Hernandez Garcia v. Commissioner of Social Security

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF PENNSYLVANIA

LUIS HERNANDEZ GARCIA, : Civil No. 1:22-CV-2039

:

Plaintiff, :

:

v. :

: (Magistrate Judge Bloom)

COMMISSIONER OF SOCIAL :

SECURITY, :

:

Defendant. :

MEMORANDUM OPINION

I. Introduction

On March 29, 2019, Luis Hernandez Garcia filed an application for

disability and disability insurance benefits, as well as supplemental

security income. A hearing was held before an Administrative Law Judge

(“ALJ”), who found that Garcia was not disabled from his alleged onset

date, September 4, 2018, to the date of the ALJ’s decision, June 29, 2021.

Garcia now appeals this decision, arguing that the ALJ’s decision

is not supported by substantial evidence. After a review of the record,

and mindful of the fact that substantial evidence “means only—‘such

relevant evidence as a reasonable mind might accept as adequate to

support a conclusion,’” , 139 S. Ct. 1148, 1154 (2019),

we conclude that substantial evidence supports the ALJ’s decision in this

case. Therefore, we will affirm the decision of the Commissioner denying

Garcia’s claim.

II. Statement of Facts and of the Case

On March 29, 2019, Luis Hernandez Garcia applied for disability

and disability insurance benefits, alleging disability due to back pain,

knee arthritis, depression, anxiety, high cholesterol, and high blood

pressure. (Tr. 606). He alleged an onset date of disability of September

4, 2018. ( ). Garcia was 47 years old at the time of his alleged onset of

disability, had a general equivalency degree, and had past relevant work

as a cleaner, a truck operator, and a laborer. (Tr. 32).

Garcia’s medical records indicate that he began seeking treatment

for back pain after he was involved in a forklift collision on September 4,

2018, the alleged onset date. (Tr. 817). On September 12, 2018, Garcia

treated with Dr. Robert Bagian, M.D., complaining of dull, diffuse pain

throughout his back. (Tr. 1006). During the visit, Garcia walked with a

normal gait, turned his head without difficulty, had full strength in his

lower extremities and his back muscles, and exhibited normal sensitivity

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to light touch. (Tr. 1008). Dr. Bagian opined that Garcia could return to

work immediately, but could not operate or work on industrial

machinery, lift more than five pounds, climb stairs or ladders, bend,

twist, or change positions frequently. (Tr. 1009).

On January 7, 2019, Garcia received an independent medical

evaluation from Dr. Michael S. Rosenthal, D.O. (Tr. 817). On

examination, Garcia exhibited spasms and tenderness in the left lumbar

paravertebral muscles, tenderness over the left sacroiliac joint, and a

limited range of motion in his spine. (Tr. 819). However, Garcia also

displayed full strength in his upper and lower extremities, had a normal

gait, performed tiptoe, heel, and tandem walking, displayed normal

reflexes, and performed seated and supine straight leg raises without

pain. ( ). Based on these findings, Dr. Rosenthal opined that Garcia

could not lift, carry, push, or pull more than 10 pounds and could only

occasionally twist or bend at the waist. (Tr. 820).

The following day, Garcia was evaluated by a second independent

medical examiner, Dr. John Kline, M.D. (Tr. 677). During the

examination, Garcia exhibited a normal gait, full range of motion in the

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lumbosacral spine, hips, knees, and ankles, full strength in his upper and

lower body, normal reflexes, and appropriate sensitivity to light touch.

(Tr. 680-81). His spine was nontender on palpation and he did not exhibit

palpable muscle spasms or reproducible trigger points in his back. (Tr.

681). Though Garcia had positive Waddell’s findings, Dr. Kline noted

that he “demonstrated a high degree of symptom exaggeration or

inappropriate pain behavior” during testing. (Tr. 682). Based on those

findings, Dr. Kline opined that Garcia could immediately return to work

with no limitations. (Tr. 684).

Between October 19, 2018 and February 13, 2019, Garcia attended

four appointments with Dr. Avidon Appel, D.O. (Tr. 971, 981). During

those sessions, Garcia experienced muscle spasms and pain in his back,

numbness and tingling in his left thigh, and a limited range of motion in

his spine. (Tr. 972-73, 981). However, Garcia’s reflexes and sensation

were intact, his lungs were clear to auscultation, and his back pain and

flexibility improved throughout his sessions. (Tr. 971-72, 981). At the

end of the last session, Dr. Appel stated that Garcia could return to light

sedentary work but would require frequent breaks to stand and stretch

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and could not lift or carry more than five pounds, sit, or stand for more

than 15 minutes at a time, or walk more than ten minutes at a time. (Tr.

983).

In April of 2019, Garcia began therapy for anxiety and depression.

(Tr. 920). Though he was discharged after two months for

nonattendance, he resumed therapy in July of 2019. (Tr. 921, 1052).

During this therapy sessions, Garcia consistently denied suicidal

ideation and was alert, oriented, and goal directed. (Tr. 1045, 1047, 1050,

1052). Garcia’s treatment notes also indicate that he was calm and

cooperative, that his cognition, memory, and judgment were fair to good,

that his gait was within normal limits, and that he did not appear to be

experiencing delusions or paranoia during his visits. (Tr. 1047-51). On

several occasions, Garcia reported that he was consistently taking his

medication, which was ameliorating his paranoia, improving his sleep,

and decreasing the frequency of his nightmares. (Tr. 1045, 1047, 1050,

1052).

Between August 14, 2019 and October 18, 2019, Garcia sought

treatment at UPMC for headaches and fatigue. (Tr. 936-50). After

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reporting excessive snoring, Garcia was diagnosed with obstructive sleep

apnea. (Tr. 942, 948-49). Garcia’s treatment notes show that he

consistently exhibited a normal gait and had full strength in his upper

and lower extremities, intact sensation to light touch, and normal

reflexes. (Tr. 939-40, 945, 949).

On October 24, 2019, Garcia was evaluated by two consultative

examiners—Dr. Ahmed Kneifati, M.D., and Dr. Kathleen Ledermann,

Psy.D. (Tr. 871-89). During his examination with Dr. Kneifati, Garcia

experienced tenderness in his spine and knees but exhibited a normal

gait, could walk on his heels and toes without difficulty, and had stable

joints. (Tr. 887). Dr. Kneifati found that Garcia had no manipulative

limitations, could continuously lift and carry up to 10 pounds, and could

occasionally lift and carry up to 20 pounds. (Tr. 892, 894). He also opined

that Garcia could stand for up to three hours and walk for up to two hours

in an 8-hour workday and could continuously stand for two hours and

walk for one hour. (Tr. 893). Finally, Dr. Kneifati stated that Garcia

required a quiet work environment and could only tolerate occasional

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exposure to unprotected heights, moving mechanical parts, humidity,

wetness, extreme cold, and extreme heat. (Tr. 896).

During his examination with Dr. Ledermann, Garcia was

cooperative, exhibited adequate social skills, displayed normal grooming

and hygiene, had normal thought processes and speech, and was alert

and oriented to person, place, and time. (Tr. 872-73). During memory

and attention tests, Garcia could recall three out of three objects

immediately and one of three objects after a delay, perform serial sevens,

do simple counting, and perform simple calculations. ( ). Based on

these findings, Dr. Ledermann opined that Garcia had, at most, moderate

limitations in interacting with others, mild limitations in understanding,

remembering, and carrying out complex instructions, and no limitations

in understanding, remembering, and carrying out simple instructions.

(Tr. 876-77).

In May of 2020, Garcia began physical therapy for his back pain.

(Tr. 1137, 1168). However, on August 10, 2020, Garcia was discharged

from physical therapy for failing to attend further sessions. (Tr. 1138).

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Garcia’s discharge note indicated that his “progress towards goals is poor

and his tolerance to treatment is poor.” ( ).

In January of 2021, Garcia was scheduled for surgery to remove

hardware from his right foot. (Tr. 1513). In the weeks leading up to his

surgery, Garcia reported on two occasions that he was not experiencing

fatigue and that he could dress, bathe, and feed himself, walk up to two

blocks on level ground, and climb a flight of stairs or a hill. (Tr. 1510-14).

He also reported that he could perform heavy work, like scrubbing floors,

lifting, or moving furniture, and could play strenuous sports, such as

swimming, skiing, and singles tennis. (Tr. 1513).

On March 9, 2021, Garcia visited UPMC, complaining of fatigue,

nonrestorative sleep, a generalized body ache that had been persisting

for more than 10 years, and pain in his hands, shoulders, back, hips,

knees, and feet. (Tr. 1569). On examination, Garcia exhibited tenderness

in his trapezius, arms, forearms, and thighs, and had Heberden’s nodes

on both hands. (Tr. 1574). However, Garcia exhibited a full range of

motion and had no joint fullness or tenderness in his wrists, shoulders,

ankles, or feet. ( ). Garcia’s treatment notes state that he “has chronic

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pain, fatigue, schizophrenia, anxiety, and depression” and that it “seems

that patient has chronic fatigue syndrome….” (Tr. 1575). However,

approximately one week later, on March 22, 2021, Garcia again denied

experiencing excessive fatigue. (Tr. 1549).

Against the backdrop of this evidence, the ALJ conducted a hearing

regarding Garcia’s disability application on May 11, 2021. (Tr. 46-77).

Garcia and a vocational expert both testified at the hearing. ( ).

Following the hearing, on June 29, 2021, the ALJ issued a decision

denying Garcia’s application for benefits. (Tr. 12-34). First, the ALJ

concluded that Garcia engaged in substantial gainful activity during the

fourth quarter of 2019, but otherwise did not engage in substantial

gainful activity between September 4, 2018, his alleged onset date, and

June 29, 2021, the date the decision was issued. (Tr. 24-25). At Step 2

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

found that Garcia suffered from the following severe impairments:

degenerative disc disease, osteoarthritis in both knees and multiple other

joints, obesity, major depressive disorder, delusional disorders, and an

anxiety disorder. (Tr. 25). The ALJ also found that Garcia had been

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treated for hypertension and high cholesterol. ( ). However, the ALJ

concluded that those conditions were non-severe because none of them

caused more than a minimal limitation in Garcia’s ability to perform

basic work-related activities. ( ). At Step 3, the ALJ concluded that

none of Garcia’s severe impairments met or equaled the severity of a

listed impairment under the Commissioner’s regulations. (Tr. 25-29).

Between Steps 3 and 4, the ALJ concluded that Garcia had the

residual functional capacity to:

[P]erform light work, as defined in 20 CFR 404.1567(b) and

416.967(b), except the claimant can frequently climb ramps or

stairs but only occasionally climb ladders, ropes, or scaffolds.

He can frequently balance, stoop, kneel, crouch, or crawl. The

claimant can perform simple, routine, repetitive tasks

involving one or two step tasks requiring little to no

demonstration that can be learned within 30 days or less from

the beginning of the job. He can make judgements on simple

work-related decisions. The claimant can occasionally

interact with the public, coworkers, and supervisors in a

routine work setting.

(Tr. 29).

In reaching this RFC determination, the ALJ considered the

objective medical record detailed above, Garcia’s reported symptoms, and

the medical opinion evidence. (Tr. 29-35). Ultimately, the ALJ found

10

that Garcia’s statements concerning the intensity, persistence, and

limiting effects of his impairments were not entirely consistent with the

objective medical evidence. (Tr. 30). Garcia testified that he suffers from

pain in both knees, his lower back, and his right foot. (Tr. 54, 59).

According to Garcia, he has trouble walking up steps, can only sit, stand,

or drive for 30 minutes at a time, and cannot lift more than ten pounds.

(Tr. 58, 64-65). However, Garcia testified that he could walk on a flat

surface for 30-40 minutes without stopping, shower by himself, make

sandwiches, and brew coffee. (Tr. 65-66). He also testified that he could

perform simple household chores, such as vacuuming, washing clothes,

cleaning his table, and washing pans, and that his sons assist him with

more strenuous chores. (Tr. 66).

Garcia also testified that he suffers from migraines, sleep apnea,

depression, and schizophrenia, which causes auditory hallucinations and

paranoia. (Tr. 60-63, 69). According to Garcia, his paranoia is so severe

that, when he is home alone, he believes people are coming to murder

him. (Tr. 63). He testified that his migraines are intense, but that

medication has reduced their frequency from four to five times per month

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to once or twice per month. (Tr. 61-62). Finally, Garcia testified that

although he uses a device to ameliorate his sleep apnea, he only sleeps

for five to six hours per night and sometimes has trouble sleeping due to

nightmares. (Tr. 69).

The ALJ found Garcia’s testimony to be inconsistent with the

objective clinical findings. (Tr. 26). He did not find Garcia wholly

credible, as Dr. Klein noted that Garcia exaggerated his symptoms and

overreacted to pain during his examination. (Tr. 32). The ALJ reasoned

that although Garcia testified to debilitating mental health symptoms,

he told his mental health providers that his symptoms were well-

controlled and manageable on psychotropic medications. ( ). The ALJ

also noted that Garcia’s activities of daily living were inconsistent with

his alleged mental impairments, as Garcia testified that he could manage

his own personal care, complete household chores, drive a car, shop for

groceries, and prepare simple meals. ( ). Regarding Garcia’s alleged

physical impairments, the ALJ noted that Garcia told his medical

providers that he could walk one to two blocks on level ground, climb a

flight of stairs or climb a hill, perform heavy work, such as scrubbing

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floors, lifting, or moving furniture, and participate in strenuous sports,

like swimming, skiing, and singles tennis. ( ). Finally, the ALJ noted

that Garcia was discharged from mental health counseling and physical

therapy for failing to attend sessions. ( ).

Next, the ALJ considered the opinions of two state agency

consultants—Dr. Josie Henderson, M.D., and Dr. Michael Brown, D.O.

(Tr. 33). Dr. Henderson opined that Garcia could frequently climb ramps

and stairs, balance, stoop, kneel, crouch, and crawl and occasionally

climb ladders, ropes, and scaffolds. (Tr. 87-88). She also found that

Garcia had no visual, manipulative, or communicative limitations but

could not tolerate concentrated exposure to extreme cold, wetness,

humidity, and hazards. (Tr. 88). Dr. Brown’s opinion was identical to

Dr. Henderson’s, except that Dr. Brown did not assess any environmental

limitations. (Tr. 125-141). The ALJ found both opinions persuasive

because both physicians supported their conclusions by referencing

Garcia’s normal examination findings, such as his normal gait, intact

sensations and reflexes, full strength, and normal motor functions. (Tr.

33). However, the ALJ found Dr. Brown’s opinion slightly more

13

persuasive, as he did not find support for the environmental limitations

in Dr. Henderson’s opinion. ( ).

The ALJ also considered Dr. Kneifati’s opinion, which he found

partially persuasive. (Tr. 33). The ALJ determined that Dr. Kneifati

adequately supported his opinion that Garcia could lift and carry at the

light level and required postural limitations. ( ). However, the ALJ

found that Dr. Kneifati’s limitations regarding Garcia’s standing and

walking abilities were not supported, as his own examination showed

that Garcia had a normal gait, could walk on his toes and heels without

difficulty, and had stable joints. ( ).

The ALJ also considered Dr. Appel’s opinion, which he found

unpersuasive. (Tr. 33-34). He reasoned that Dr. Appel’s limitations on

sitting, standing, walking, and lifting were inconsistent with his

examination findings, which showed that Garcia had normal reflexes,

motor function, and sensitivity to light touch. (Tr. 34). He also reasoned

that Garcia’s activities of daily living did not support significant

limitations, as Garcia could prepare meals, complete household chores,

manage personal care, and drive a car. ( ).

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Next, the ALJ considered Dr. Kline’s opinion that Garcia could

return to work with no limitations and found it entirely unpersuasive.

(Tr. 34). The ALJ reasoned that although Dr. Kline’s examination

produced normal findings, the totality of the medical evidence supported

greater restrictions. ( ). In reaching that determination, the ALJ noted

that Garcia experienced side effects from his medication, such as fatigue,

had a limited range of motion in his spine, experienced paraspinal

tenderness, and suffered from pain and tenderness in multiple joints

from osteoarthritis. ( ).

The ALJ also found Dr. Bagian’s opinion unpersuasive. (Tr. 34).

The ALJ reasoned that Dr. Bagian’s assessed limitations on lifting,

bending, twisting, climbing, and operating machinery were inconsistent

with his own examination findings, which showed that Garcia could walk

on his heels and toes and had a normal gait, full strength in his

extremities and back muscles, and intact sensation to light touch. ( ).

The ALJ also found that Dr. Bagian’s opinion was inconsistent with

Garcia’s statements that he could climb a flight of stairs or climb a hill,

perform heavy work, such as scrubbing floors, lifting or moving furniture,

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and participate in strenuous sports, like swimming, skiing, and singles

tennis. ( ).

Similarly, the ALJ found Dr. Rosenthal’s opinion unpersuasive on

the grounds that it contradicted the findings in his own examination and

other medical evidence in the record. (Tr. 34). Though Dr. Rosenthal

limited Garcia to sedentary work, the ALJ noted that during the

examination, Garcia walked with a normal gait and had a full range of

motion in his joints, full strength, and normal reflexes. ( ). The ALJ

also noted that other examinations in the record showed similar

unremarkable results. ( ).

By contrast, the ALJ found the opinions of two state agency

psychological consultants—Dr. Thomas Fink, Psy.D., and Dr. John

Gavazzi, Psy.D.—generally persuasive. (Tr. 35). Dr. Fink opined that

Garcia could follow simple instructions, communicate with others, and

perform simple tasks within his physical limitations. (Tr. 90). Similarly,

Dr. Gavazzi opined that Garcia was not limited in his ability to

remember, understand, concentrate, or maintain pace. (Tr. 121).

Though Dr. Gavazzi found that Garcia struggled with social skills due to

16

paranoia, he opined that Garcia could maintain socially appropriate

behavior and could perform simple, routine, repetitive tasks in a stable

environment. ( ).

The ALJ found that both opinions were supported by the findings

regarding Garcia’s normal mental status examinations, which showed

that he was alert and oriented, that his memory and cognition were

intact, that his thought processes were goal-directed, and that he

displayed fair to good insight and judgment. (Tr. 35). However, the ALJ

found that Drs. Fink and Gavazzi did not adequately account for Garcia’s

paranoia and auditory hallucinations. ( ). In light of those conditions,

the ALJ found that Garcia could only occasionally interact with the

public, coworkers, and supervisors in a routine work setting. ( ).

Finally, the ALJ considered Dr. Ledermann’s opinion, which he

found partially persuasive. (Tr. 35). He found that Dr. Ledermann

adequately supported her opinion regarding Garcia’s social functioning.

( ). However, the ALJ found that Dr. Ledermann overestimated some

areas of Garcia’s cognitive functioning and underestimated others. ( ).

Specifically, the ALJ found that Garcia was more limited in his ability to

17

adapt and manage himself, concentrate, persist, and maintain pace in

light of his suicidal ideations, paranoia, and poor attention. ( ). The

ALJ also found that Garcia was less limited in his ability to understand,

remember, and apply information, as his memory was intact, he

displayed fair to good judgment and insight, and he was able to think

logically. ( ).

Having made these findings, the ALJ found at Step 4 that Garcia

could not perform his past work but found at Step 5 that he could perform

other jobs in the national economy, such as a cleaner, bakery worker, and

produce weigher. (Tr. 36-37). Accordingly, the ALJ found that Garcia

had not met the stringent standard prescribed for disability benefits and

denied his claim. (Tr. 37).

This appeal followed. On appeal, Garcia challenges the ALJ’s

decision on the grounds that he failed to consider Garcia’s chronic fatigue

syndrome, incorrectly evaluated the opinions of Drs. Kneifati, Appel,

Bagian, and Rosenthal, and ignored evidence of manipulative

limitations. As discussed in greater detail below, having considered the

18

arguments of counsel and carefully reviewed the record, we conclude that

the ALJ’s decision should be affirmed.

III. Discussion

A. Substantial Evidence Review – the Role of This Court

This Court’s review of the Commissioner’s decision to deny benefits

is limited to the question of whether the findings of the final

decisionmaker are supported by substantial evidence in the record.

42 U.S.C. §405(g); , 529 F.3d 198, 200 (3d

Cir. 2008); , 901 F. Supp. 2d 533, 536 (M.D. Pa. 2012).

Substantial evidence means less than a preponderance of the evidence

but more than a mere scintilla. , 402 U.S. 389, 401

(1971). 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.”

, 487 U.S. 552, 565 (1988).

A single piece of evidence is not substantial evidence if the ALJ

“ignores, or fails to resolve, a conflict created by countervailing evidence.”

, 994 F.2d 1058, 1064 (3d Cir. 1993) (quoting

19

, 710 F.2d 110, 114 (3d Cir. 1983)) (internal quotations

omitted). However, where there has been 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.”

, 383 U.S. 607, 620 (1966). The court must “scrutinize the record

as a whole” to determine if the decision is supported by substantial

evidence. , 304 F. Supp.2d 623, 627 (M.D. Pa. 2003).

The Supreme Court has explained the limited scope of our review,

noting that “[substantial evidence] means—and means only—‘such

relevant evidence as a reasonable mind might accept as adequate to

support a conclusion.’” , 139 S. Ct. at 1154 (quoting

, 305 U.S. 197, 229 (1938)). Under this standard, we

must look to the existing administrative record to determine if there is

“‘sufficient evidence’ to support the agency’s factual determinations.”

Thus, the question before us is not whether the claimant is disabled, but

rather whether the Commissioner’s finding that he or she is not disabled

20

is supported by substantial evidence and was based upon a correct

application of the law. , 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); , 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”); ,

900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal

matters is plenary); , 901 F. Supp. 2d at 536 (“[T]he court has

plenary review of all legal issues . . . .”).

When conducting this review, “we must not substitute our own

judgment for that of the fact finder.” , 777 F.3d 607, 611

(3d Cir. 2014) (citing , 399 F.3d 546, 552 (3d Cir.

2005)). Thus, we cannot reweigh the evidence. Instead, we must

determine whether there is substantial evidence to support the ALJ’s

findings. In doing so, we must also determine whether the ALJ’s decision

meets the burden of articulation necessary to enable judicial review; that

is, the ALJ must articulate the reasons for his decision.

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, 220 F.3d 112, 119 (3d Cir. 2000). This does

not require the ALJ to use “magic” words, but rather the ALJ must

discuss the evidence and explain the reasoning behind his or her decision

with more than just conclusory statements.

, 577 F.3d 500, 504 (3d Cir. 2009) (citations omitted). Ultimately, the

ALJ’s decision must be accompanied by “a clear and satisfactory

explication of the basis on which it rests.” , 642 F.2d 700,

704 (3d Cir. 1981).

B. Initial Burdens of Proof, Persuasion, and Articulation for the ALJ

To receive disability benefits under the Social Security Act, a

claimant must show that he or she is unable 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);

20 C.F.R. §§404.1505(a), 416.905(a). This requires a claimant to

show a severe physical or mental impairment that precludes her from

engaging in previous work or “any other substantial gainful work which

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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 Title II of the Social Security Act, a claimant must show that he or

she is under retirement age, contributed to the insurance program, 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, the ALJ follows a five-step

evaluation. 20 C.F.R. §§404.1520(a), 416.920(a). The ALJ must

sequentially determine whether the claimant: (1) is engaged in

substantial gainful activity; (2) has a severe impairment; (3) has a severe

impairment that meets or equals a listed impairment; (4) is able to do his

or her past relevant work; and (5) 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 determine the 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).” , 220 F.3d at 121 (citations omitted); 20

23

C.F.R. § 404.1545(a)(1). In making this assessment, the ALJ must

consider all 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), 416.945(a)(2). Our

review of the ALJ’s determination of the plaintiff’s RFC is deferential,

and that determination will not be set aside if it is supported by

substantial evidence. 312 F.3d 113, 129 (3d Cir.

2002).

The claimant bears the burden at Steps 1 through 4 to show a

medically determinable impairment that prevents her from engaging in

any past relevant work. , 994 F.2d at 1064. If met, the burden

then shifts to the Commissioner to show at Step 5 that there are jobs in

significant numbers in the national economy that the claimant can

perform consistent with the claimant’s RFC, age, education, and work

experience. 20 C.F.R. §§404.1512(f), 416.912(f); , 994 F.2d at 1064.

With respect to the RFC determination, courts have followed

different paths when considering the impact of medical opinion evidence

on this determination. While some courts emphasize the necessity of

24

medical opinion evidence to craft a claimant’s RFC,

962 F. Supp. 2d 761, 778–79 (W.D. Pa. 2013), other

courts have taken the approach 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.” , 174 F. App’x

6, 11 (3d Cir. 2006). Additionally, in cases that involve no credible

medical opinion evidence, courts have held that “the proposition that an

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

misguided.” , 129 F. Supp. 3d 209, 214–15 (W.D. Pa.

2015).

Given these differing approaches, we must evaluate the factual

context underlying an ALJ’s decision. Cases that emphasize the

importance of medical opinion support for an RFC assessment typically

arise in the factual setting where well-supported medical sources have

found limitations to support a disability claim, but an ALJ has rejected

the medical opinion based upon an assessment of other evidence. ,

962 F. Supp. 2d at 778–79. These cases simply restate the notion that

medical opinions are entitled to careful consideration when making a

25

disability determination. On the other hand, when no medical opinion

supports a disability finding or when an ALJ relies upon other evidence

to fashion an RFC, courts have routinely sustained the ALJ’s exercise of

independent judgment based upon all the facts and evidence.

, 174 F. App’x 6; 129 F. Supp. 3d at 214–15.

Ultimately, it is our task to determine, considering the entire record,

whether the RFC determination is supported by substantial evidence.

312 F.3d 113.

C. Legal Benchmarks for the ALJ’s Assessment of Medical Opinions

The plaintiff filed this disability application on March 29, 2019,

after Social Security Regulations regarding the consideration of medical

opinion evidence were amended. Before March of 2017, the regulations

established a hierarchy of medical opinions, deeming treating sources to

be the gold standard. However, in March of 2017, the regulations

governing the treatment of medical opinions were amended. Under the

amended regulations, ALJs are to consider several factors to determine

the persuasiveness of a medical opinion: supportability, consistency,

26

relationship with the claimant, specialization, and other factors tending

to support or contradict a medical opinion. 20 C.F.R. § 404.1520c(c).

Supportability and consistency are the two most important factors,

and an ALJ must explain how these factors were considered in his or her

written decision. 20 C.F.R. §§ 404.1520c(b)(2), 416.920c(b)(2);

, 615 F. Supp. 3d 308, 316 (E.D. Pa. 2022). Supportability

means “[t]he more relevant the objective medical evidence and

supporting explanations . . . are to support his or her medical opinion(s)

. . . . the more persuasive the medical opinions . . . will be.” 20 C.F.R. §§

404.1520c(c)(1), 416.920c(c)(1). The consistency factor focuses on how

consistent the opinion is “with the evidence from other medical sources

and nonmedical sources.” 20 C.F.R. §§ 404.1520c(c)(2), 416.920c(c)(2).

While there is an undeniable medical aspect to the evaluation of

medical opinions, it is well settled that “[t]he ALJ – not treating or

examining physicians or State agency consultants – must make the

ultimate disability and RFC determinations.”

, 667 F.3d 356, 361 (3d Cir. 2011). When confronted with several

medical opinions, the ALJ can choose to credit certain opinions over

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others but “cannot reject evidence for no reason or for the wrong reason.”

, 994 F.2d at 1066. Further, the ALJ can credit parts of an opinion

without giving credit to the whole opinion and may formulate a

claimant’s RFC based on different parts of different medical opinions, so

long as the rationale behind the decision is adequately articulated.

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

D. The ALJ’s Decision is Supported by Substantial Evidence.

Our review of the ALJ’s decision denying an application for benefits

is significantly deferential. Our task is simply to determine whether the

ALJ’s decision is supported by substantial evidence in the record; that is

“only [ ] ‘such relevant evidence as a reasonable mind might accept as

adequate to support a conclusion.’” , 139 S. Ct. at 1154. Judged

against this deferential standard of review, we conclude that substantial

evidence supported the ALJ’s decision in this case.

Garcia first argues that the ALJ erred by failing to consider his

chronic fatigue syndrome (“CFS”) in accordance with Social Security

Regulation (“SSR”) 14-1p. (Doc. 12 at 9-10). However, as the

Commissioner argues, it does not appear that Garcia was formally

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diagnosed with CFS. (Doc. 14 at 16). Garcia only points us to one medical

record that mentions CFS, (Doc. 12 at 9-10), which states that it “

that patient has chronic fatigue syndrome….” (Tr. 1575) (emphasis

added). In our view, this one speculative note within over 1,000 pages of

medical records does not constitute a diagnosis. ,

788 F.2d 1389, 1391 (8th Cir. 1986) (reasoning that a finding of “

organic brain syndrome” was too speculative to constitute a definitive

diagnosis) (emphasis in original).

Even if Garcia had been formally diagnosed with CFS, we believe

the ALJ’s failure to consider that impairment would be harmless. Social

Security appeals are subject to harmless error analysis.

, 639 F. App’x 810, 814 (3d Cir. 2016). Under the

harmless error analysis, a remand is warranted only if the error

“prejudices a party’s ‘substantial rights;’” that is, if the error “likely

affects the outcome of the proceeding, . . .” , 72 F. Supp. 3d

479, 494 (D. Del. 2014). It is well-settled that “the burden of showing

that an error is harmful normally falls upon the party attacking the

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agency’s determination.” , 556 U.S. 396, 409, 129 S.

Ct. 1696, 1706, 173 L.Ed. 2d 532 (2009).

In our view, Garcia has not shown that the outcome of the

proceeding would likely have been different if the ALJ had considered

CFS as a medically determinable impairment. A claimant is not disabled

unless he has a “medically determinable impairment that could

reasonably be expected to produce [his] symptoms…” 20 C.F.R. §

404.1529. It is the claimant’s burden to put forth evidence showing “how

his impairments, whether individually or in combination, amount to a

qualifying disability.” , 2020 WL 2301444,

at *1 (D.N.J. May 8, 2020) (citing , 482 U.S. 137, 146

n.5 (1987)). However, Garcia does not contend, either in his social

security application or his hearing testimony, that he is disabled due to

extreme fatigue. (Tr.45-77, 606).1 In fact, Garcia told medical providers

1 Though Garcia testified that he slept for five to six hours per night, he

did not testify that he suffered from extreme fatigue. (Tr. 69). Moreover,

Garcia testified that he had trouble sleeping because he had sleep apnea

and experienced nightmares, not because he had CFS. ( ). We note

that Garcia’s testimony is inconsistent with a diagnosis of CFS, which

SSR 14-1p defines as an impairment that causes prolonged fatigue which

30

on multiple occasions that he was not excessively tired. (Tr. 1510-14,

1549). Because Garcia does not claim to be disabled due to fatigue, we

believe that any failure by the ALJ to consider CFS as a medically

determinable impairment is, at most, harmless error.

Garcia also argues that the ALJ erred in finding Dr. Appel’s opinion

unpersuasive. (Doc. 12 at 11-12). As detailed above, the ALJ reasoned

that Dr. Appel’s extremely restrictive opinion was inconsistent with his

own examination findings and Garcia’s activities of daily living. (Tr. 33-

34). Garcia contends that, as a layperson, the ALJ is unqualified to

determine whether the results of Dr. Appel’s physical examination

contradict his opinion. (Doc. 12 at 11). However, an ALJ may consider

contradictions between an expert’s opinion and his examination notes

when fashioning an RFC determination. , 597 F.

Supp. 3d 776, 806 (E.D. Pa. 2022) (citing , 359 F. App’x

313, 316–17 (3d Cir. 2009) (nonprecedential)). Garcia also contends that

the ALJ mischaracterized his activities of daily living by stating that he

“[c]annot be explained by another physical or mental disorder.” SSR 14-

1p(I)(A)(2).

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could perform household chores. (Doc. 12 at 11). We disagree. Though

Garcia testified that his sons help him perform some chores, he also

testified that he could perform simple household chores independently.

(Tr. 65-66). Therefore, in our view, Garcia has not identified any error in

the ALJ’s treatment of Dr. Appel’s opinion.

Next, Garcia argues that the ALJ erred by finding the opinions of

Drs. Bagian, Rosenthal, and Kneifati unpersuasive. (Doc. 12 at 10-15).

Though Garcia makes multiple arguments regarding those opinions, they

all turn on the same premise—that some evidence in the record supports

the limitations set forth by each expert.2 ( ). However, “the possibility

of drawing two inconsistent conclusions from the evidence does not

prevent [the ALJ’s decision] from being supported by substantial

evidence.” , 383 U.S. at 620. Thus, the only relevant question is

2 Garcia argues that the ALJ “cherry pick[ed]” normal examination

findings and ignored abnormal ones. (Doc. 12 at 13). However, we note

that the ALJ assessed even greater limitations than Drs. Kline, Fink,

Gavazzi, and Lederman. (Tr. 34-35). In assessing those limitations, the

ALJ pointed to various abnormal findings, such as Garcia’s joint pain,

limited range of spinal motion, paraspinal tenderness, suicidal ideations,

paranoia, auditory hallucinations, and poor attention. ( ). Therefore,

as a general matter, we do not believe that the ALJ ignored evidence that

was favorable to Garcia when fashioning the RFC.

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whether the ALJ adequately articulated why he assessed fewer

limitations than Drs. Bagian, Rosenthal, and Kneifati. , 191

F. Supp. 3d at 455 (explaining that the ALJ may formulate a claimant’s

RFC based on different parts of different medical opinions, so long as he

or she adequately articulates his rationale). In our view, the ALJ

provided an adequate explanation for his assessment of the medical

opinion evidence.

As explained above, the ALJ determined that some of the

limitations set forth by Drs. Bagian, Rosenthal, and Kneifati were too

extensive considering the objective medical evidence. (Tr. 33-34). He

noted that that Garcia told his medical providers he could perform heavy

work and play strenuous sports, that the physical examinations

performed by all three physicians were unremarkable, and that other

physical examinations throughout the medical record showed that Garcia

had a normal gait, full strength, intact sensations, normal reflexes, and

normal coordination. ( ). Because the ALJ explained why he rejected

each limitation and supported his reasoning by citing to the objective

medical record, the ALJ met his burden of articulation.

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Finally, Garcia argues that the ALJ should have included greater

manipulative limitations in the RFC. (Doc. 12 at 15). He contends that

the ALJ ignored evidence that he exhibited tenderness in his trapezius,

arm, and forearm muscles and had Heberden’s nodes, joint tenderness,

and osteoarthritis in both hands. ( ). However, all three physicians

who expressly considered manipulative limitations found that Garcia

had none.3 (Tr. 88, 119, 894). We cannot say that the ALJ erred by

adopting the unanimous opinion of those experts.

, No. 1:22-CV-1457, 2023 WL 5617791, at *12 (M.D. Pa. Aug. 30,

2023) (remanding a case where the ALJ rejected every medical opinion

in the record).

Accordingly, under the deferential standard of review that applies

to appeals of Social Security disability determinations, we conclude that

substantial evidence supported the ALJ’s evaluation of this case, and this

decision should be affirmed.

3 Though Drs. Appel and Kline did not evaluate whether Garcia had any

manipulative limitations, Dr. Appel’s report shows that Garcia exhibited

a full range of motion in both wrists and Dr. Kline opined that Garcia

could return to work without any restrictions whatsoever. (Tr. 684, 973).

34

IV. Conclusion

For the foregoing reasons, the decision of the Commissioner in this

case will be affirmed, and the plaintiff’s appeal denied.

An appropriate order follows.

Submitted this 16th day of February 2024.

Daryl F. Bloom

United States Magistrate Judge

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