2), “[t]he law is clear

... that the opinion of a treating physician does not bind the ALJ on the

issue of functional capacity,” Brown v. Astrue, 649 F.3d 193, 197 n.

2 (3d Cir.2011). State agent opinions merit significant consideration

as well. See SSR 96–6p (“Because State agency medical and

psychological consultants ... are experts in the Social Security

disability programs, ... 20 C.F.R. §§ 404.1527(f) and 416.927(f)

require [ALJs] ... to consider their findings of fact about the nature and

severity of an individual's impairment(s)....”).

Chandler, 667 F.3d at 361.

Thus, while a treating source’s opinion is entitled to careful consideration by

the ALJ, that opinion does not control the disability determination. Further, it is well

settled that: ‘”[t]here is no legal requirement that a physician have made the

particular findings that an ALJ adopts in the course of determining an RFC.”

Titterington v. Barnhart, 174 F. App'x 6, 11 (3d Cir. 2006).

Here, the ALJ’s evaluation of Dr. Ramage’s opinions and the ALJ’s RFC

determination met all of the requirements prescribed by law and were supported by

substantial evidence; that is, “‘such relevant evidence as a reasonable mind might

accept as adequate to support a conclusion.’” Biestek, 139 S. Ct. at 1154. At the

outset, the ALJ’s decision to give little weight to Dr. Ramage’s opinions drew

support from substantial evidence. On this score, for the most part, Dr. Ramage’s

extreme medical opinions concerning Bowman’s limitations were expressed in a

singularly unpersuasive manner through a check box form. Thus, Dr. Ramage’s

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opinions on these issues of pivotal importance ran afoul of the well settled rule that:

“[f]orm reports in which a physician's obligation is only to check a box or fill in a

blank are weak evidence at best.” Passaretti v. Berryhill, No. 4:17-CV-1674, 2018

WL 3361058, at *8 (M.D. Pa. July 10, 2018) (quoting Mason v. Shalala, 994 F.2d

1058, 1065 (3d Cir. 1993) (quotations omitted)). See Herzog v. Saul, No. 1:20-CV-

1081, 2021 WL 2222723, at *9 (M.D. Pa. June 2, 2021).

Moreover, to the extent that Dr. Ramage expressed views in a more fulsome

manner, the doctor’s narrative description of the degree of Bowman’s impairments

was so extreme that it lacked credibility. For example, Dr. Ramage reported that

during an eight-hour work day, Bowman would be required to take sixteen

unscheduled half hour breaks. (Tr. 1452). Thus, Dr. Ramage’s report suggested that

Bowman’s entire work day would consist of a nothing more than a series of lengthy

unscheduled breaks.

Furthermore, the weaknesses in these medical opinions became even more

apparent when the medical opinions were juxtaposed against Dr. Ramage’s

treatment notes. Those treatment notes described a far more routine course of care,

punctuated by repeated unremarkable and normal medical examinations and test

results. In particular, it is difficult to reconcile the very extreme limitations recited

by Dr. Ramage in her August 15, 2017 medical opinion assessments with the

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doctor’s own treatment notes of that same date, in which Bowman generally denied

severe physical or emotional problems. (Tr. 1644). Given that an ALJ may discount

a treating source opinion when it conflicts with other objective tests or examination

results, Johnson, 529 F.3d at 202–03, or when there are material discrepancies

between the treating source’s medical opinion and the doctor’s actual treatment

notes, Torres, 139 F. App'x at 415, these findings, which are supported by the

evidentiary record, fully justified the ALJ’s decision to afford little weight to Dr.

Ramage’s opinion.

Having discounted this treating source opinion the ALJ, however, “did not

merely rubber stamp” the other medical opinions in reaching this decision. Chandler,

667 F.3d at 361. Instead, the ALJ individually and critically assessed each of those

remaining medical opinions. The ALJ then fashioned a limited light work RFC for

Bowman, but nonetheless found that she could perform this limited range of work.

We are mindful that our “‘review of the ALJ's assessment of the [claimant]’s RFC

is deferential,’ and the ‘RFC assessment will not be set aside if it is supported by

substantial evidence.’” Stancavage v. Saul, 469 F. Supp. 3d 311, 339 (M.D. Pa.

2020). In the instant case, we find that the ALJ’s assessment of the evidence

complied with the dictates of the law and was supported by substantial evidence, a

term of art which means less than a preponderance of the evidence but more than a

33

mere scintilla, Richardson, 402 U.S. at 401, and “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, 487 U.S. at 565.

This is all that the law requires, and all that a claimant can demand in a

disability proceeding. Thus, notwithstanding the plaintiff’s argument that this

evidence might have been viewed in a way which would have also supported a

different finding, we are obliged to affirm this ruling once we find that it is

“supported by substantial evidence, ‘even [where] this court acting de novo might

have reached a different conclusion.’” Monsour Med. Ctr. v. Heckler, 806 F.2d

1185, 1190–91 (3d Cir. 1986) (quoting Hunter Douglas, Inc. v. NLRB, 804 F.2d

808, 812 (3d Cir. 1986)). Accordingly, under the deferential standard of review that

applies to appeals of Social Security disability determinations, we find that

substantial evidence supported the ALJ’s evaluation of this case.

IV. Conclusion

For the foregoing reasons, IT IS ORDERED that the final decision of the

Commissioner denying these claims is AFFIRMED.

An appropriate order follows.

/s/ Martin C. Carlson

Martin C. Carlson

United States Magistrate Judge

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DATED: August 19, 2022

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