Grove v. Commissioner of Social Security

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF PENNSYLVANIA

MELISSA DAWN GROVE, :

Plaintiff : CIVIL ACTION NO. 3:22-cv-0915

v. : (JUDGE MANNION)

COMMISSIONER OF SOCIAL :

SECURITY,

:

Defendant

:

MEMORANDUM

Pending before the court is Plaintiff Melissa Dawn Grove’s appeal of

the final administrative decision of the Commissioner of Social Security

denying her claims for disability insurance benefits and supplemental

security income. (Doc. 1). Magistrate Judge Joseph F. Saporito has filed a

report and recommendation (the “Report”), (Doc. 17), which recommends

that the Commissioner’s decision be affirmed. Plaintiff has filed an objection

to the Report, (Doc. 18), and the Commissioner has responded to that

objection. (Doc. 20).

When objections are timely filed to the report and recommendation of

a magistrate judge, the district court must review de novo those portions of

the report to which objections are made. 28 U.S.C. §636(b)(1); Brown v.

Astrue, 649 F.3d 193, 195 (3d Cir. 2011). Although the standard of review is

de novo, the district court “may also, in the exercise of sound judicial

discretion, rely on the Magistrate Judge’s proposed findings and

recommendations.” Bynum v. Colvin, 198 F. Supp. 3d 434, 437 (E.D. Pa.

2016) (citing United States v. Raddatz, 447 U.S. 667, 676 (1980)).

This court has jurisdiction to review the Commissioner’s decision under

42 U.S.C. §§405(g), 1383(c)(3). The court exercises plenary review over the

Commissioner’s legal conclusions, Hess v. Comm’r Soc. Sec., 931 F.3d 198,

208 n.10 (3d. Cir. 2019), and reviews the Commissioner’s factual findings for

substantial evidence. 42 U.S.C. §§405(g), 1383(c)(3); Hess, 931 F.3d at 208

n.10. “Substantial evidence” is “such relevant evidence as a reasonable mind

might accept as adequate to support a conclusion.” Chandler v. Comm’r Soc.

Sec., 667 F.3d 356 (3d Cir. 2011).

Plaintiff applied for disability insurance benefits and supplemental

security income in June 2020. After her application was denied by state

agency reviewers initially and on reconsideration, Plaintiff requested an

administrative hearing. An Administrative Law Judge (ALJ) denied Plaintiff’s

application in a written decision, concluding that Plaintiff was not disabled

under Social Security law. The Social Security Appeals Council denied

Plaintiff’s request for review, making the ALJ’s decision the final decision of

the Commissioner. (Doc. 17, at 2–3).

Plaintiff argues that the ALJ’s residual functioning capacity (RFC)1

determination is not supported by substantial evidence because the ALJ

failed to properly evaluate the opinion of Plaintiff’s treating neurologist Dr.

Ravi Dukkipati. (Doc. 14, at 4). An ALJ assesses an applicant’s RFC “based

on all the relevant medical and other evidence.” 20 C.F.R. §§404.1545(a)(3),

416.945(a)(3). Medical opinions are considered using factors including (1)

supportability, (2) consistency, (3) relationship with claimant, and (4)

specialization, with supportability and consistency being the two most

important factors. §§404.1520c(a)–(c), 416.920c(a)–(c). ALJs must

articulate in their decision how persuasive they find the medical opinions in

an applicant’s case record, but are not required to articulate how each

medical opinion was considered individually. §§404.1520c(b)(1),

416.920c(b)(1).

The Report concludes that the ALJ considered the opinion and

articulated his finding regarding its persuasiveness properly. (Doc. 17, at 32).

It also concludes that the ALJ’s findings regarding Dr. Dukkipati’s opinions

1 An applicant’s residual functioning capacity is considered as part of

the five-step sequential evaluation process used to determine whether the

applicant is disabled. 20 C.F.R. §404.1520(a)(4)(iv).

are supported by substantial evidence. (Id.). Despite the Report’s conclusion

that the ALJ’s finding “was reached based upon a correct application of the

relevant law,” (Doc. 17, at 33), Plaintiff objects that the Report

“mischaracterizes Plaintiff’s argument as simply asking the Court to re-weigh

the evidence in her favor” and improperly “attempt[s] to limit the scope of the

Court’s review[] to a consideration of whether substantial evidence supports

the ALJ’s decision overall.” (Doc. 18, at 2). Nonetheless, the court must

review these legal conclusions de novo.

Dr. Dukkipati assessed Plaintiff on three occasions and opined on

Plaintiff’s limitations. (Doc. 14, at 6–7). The ALJ specifically articulated his

consideration of Dr. Dukkipati’s July 6, 2021 opinion, finding certain portions

regarding moderate and lesser mental health limitations persuasive while

finding the remainder of the opinion regarding marked and moderate

limitations unpersuasive. (Tr. 26). Plaintiff contends that the ALJ improperly

found Dr. Dukkipati’s opinions unpersuasive by reason of his conclusion that

they were not supported by Plaintiff’s treatment history.2 According to

2 That is, the ALJ found that “the absence of documentation of inpatient

psychiatric hospitalization, participation in a partial hospitalization or

intensive outpatient program, emergency treatment, medication

management with a psychiatric provider or therapy or treatment with a

psychological or other specialized mental health provider for mental health

symptoms” weighed against some of Dr. Dukkipati’s opinions regarding

marked and moderate limitations. (Tr. 26).

Plaintiff, the ALJ erred by failing “to consider any explanation Plaintiff might

have for the lack of additional treatment” and by not “question[ing] Plaintiff

regarding her mental health treatment during the hearing.” (Doc. 14, at 9).

First, the ALJ did not find that Plaintiff was disabled based on “a lapse

in treatment or failure to treat alone.” Wooten v. Astrue, 2012 WL 6601397,

at *4. Rather, his determination was based on consideration of plaintiff’s

testimony, medical records, and numerous medical opinions. Even with

respect just to Dr. Dukkipati’s opinions, a failure to treat was not the sole

consideration; the ALJ also found these opinions unsupported by other

record evidence. (Tr. 26). Second, Plaintiff faults the ALJ for failing to

consider her explanations for lack of treatment, (Doc. 14, at 9), but as

explanation cites only Plaintiff’s testimony that anxiety and depression made

her feel like she “can’t do anything” and that she discussed her symptoms

and medication side effects with her neurologist. (Tr. 64–65). Her general

testimony that she felt like she couldn’t do anything and treated with a

neurologist does not purport to explain the lack of psychiatric or

psychological treatment. At any rate, “the ALJ’s mere failure to cite specific

evidence does not establish that the ALJ failed to consider it.” Phillips v.

Barnhart, 91 Fed. Appx. 775, 780 n.7 (3d Cir. 2004). In light of the indirect

connection between this testimony and the lack of treatment relied by the

ALJ, the ALJ’s failure to cite it in his consideration of Dr. Dukkipati’s opinion

does not yield the conclusion that he failed to consider it, or render his

explanation insufficient. And the ALJ did discuss Plaintiff’s testimony

concerning her depression and anxiety in his summary of the evidence. (Tr.

17). Finally, Plaintiff offers no support for the proposition that the ALJ was

required to solicit such explanation testimony. The court concludes that the

ALJ’s finding with respect to the persuasiveness Dr. Dukkipati’s opinion,

measured against whatever explanation for lack of treatment the record

contains, is supported by substantial evidence.

Plaintiff next faults the ALJ’s reasoning that some of Dr. Dukkipati’s

opinions were unsupported by, in part, “the record that does not reflect the

claimant’s exhibition of significant behavioral, cognitive, memory or

attentional deficits.” (Tr. 26). Plaintiff argues that it was improper for the ALJ

to make a finding about Plaintiff’s workplace limitations by relying on records

from treatment during medical appointments, because “these examinations

have little bearing on Plaintiff’s ability to function during the normal workday.”

(Doc. 14, at 9–10). In support of this argument, Plaintiff offers two decisions

of the Court of Appeals.

Morales v. Apfel, 225 F.3d 310, 319 (3d Cir. 2000) concluded that an

ALJ had erred in rejecting the opinion of a social security plaintiff’s treating

psychiatrist that the plaintiff had marked limitations in a number of work-

related activities based on that psychiatrist’s notation that the plaintiff was

stable with medication. The court noted that for a person, like the plaintiff,

“who suffers from an affective or personality disorder marked by anxiety, the

work environment is completely different from home or a mental health

clinic.” Id. Thus, the psychiatrist’s opinion regarding the plaintiff’s work-

related limitations “should not be supplanted by an inference gleaned from

treatment records reporting on the claimant in an environment absent of the

stresses that accompany the work setting.” Id.

Likewise, Brownawell v. Comm’r Soc. Sec., 554 F.3d 352, 356 (3d Cir.

2008) regarded as improper an ALJ’s decision to discredit the opinion of a

plaintiff’s consulting psychologist regarding the plaintiff’s abilities based on

what the ALJ deemed inconsistencies in the text of the psychologist’s

evaluation. The psychologist had opined that the plaintiff had no ability to

maintain attention or concentrate, but reported in his evaluation that the

plaintiff had good attention and concentration. Id. The court explained that

“[t]hese assessments are not necessarily contradictory, however, as one

assessment was describing [the plaintiff’s] condition at the time of Dr.

Picciotto’s examination and the other reflected Dr. Picciotto’s assessment of

[the plaintiff’s] ability to function in a work setting.” Id. The court again

underscored “the distinction between a doctor’s notes for purposes of

treatment and that doctor’s ultimate opinion on the claimant’s ability to work.”

Id. (citing Morales, 225 F.3d at 319).

Unlike the ALJs in Morales and Brownawell, the ALJ here did not

discredit Dr. Dukkipati’s opinions regarding Plaintiff’s work-related limitations

because of some seemingly inconsistent finding by Dr. Dukkipati regarding

Plaintiff’s treatment condition. That is the type of reasoning the Third Circuit

“has admonished.” Brownawell, 554 F.3d at 356 (citing Morales, 225 F.3d at

319). Rather, the ALJ found some of Dr. Dukkipati’s opinions unpersuasive

based in part on the ALJ’s finding that the record as a whole does not reflect

the exhibition of significant behavioral, cognitive, memory, or attentional

deficits by Plaintiff. (Tr. 22, 26). Inconsistency with other medical evidence is

a valid factor in considering the persuasiveness of a medical opinion. 20

C.F.R. §404.1520c(c)(2). And the ALJ’s conclusion that the record does not

reflect the exhibition of significant deficits is a factual finding supported by

substantial evidence. (See Tr. 602, 648, 781–82, 784–85, 799, 828, 957,

1176). The reality that “the value of isolated treatment notes” may be

“mitigate[d]” by the cyclical nature of mental health symptoms, Ehredt v.

Comm’r Soc. Sec., 2014 WL 4384614, at *2 n.2 (W.D. Pa. 2014), does not

make treatment notes irrelevant.

Plaintiff next argues that the ALJ’s assessment of Dr. Dukkipati’s

opinions regarding Plaintiff’s physical and other limitations was “legally

erroneous where the ALJ picked and chose findings to support his

conclusion while failing to provide an accurate explanation as to how he

considered evidence averse to his position.” (Doc. 14, at 11). In her reply

brief, Plaintiff cites May 2021 (1) emergency rooms records stating that

Plaintiff reported difficulty walking even with a cane and (2) follow-up physical

examinations reporting a sensory deficit and motor weakness. (Doc. 16, at 2

(citing Tr. 1087, 1088, 1123)). Plaintiff asserts that the ALJ “failed to address

these findings in discrediting Dr. Dukkipati’s opinions.” (Doc. 16, at 2–3). But

the ALJ merely cited, as one among several bases for discrediting Dr.

Dukkipati’s opinions, “notes of treatment apart from the consultative

examination that generally reflect the claimant’s ability to walk with a normal

gait without cane use.” (Tr. 26) (emphasis added). While these particular

reports indicated difficulty, others, including later ones, did not. (See, e.g.,

Tr. 1317). Thus, the ALJ’s factual determination regarding Plaintiff’s ability to

walk is supported by substantial evidence. See Cotter v. Harris, 642 F.2d

700, 705 (3d Cir. 1981) (“[W]hen the medical testimony or conclusions are

conflicting, the ALJ is not only entitled but required to choose between

them.”) Given that the ALJ specifically discussed Plaintiff’s May 2021

emergency room visit in his summary of evidence, (Tr. 20), including her use

of a walker, there is little reason to infer that he ignored the report concerning

this instance of plaintiff’s walking difficulties.

Plaintiff finally asserts that the ALJ “mischaracterize[d] the record to

suggest that the evidence reflects normal findings while failing to

acknowledge evidence supporting more severe limitations.” (Doc. 14, at 12).

According to Plaintiff, the records of Plaintiff’s May 2021 hospitalization

present “a far more serious picture” than the ALJ’s characterization of that

visit does. (Id.) Plaintiff argues that the ALJ “diminishe[d] the significance” of

the report of sensory deficits and motor weakness “[b]y failing to address

how this evidence relates to Dr. Dukkipati’s opinion.” (Id.) But the ALJ need

not “refer to every piece of evidence submitted.” Walker v. Astrue, 733 F.

Supp. 2d 582, 587 (E.D. Pa. 2010). The ALJ did explain that the general

reflection of the record regarding Plaintiff’s walking ability did not support Dr.

Dukkipati’s opinions, and his overall discussion does not suggest that he

failed to consider relevant evidence. The ALJ has satisfied his burden of

articulation by providing a “discussion of evidence and an explanation of

reasoning for his conclusion sufficient to enable meaningful judicial review.”

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

For the foregoing reasons, the Report will be ADOPTED IN ITS

ENTIRETY and Plaintiff’s objections thereto will be OVERRULED. The

decision of the Commissioner of Social Security denying Plaintiff’s claims for

disability insurance benefits and supplemental security income will be

AFFIRMED. An appropriate order shall issue.

s/ Malachy E. Mannion

MALACHY E. MANNION

United States District Judge

DATE: September 26, 2023

22-0915-01