Taylor v. Social Security Administration Commissioner of

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF TENNESSEE

AT KNOXVILLE

REBECCA J. TAYLOR, )

)

Plaintiff, )

)

v. ) No. 2:19-CV-203-DCP

)

ANDREW M. SAUL, )

Acting Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION

This case is before the undersigned pursuant to 28 U.S.C. § 636(b), Rule 73 of the Federal

Rules of Civil Procedure, and the consent of the parties [Doc. 16].

Now before the Court is Plaintiff’s Motion for Summary Judgment and Memorandum in

Support [Docs. 12 & 13] and Defendant’s Motion for Summary Judgment and Memorandum in

Support [Docs. 14 & 15]. Rebecca J. Taylor (“Plaintiff”) seeks judicial review of the decision of

the Administrative Law Judge (“the ALJ”), the final decision of Defendant Andrew M. Saul (“the

Commissioner”). For the reasons that follow, the Court will DENY Plaintiff’s motion and

GRANT the Commissioner’s motion.

I. PROCEDURAL HISTORY

On June 26, 2016, Plaintiff protectively filed an application for disability insurance benefits

pursuant to Title II of the Social Security Act, 42 U.S.C. §§ 401 et seq., claiming a period of

disability that began on April 11, 2016. [Tr. 12, 132–41]. After her application was denied initially

and upon reconsideration, Plaintiff requested a hearing before an ALJ. [Tr. 89–90]. A hearing

was held on September 19, 2018. [Tr. 30–49]. On November 13, 2018, the ALJ found that

Plaintiff was not disabled. [Tr. 9–29]. The Appeals Council denied Plaintiff’s request for review

on September 12, 2019 [Tr. 1–6], making the ALJ’s decision the final decision of the

Commissioner.

Having exhausted her administrative remedies, Plaintiff filed a Complaint with this Court

on November 13, 2019, seeking judicial review of the Commissioner’s final decision under Section

405(g) of the Social Security Act. [Doc. 1]. The parties have filed competing dispositive motions,

and this matter is now ripe for adjudication.

II. ALJ FINDINGS

The ALJ made the following findings:

1. The claimant meets the insured status requirements of the Social

Security Act through December 31, 2021.

2. The claimant has not engaged in substantial gainful activity since

April 11, 2016, the alleged onset date (20 CFR 404.1571 et seq.).

3. The claimant has the following severe impairments: valvular

aortic stenosis status post valve replacement; coronary artery disease

status post coronary artery bypass grafting; venous insufficiency;

diabetes; and obesity (20 CFR 404.1520(c)).

4. The claimant does not have an impairment or combination of

impairments that meets or medically equals the severity of one of

the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1

(20 CFR 404.1520(d), 404.1525, 404.1526).

5. After careful consideration of the entire record, the undersigned

finds that the claimant has the residual functional capacity to

perform light work as defined in 20 CFR 404.1567(b) except she is

limited to the following: stand/walk for four hours; sit for six hours;

occasional postural except no ropes, ladders, or scaffolds; and avoid

concentrated exposure to extreme heat and cold, wetness, and

hazards.

6. The claimant is capable of performing past relevant work as a

teacher. This work does not require the performance of work-

related activities precluded by the claimant’s residual functional

capacity (20 CFR 404.1565).

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7. The claimant has not been under a disability, as defined in the

Social Security Act, from April 11, 2016, through the date of this

decision (20 CFR 404.1520(f)).

[Tr. 14–23].

III. STANDARD OF REVIEW

When reviewing the Commissioner’s determination of whether an individual is disabled

pursuant to 42 U.S.C. § 405(g), the Court is limited to determining whether the ALJ’s decision

was reached through application of the correct legal standards and in accordance with the

procedure mandated by the regulations and rulings promulgated by the Commissioner, and

whether the ALJ’s findings are supported by substantial evidence. Blakley v. Comm’r of Soc. Sec.,

581 F.3d 399, 405 (6th Cir. 2009) (citation omitted); Wilson v. Comm’r of Soc. Sec., 378 F.3d 541,

544 (6th Cir. 2004).

Substantial evidence is “more than a scintilla of evidence but less than a preponderance; it

is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”

Cutlip v. Sec’y of Health & Human Servs., 25 F.3d 284, 286 (6th Cir. 1994) (citations omitted). It

is immaterial whether the record may also possess substantial evidence to support a different

conclusion from that reached by the ALJ, or whether the reviewing judge may have decided the

case differently. Crisp v. Sec’y of Health & Human Servs., 790 F.2d 450, 453 n.4 (6th Cir. 1986).

The substantial evidence standard is intended to create a “‘zone of choice’ within which the

Commissioner can act, without the fear of court interference.” Buxton v. Halter, 246 F.3d 762,

773 (6th Cir. 2001) (quoting Mullen v. Bowen, 800 F.2d 535, 545 (6th Cir. 1986)). Additionally,

the Supreme Court recently explained that “‘substantial evidence’ is a ‘term of art,’” and “whatever

the meaning of ‘substantial’ in other settings, the threshold for such evidentiary sufficiency is not

high.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (citation omitted). Rather, substantial

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

as adequate to support a conclusion.’” Id. (quoting Consol. Edison Co. v. NLRB, 305 U.S. 197,

229 (1938)).

Therefore, the Court will not “try the case de novo, nor resolve conflicts in the evidence,

nor decide questions of credibility.” Garner v. Heckler, 745 F.2d 383, 387 (6th Cir. 1984) (citation

omitted). On review, the plaintiff “bears the burden of proving his entitlement to benefits.” Boyes

v. Sec’y. of Health & Human Servs., 46 F.3d 510, 512 (6th Cir. 1994) (citation omitted).

Furthermore, the Court is not under any obligation to scour the record for errors not identified by

the claimant and arguments not raised and supported in more than a perfunctory manner may be

deemed waived. See McPherson v. Kelsey, 125 F.3d 989, 995–96 (6th Cir. 1997) (noting that

conclusory claims of error without further argument or authority may be considered waived).

IV. DISABILITY ELIGIBILITY

“Disability” means an individual cannot “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) and 1382c(a)(3)(A). An individual will only be

considered disabled:

if his physical or mental impairment or impairments are of such

severity that he is not only unable to do his previous work but

cannot, considering his age, education, and work experience, engage

in any other kind of substantial gainful work which exists in the

national economy, regardless of whether such work exists in the

immediate area in which he lives, or whether a specific job vacancy

exists for him, or whether he would be hired if he applied for work.

§§ 423(d)(2)(A) and 1382c(a)(3)(B).

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Disability is evaluated pursuant to a five-step analysis summarized as follows:

1. If claimant is doing substantial gainful activity, he is not

disabled.

2. If claimant is not doing substantial gainful activity, his

impairment must be severe before he can be found to be disabled.

3. If claimant is not doing substantial gainful activity and is

suffering from a severe impairment that has lasted or is expected to

last for a continuous period of at least twelve months, and his

impairment meets or equals a listed impairment, claimant is

presumed disabled without further inquiry.

4. If claimant’s impairment does not prevent him from doing his

past relevant work, he is not disabled.

5. Even if claimant’s impairment does prevent him from doing his

past relevant work, if other work exists in the national economy that

accommodates his residual functional capacity (“RFC”) and

vocational factors (age, education, skills, etc.), he is not disabled.

Walters v. Comm’r of Soc. Sec., 127 F.3d 525, 529 (6th Cir. 1997) (citing 20 C.F.R. § 404.1520).

A claimant’s residual functional capacity (“RFC”) is assessed between steps three and four and is

“based on all the relevant medical and other evidence in your case record.” 20 C.F.R. §§

404.1520(a)(4) and -(e), 416.920(a)(4), -(e). An RFC is the most a claimant can do despite his

limitations. §§ 404.1545(a)(1) and 416.945(a)(1).

The claimant bears the burden of proof at the first four steps. Walters, 127 F.3d at 529.

The burden shifts to the Commissioner at step five. Id. At the fifth step, the Commissioner must

prove that there is work available in the national economy that the claimant could perform. Her

v. Comm’r of Soc. Sec., 203 F.3d 388, 391 (6th Cir. 1999) (citing Bowen v. Yuckert, 482 U.S. 137,

146 (1987)).

V. ANALYSIS

Plaintiff asserts that the ALJ’s RFC determination is not supported by substantial evidence,

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as she challenges the ALJ’s rejection of the opinions of her treating physician, Amy Proffitt, M.D.,

as well as the opinion of consultative examiner, Robert Blaine, M.D. Additionally, Plaintiff

contends that the ALJ’s credibility assessment is deficient because of his failure to appropriately

consider the medical opinions of record, as well as his failure to appropriately acknowledge

Plaintiff’s work history. The Court will examine Plaintiff’s allegations of error in turn.

A. ALJ’s Treatment of Medical Opinions

Plaintiff reviews Dr. Proffitt and Dr. Blaine’s opinions and first claims that they establish

greater limitations than those set forth in the ALJ’s RFC determination and are consistent with a

finding that Plaintiff is disabled under the applicable regulations. [Doc. 13 at 4–9]. However,

Plaintiff asserts that the ALJ failed to provide sufficient reasons for rejecting the opinions of her

treating provider and an examining source and that the ALJ erred by accepting the opinions of the

nonexamining state agency physicians. [Id. at 9–18]. Plaintiff contends that Dr. Blaine and Dr.

Proffitt’s opinions are more consistent with an ability to perform sedentary work, and that she is

entitled to a finding of disability if she is limited to sedentary work. [Id. at 8].

The Commissioner responds that the ALJ properly provided good reasons for the weight

he afforded each medical opinion, as well as that the ALJ detailed how Dr. Proffitt’s opinions were

not supported by medically acceptable clinical signs and diagnostic techniques and were

inconsistent with other evidence in the medical record. [Doc. 15 at 8–11]. Additionally, the

Commissioner asserts that the ALJ reviewed how Dr. Blaine’s opinion was not supported by the

medical record, and therefore he appropriately accepted the opinions of the nonexamining state

agency consultants. [Id. at 12–15].

1. Medical Opinions

After becoming symptomatic of severe aortic stenosis, Plaintiff underwent an aortic valve

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replacement on May 10, 2016. [Tr. 319]. On November 4, 2016, her primary care physician, Dr.

Proffitt, completed an Attending Physician’s Statement, with diagnoses of her status post aortic

valve replacement, insulin-dependent diabetes mellitus, chronic knee and leg pain, coronary artery

disease, and venous insufficiency. [Tr. 604–05; 747–48]. Dr. Proffitt noted Plaintiff’s current

symptoms of fluctuating uncontrolled sugars, chronic leg pain and swelling, and shortness of

breath. [Tr. 604; 747]. Further, Dr. Proffitt opined that Plaintiff was disabled as of May 2016 and

noted that she sees Plaintiff every three to four months; that Plaintiff could not walk, stand, or talk

for more than five minutes or sit for more than twenty to thirty minutes; and that prior to her

operation, Plaintiff had marked limitations in her cardiac functional capacity. [Id.]. Dr. Proffitt

also found that Plaintiff could perform zero hours of even sedentary activity in an eight-hour

workday. [Tr. 605; 748]. Dr. Proffitt indicated that she did not expect any significant improvement

in the future, and that Plaintiff’s recovery “is limited by the several issues she has and nearly every

job is limited by some aspect of her medical issues.” [Id.]. 1

The Commissioner also notes an undated letter from Dr. Proffitt wherein she listed

Plaintiff’s diagnoses of “diabetes, aortic stenosis requiring aortic valve replacement, chronic knee

pain and leg pain, as well as coronary artery disease and venous insufficiency,” explaining that

Plaintiff “has chronic lower extremity pain as well as the venous insufficiency from a prior CABG;

the lower extremity edema worsens the lower extremity pain” and that “[t]he swelling is present

especially when on her legs and also even when seated and not able to elevate her lower extremities

1 Plaintiff asserts that “Dr. Proffitt completed another Treating Source Statement on

November 11, 2016 . . . and opined she could not perform all of the duties of her regular

occupation, and does not expect to return to that occupation.” [Doc. 13 at 5]. However, upon the

Court’s review, this “Supplementary Proof of Loss–Claimant’s Statement” is signed by Plaintiff,

see [Tr. 602–03], and followed by the Attending Physician’s Statement described above.

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throughout the day, and worsens as the day progresses.” [Tr. 654, 845]. Dr. Proffitt noted her

“office visit notes from March 24, 2016 and May 26, 2016 that reference[ ] [Plaintiff’s] venous

insufficiency and the fact that the swelling makes the pain worse in her lower extremities and that

this would be one of the major factors that would make this difficult for [Plaintiff] to return to

work.” [Id.].

Dr. Proffitt completed an additional Attending Physician’s Statement, in connection with

Plaintiff’s long-term disability insurance claim, on April 24, 2017. [Tr. 742–43]. Dr. Proffitt listed

diagnoses of venous insufficiency and chronic bilateral lower-extremity pain and noted that

Plaintiff’s lower extremity edema is worse when standing or sitting for prolonged periods. [Tr.

742]. Additionally, Dr. Proffitt found that Plaintiff was unable to stand or sit for more than thirty

minutes at a time, as well as that she required being off her feet, with her feet elevated, at least

hourly. [Id.]. Dr. Proffitt opined that in an eight-hour workday, Plaintiff could perform sedentary

activity for at least two hours, and light activity for at least one hour. [Tr. 743]. Lastly, Dr. Proffitt

completed another Attending Physician’s Statement on October 31, 2017 and opined identical

limitations. [Tr. 740–741].

Dr. Blaine performed a consultative examination on October 18, 2016.2 [Tr. 597]. On

examination, Dr. Blaine assessed that Plaintiff’s lungs were clear to auscultation, as she was not

dyspneic at rest, but became mildly dyspneic with exertion; that her heart showed a regular rhythm

with a grade 4/6 systolic blowing murmur and a loud first heart sound, and that her radial and

dorsalis pedis pulses were 2+ bilaterally. [Tr. 599]. Additionally, Dr. Blaine indicated that

Plaintiff’s cervical spine flexion is 50 degrees, extension is to 50 degrees, lateral rotation is 70

2 Plaintiff’s brief incorrectly states that this examination occurred on October 18, 2018.

[Doc. 13 at 6].

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degrees to either side, and lateral flexion is 35 degrees to either side; that her shoulder abduction

was to 150 degrees on the right and 100 degrees on the left, with internal rotation to 80 degrees

bilaterally, and external rotation to 85 degrees on the right and 60 degrees on the left. [Id.]. Dr.

Blaine indicated that Plaintiff’s hip flexion was 90 degrees bilaterally, internal rotation was five

degrees bilaterally, external rotation was 50 degrees bilaterally, abduction was 40 degrees

bilaterally, and her adduction was 10 degrees bilaterally. [Id.].3 Next, Dr. Blaine found that

Plaintiff’s sensation was intact to light touch in all four extremities and was symmetrical; that her

grip strength was 5/5 bilaterally; flexor and extensor strength of both upper and lower extremities

was 5/5; her straight leg raise was negative bilaterally; and that she demonstrated normal station,

gait, tandem walk, heel and toe walk, and single-leg stand. [Id.].

Therefore, Dr. Blaine diagnosed Type 1 diabetes, aortic stenosis, venous insufficiency in

the right leg, chronic bilateral knee pain consistent with degenerative disc disease, breast cancer,

hypertension, obstructive sleep apnea, dyspnea probably related to cardiac origin, and morbid

obesity. [Tr. 600]. Dr. Blaine assessed that Plaintiff could stand or walk for three hours in an

eight-hour day, limited by dyspnea and knee and leg pain; that she could lift and carry five pounds

frequently and twenty-five pounds infrequently; and that she could probably sit for about four

hours in an eight-hour day with reasonable rest breaks. [Id.].

Nonexamining state agency physician Celia Gulbenk, M.D., reviewed the evidence of

record at the initial level of the agency’s review on November 21, 2016, and opined that Plaintiff

could occasionally lift and/or carry up to twenty pounds, as well as frequently lift and/or carry up

3 Dr. Blaine also assessed Plaintiff’s range of motion relating to her elbows, knees, ankles,

and thoracolumbar spine. [Id.].

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to ten pounds; that she could stand and/or walk, as well as sit, for a total of about six hours in an

eight-hour workday; and that she was unlimited in the ability to push and/or pull, with the

exception of the opined limitations. [Tr. 60]. Additionally, Dr. Gulbenk assessed that Plaintiff

could occasionally climb ramps and stairs, balance, stoop, kneel, crouch, and crawl, but that she

could never climb ladders, ropes, or scaffolds. [Tr. 60–61]. Kanika Chaudhuri, M.D., examined

the evidence of record at the reconsideration level of the agency’s review on January 18, 2017 and

opined that Plaintiff could perform light work with similar postural limitations, as well as that

Plaintiff should avoid concentrated exposure to extreme heat. [Tr. 74–77].

In the disability decision, the ALJ reviewed Dr. Proffitt’s November 4, 2016, April 24,

2017, and October 31, 2017 assessments, as well as Dr. Blaine’s consultative examination and

opinion. [Tr. 20]. However, the ALJ accepted the assessment of the nonexamining state agency

physicians “because they are supported by the medical signs and findings are consistent with the

medical record.” [Tr. 21]. Conversely, the ALJ rejected Dr. Blaine’s assessment “because it was

not well supported by exam[ination] findings and is inconsistent with the medical record.” [Id.].

Similarly, the ALJ rejected Dr. Proffitt’s assessments “because they are not well supported by

medically acceptable clinical signs and diagnostic techniques and are inconsistent with other

medical evidence,” as well as that they “are inconsistent with the claimant’s own testimony at the

hearing concerning her functional abilities.” [Id.]. Immediately following this analysis, the ALJ

provided that:

The claimant’s treatment record from her treating specialists reveals that her

valvular aortic stenosis and coronary artery disease were improved and stable with

treatment. Her treatment record also indicates generally that her edema was

improved and that she was not having as much swelling or symptoms from venous

insufficiency. The claimant’s diabetes and her A1c decreased with compliance

with treatment. The evidence does not show that the claimant’s diabetes has

seriously damaged the claimant’s heart, kidneys, or vital organs.

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[Id.]. Additionally, the ALJ accepted the assessments of the nonexamining state agency physicians

that Plaintiff did not have a severe mental impairment because they were consistent with the

longitudinal medical evidence, as Plaintiff’s symptoms of her mental impairments were controlled

with the use of prescribed medication. [Id.]. The ALJ detailed that there was no record of

specialized mental health treatment or inpatient psychiatric treatment or hospitalization, and that

Plaintiff’s “records show that she is able to communicate with others, act in her own interest, and

perform most ordinary activities.” [Id.].

2. Standards for Evaluation of Medical Opinions

With respect to Dr. Proffitt’s assessments, under the Social Security Act and its

implementing regulations, if a treating physician’s opinion as to the nature and severity of an

impairment is (1) well-supported by medically acceptable clinical and laboratory diagnostic

techniques and (2) is not inconsistent with the other substantial evidence in the case record, it must

be given “controlling weight.” 20 C.F.R. §§ 404.1527(c); 416.927(c)(2).4 When an opinion does

not garner controlling weight, the appropriate weight to be given to the opinion will be determined

based upon the length of treatment, frequency of examinations, nature and extent of the treatment

relationship, amount of relevant evidence that supports the opinion, the opinion’s consistency with

the record as a whole, the specialization of the source, and other factors which tend to support or

4 The treating physician rule has been abrogated as to claims filed on or after March 27,

2017. See 20 C.F.R. §§ 404.1520c; 416.920c (“We will not defer or give any specific evidentiary

weight, including controlling weight, to any medical opinion(s) . . . including those from your

medical sources.”); see also Revisions to Rules Regarding the Evaluation of Medical Evidence, 82

Fed. Reg. 5844-01, 2017 WL 168819, at *5852–57 (Jan. 18, 2017). The new regulations eliminate

the term “treating source,” as well as what is customarily known as the treating physician rule. Id.

As Plaintiff’s application was filed before March 27, 2017, the treating physician rule applies. See

id. §§ 404.1527; 416.927.

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contradict the opinion. Id.

The ALJ is not required to explain how he considered each of these factors, but must

nonetheless give “good reasons” for giving a treating physician’s opinion less than controlling

weight. Francis v. Comm’r of Soc. Sec., 414 F. App’x 802, 804 (6th Cir. 2011); see also Morr v.

Comm’r of Soc. Sec., 616 F. App’x 210, 211 (6th Cir. 2015) (holding “good reasons” must be

provided “that are sufficiently specific to make clear to any subsequent reviewers the weight given

to the treating physician’s opinion and the reasons for that weight”) (citing Wilson v. Comm’r of

Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004); 20 C.F.R. §§ 404.1527(c)(2) & 416.927(c)(2)).

Opinions from non-treating sources are never assessed for controlling weight but are

evaluated using the regulatory balancing factors set forth in 20 C.F.R. § 416.927(c). Gayheart

v. Comm’r of Soc. Sec., 710 F.3d 365, 376 (6th Cir. 2013) (citing 20 C.F.R. § 404.1527(c)). These

opinions are weighed “based on the examining relationship (or lack thereof), specialization,

consistency, and supportability.” Id. (citing 20 C.F.R. § 404.1527(c)). “Other factors ‘which tend

to support or contradict the opinion’ may be considered in assessing any type of medical

opinion.” Id. (quoting 20 C.F.R. § 404.1527(c)(6)). Ultimately, there is no rule that requires an

articulation of each of these factors. Albaugh v. Comm’r of Soc. Sec., No. 14-CV-10963, 2015

WL 1120316, at *6 (E.D. Mich. Mar. 11, 2015).

The ALJ is not required to give “good reasons” for the weight assigned to the opinions of

non-treating and examining consultants, as “this requirement only applies to treating

sources.” Ealy v. Comm’r of Soc. Sec., 594 F.3d 504, 514 (6th Cir. 2010) (citing Smith v.

Comm’r of Soc. Sec., 482 F.3d 873, 876 (6th Cir. 2007)). However, “[u]nless a treating source’s

opinion is given controlling weight, the administrative law judge must explain in the decision the

weight given to the opinions of a State agency medical or psychological consultant . . . .” 20 C.F.R.

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§ 416.927(e)(2)(ii). Social Security Ruling (SSR) 96–6P provides that, although “[a]dministrative

law judges . . . are not bound by findings made by State agency . . . physicians and psychologists

. . . they may not ignore these opinions and must explain the weight given to the opinions in their

decisions.” 1996 WL 374180, at *3 (July 2, 1996).

3. Analysis

In essence, Plaintiff challenges the acceptance of the opinions of the nonexamining state

agency physicians over those of Dr. Proffitt and Dr. Blaine—Plaintiff’s treating physician and

consultative examiner. Plaintiff asserts that the ALJ failed to provide any “obvious consideration

to the regulation that provides the opinions of treating sources are generally entitled to more

weight.” [Doc. 13 at 10]. Additionally, Plaintiff challenges the ALJ’s acceptance of the

nonexamining state agency physicians’ opinions over those of Dr. Proffitt and Dr. Blaine. Plaintiff

maintains that the “complete rejection of [Dr. Blaine’s] opinion is an impermissible substitution of

[the ALJ’s] opinion for that of Dr. Blaine, a physician the Agency chose to evaluate Plaintiff’s

limitations.” [Id.]. Similarly, Plaintiff contends that the ALJ erred by failing to cite to specific

examples of how Dr. Blaine’s opinion was inconsistent with the medical record, and only used

general statements regarding Plaintiff’s improvement when discussing Dr. Proffitt’s opinion. [Id.

at 11]. Plaintiff then reviews the medical record regarding Plaintiff’s edema and venous

insufficiency to claim that “the ALJ’s assertion represents a highly selective reading of the record,

ignoring important pieces of evidence in favor of blanket statements of improvement.” [Id.].

First, when reviewing Dr. Proffitt’s opinions, the ALJ acknowledged that Dr. Proffitt was

Plaintiff’s treating doctor at First Choice Internal Medicine. [Tr. 20]. Therefore, while the ALJ

was not required to explain his consideration of each of the factors under the treating physician

rule, he acknowledged Dr. Proffitt’s treating relationship with Plaintiff. See Francis v. Comm’r of

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Soc. Sec., 414 F. App’x 802, 804 (6th Cir. 2011).

Next, the Court does not agree with Plaintiff’s statement that the ALJ’s analysis of Dr.

Proffitt’s opinions was limited to two sentences. The ALJ found that Dr. Proffitt’s assessments

were not well supported by medically acceptable clinical signs and diagnostic techniques and

inconsistent with other medical evidence, including Plaintiff’s own testimony at the hearing

regarding her functional abilities. [Tr. 21]. The Sixth Circuit has directed that “it is not enough to

dismiss a treating physician’s opinion as ‘incompatible’ with other evidence of record; there must

be some effort to identify the specific discrepancies and to explain why it is the treating physician’s

conclusion that gets the short end of the stick.” See Friend v. Comm’r of Soc. Sec., 375 F. App’x

543, 552 (6th Cir. 2010). The ALJ met that standard here by summarizing how Plaintiff’s

treatment records were inconsistent with Dr. Proffitt’s opinions, which he also discussed

throughout the RFC determination. See White v. Comm’r of Soc. Sec., 572 F.3d 272, 285–86 (6th

Cir. 2009); see also Crum v. Comm’r of Soc. Sec., 660 F. App’x 449, 457 (6th Cir. 2016) (“No

doubt, the ALJ did not reproduce the list of these treatment records a second time when she

explained why Dr. Bell’s opinion was inconsistent with this record. But it suffices that she listed

them elsewhere in her opinion.”); Simmons v. Berryhill, No. 4:17-CV-15-TWP-CHS, 2018 WL

1413179, at *5 (E.D. Tenn. Mar. 21, 2018) (“The ALJ’s analysis of a treating physician’s opinion

may cite inconsistencies in the evidence, but the ALJ need not refer again to specific

inconsistencies again when those were listed earlier in the decision.”).

Therefore, Plaintiff’s argument against the ALJ’s treatment of Dr. Proffitt’s opinion

revolves around whether the ALJ’s finding that Dr. Proffitt’s opinion was inconsistent with the

medical record is supported by substantial evidence. As detailed above, the ALJ reviewed that Dr.

Proffitt’s opinion was inconsistent with Plaintiff’s testimony at the hearing regarding her

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functional abilities. [Tr. 21]. Earlier in the disability decision, the ALJ noted that postoperative

treatment records from Plaintiff’s aortic valve replacement “have shown a mechanical aortic valve

with normal function,” as well as that Plaintiff “was noted to have an exam consistent with normal

prosthetic aortic function.” [Tr. 19]. Additionally, the ALJ detailed that Plaintiff was “described

as well recovered and clinically stable in November 2017,” as well as that treatment records from

her cardiologist document that she continued to feel well, remained normally active, and could do

housework and shopping without significant limitation. [Id.].5 The ALJ also found that Plaintiff’s

treatment record “from her treating specialists reveals that her valvular aortic stenosis and coronary

artery disease were improved and stable with treatment,” and, therefore, the intensity, persistence,

and limiting effects of her symptoms were not consistent with the degree alleged. [Id.].

When reviewing the medical opinions of record, the ALJ summarized the medical record

to state that Dr. Proffitt’s assessments were inconsistent with Plaintiff’s testimony at the hearing

regarding her functional abilities, treatment records revealing that her valvular aortic stenosis and

coronary artery disease were improved and stable with treatment, that her edema was improved

and that she was not having as much swelling or symptoms from her venous insufficiency, and

that Plaintiff’s diabetes had improved and her A1c decreased with compliance with treatment. [Tr.

21]. Lastly, the ALJ noted that the medical record did not show that Plaintiff’s diabetes had

seriously damaged her heart, kidneys, or vital organs. [Id.].

5 While the ALJ generally cites to several medical records, a November 22, 2017 treatment

note from Dr. Proffitt states that Plaintiff “seemed to be well recovered and was clinically stable”

when Dr. Proffitt last saw Plaintiff one year ago, which was approximately four months from her

valve replacement. [Tr. 709]. However, the November 22nd treatment note also states that

Plaintiff “continues to feel well,” that she “remains active and on the go . . . denies any unusual

exertional dyspnea, fatigue, [or] chest discomfort,” that she did not have any palpitations, syncope,

or presyncope, and that she can do housework and shopping usually without significant limitations.

[Id.].

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First, with respect to the ALJ’s statement that Plaintiff’s edema had improved and that she

was not having as much swelling or symptoms related to her venous insufficiency, Plaintiff asserts

that the ALJ failed to acknowledge her testimony that her foot had swollen or to mention the

pictures of her feet submitted with a December 2016 function report showing extreme edema,

bruising, and an inability to wear a sandal. [Doc. 13 at 11]. Plaintiff claims that this swelling has

resulted in her spending large portions of the day elevating her legs, which was consistent with Dr.

Proffitt’s opinion.

This Court, like many others, has held “that an ALJ is not required to discuss all of the

relevant evidence in the record, nor is he required to comment on every finding in a medical

opinion” for the decision to stand. Dycus v. Astrue, No. 3:12-CV-78, 2012 WL 4215829, at *7

(E.D. Tenn. Aug. 30, 2012), report and recommendation adopted by, 2012 WL 4172138 (E.D.

Tenn. Sept. 18, 2012); see Boseley v. Comm’r of Soc. Sec., 397 F. App’x 195, 199 (6th Cir. 2010)

(“Neither the ALJ nor the Council is required to discuss each piece of data in its opinion, so long

as they consider the evidence as a whole and reach a reasoned conclusion.”). Moreover, a review

of the medical record demonstrates that substantial evidence supports the ALJ’s finding that

treatment records indicate that except for occasional exacerbation of leg swelling such as related

to a July 2018 car and plane ride, Plaintiff’s edema was improved such that she was not having as

much swelling or symptoms from venous insufficiency.

A May 26, 2016 treatment note reflects “[n]ormal exam - swelling, edema, and erythema

of tissue (trace bilateral ankle edema; no current erythema)”, while also indicating that joint

swelling was not present. [Tr. 449–50]. A June 16, 2016 treatment note from Plaintiff’s

cardiologist states that she exhibited normal range of motion and no leg edema [Tr. 428], while a

September 12, 2016 treatment note indicated no lower extremity edema [Tr. 578]. Again, a review

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of Plaintiff’s symptoms from an October 20, 2016 treatment note indicates that joint stiffness, joint

swelling, muscle pain, and muscle weakness were not present [Tr. 614], while also noting

“[n]ormal exam - swelling, edema, and erythema of tissue (trace bilateral ankle edema; no current

erythema)... [d]iscomfort in right thoracic back and mid axillary line with movement lying supine

on the table and sitting up.” [Tr. 616]. Another treatment note of that same date states that Plaintiff

“appears to be doing well with [S]alsalate in place of the Nebumetone,” that Plaintiff’s

Hydrocodone prescription was refilled; and that she “is wearing her flats all the time now in place

of heels.” [Tr. 609]. A February 22, 2017 treatment note states that Plaintiff continues with

significant leg pain and swelling, as well as that if she does not have to work on her feet, her

swelling is much improved. [Tr. 751]. Similarly, an October 17, 2017 treatment note states that

Plaintiff had continued leg pain, “but not as much of the swelling.” [Id.]. Additionally, a

November 22, 2017 progress note indicates no lower extremity edema, clubbing, or cyanosis. [Tr.

715]. Lastly, the Commissioner notes that Dr. Proffitt reported that Plaintiff had full muscle

strength in all muscles and normal musculoskeletal findings despite the presence of some leg

swelling on March 22, which was described as “not as severe” [Tr. 947, 950], and on July 3, 2018,

following a car and plane ride. [Tr. 1019, 1023].6

The Court’s review of the medical record also demonstrates that the ALJ’s finding

regarding improvement of Plaintiff’s valvular aortic stenosis and coronary artery disease is

supported by substantial evidence. Plaintiff’s September 12, 2016 follow-up with her cardiologist

6 A summary of Plaintiff’s March 22, 2018 treatment record states that Plaintiff “indicates

continued leg pain but overall much better since she is on her feet 8 hours a day 5 days a week;

still with swelling but not as severe.” [Tr. 947]. As depicted by Plaintiff, the Court notes that this

treatment note likely was intended to state that Plaintiff’s leg pain had improved because she was

no longer on her feet eight hours per day, five days per week. See [Doc. 13 at 15].

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stated that she “has been participating in the cardiac rehab program for [the] past 2 months and is

doing well,” that she denied any exertional chest pain, that her previous symptoms of dyspnea and

fatigue had resolved, and that she did not have any palpitations, dizziness, or syncope. [Tr. 572].

Plaintiff also cites to her November 22, 2017 follow-up visit with her cardiologist, as previously

discussed, where she reported feeling well and remaining active, demonstrated no exertional chest

pain or palpitation, syncope, or presyncope, and it was concluded that Plaintiff was stable by

clinical assessment. [Tr. 710, 716]. Lastly, Plaintiff fails to point to evidence in the medical record

contrasting the ALJ’s finding that her “diabetes has seriously damaged [her] heart, kidneys, or

vital organs.” [Tr. 21]. While Plaintiff notes, for example, that Dr. Proffitt opined that her diabetes

was moderately uncontrolled on October 17, 2017 [Tr. 749], Dr. Proffitt also noted that Plaintiff’s

blood sugar had been doing better and that her A1c had slightly improved recently [Tr. 750].

Although Plaintiff would interpret the medical evidence differently, the Court finds that

the ALJ’s determination was within his “zone of choice.” Blakley v. Comm’r of Soc. Sec., 581

F.3d 399, 407 (6th Cir. 2009) (holding that “[t]he substantial-evidence standard . . . presupposes

that there is a zone of choice within which the decisionmakers can go either way” and that as long

as substantial evidence supports the ALJ’s finding, the fact that the record contains evidence which

could support an opposite conclusion is irrelevant) (quotations omitted); see also Huizar v. Astrue,

No. 3:07-CV-411-J, 2008 WL 4499995, at *3 (W.D. Ky. Sept. 29, 2008) (“While plaintiff

understandably argues for a different interpretation of the evidence from that chosen by the ALJ,

the issue is not whether substantial evidence could support a contrary finding, but simply whether

substantial evidence supports the ALJ’s findings.”). Accordingly, the ALJ adequately provided

good reasons for rejecting Dr. Proffitt’s opinions, and substantial evidence supports that finding.

Keeler v. Comm’r of Soc. Sec., 511 F. App’x 472, 473 (6th Cir. 2013) (affirming the ALJ’s

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assignment of less than controlling weight to a treating physician’s opinion because the opinion

“was contradicted by other evidence in the record demonstrating that Keeler was able to engage in

significant physical activities . . . .”).

With respect to Dr. Blaine’s opinion, the Court finds that a similar analysis applies, as the

ALJ found that Dr. Blaine’s opinion was not supported by his examination findings and was

inconsistent with the medical record. [Tr. 21]. Here, the Court finds that the ALJ properly

reviewed Dr. Blaine’s opinion, and as the opinion of an examining consultant, was not required to

provide good reasons for not affording it controlling weight. See Norris v. Comm’r of Soc. Sec.,

461 F. App’x 433, 440 (6th Cir. 2012) (holding a consultative examiner’s opinion “may be rejected

by the ALJ when the source’s opinion is not well supported by medical diagnostics or if it is

inconsistent with the record”); Barker v. Shalala, 40 F.3d 789, 794 (6th Cir. 1994) (explaining that

opinions from one-time consultative examiners are not due any special degree of deference);

Hinkle v. Berryhill, No. 2:17-CV-54, 2018 WL 2437238, at *5 (E.D. Tenn. May 30, 2018) (holding

the ALJ properly assigned little weight to a consultative examiner’s opinion, as the ALJ detailed

how the opinion was not consistent with the examination or medical record, as well as reviewed

Plaintiff’s subjective allegations). “[T]he ALJ is ‘under no special obligation’ to provide great

detail as to why the opinions of the nonexamining providers ‘were more consistent with the overall

record’ than the examining, but nontreating providers.” Jenkins v. Soc. Sec. Admin., No. 3:14-cv-

1713, 2017 WL 2692624, at *9 (M.D. Tenn. June 21, 2017) (citing Norris v. Comm’r of Soc. Sec.,

461 F. App’x 433, 440 (6th Cir. 2012)).

Additionally, the ALJ reviewed Dr. Blaine’s opinion, and detailed that Plaintiff had full

grip strength was 5/5 bilaterally and that the flexor and extensor strength of both upper and lower

extremities was 5/5; that Plaintiff’s straight leg raise was negative bilaterally and that her stating,

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gait, tandem walk, heel and toe walk, and single-leg stand were normal; and that Plaintiff was

dyspneic at rest but became mildly dyspneic with exertion. [Tr. 20–21]. Therefore, as the ALJ

stated that the opinion was inconsistent with both his examination findings and the medical record,

the Court finds that substantial evidence supports the ALJ’s rejection of Dr. Blaine’s opinion.

Plaintiff’s argument centers on the ALJ’s acceptance of the opinions of the nonexamining

state agency physicians’ opinions over those of Dr. Proffitt and Dr. Blaine. Plaintiff contends that

“the ALJ’s analysis of the opinions of the Agency’s non-examining reviewers is also erroneous,”

as the ALJ failed to “offer any explanation or cite to any specific evidence” to support his finding

that their opinions were consistent with the medical record. [Doc. 13 at 17].

“State agency medical consultants . . . are ‘highly qualified physicians and psychologists

who are experts in the evaluation of the medical issues in disability claims under the [Social

Security] Act.’” Miller v. Comm’r of Soc. Sec., 811 F.3d 825, 834 (6th Cir. 2016) (quoting Soc.

Sec. Rul. 96–6p, 1996 WL 374180, at *2 (July 2, 1996)). Therefore, “[i]n appropriate

circumstances, opinions from State agency medical and psychological consultants and other

program physicians and psychologists may be entitled to greater weight than the opinions of

treating or examining sources.” SSR 96–6p, 1996 WL 374180, at *3. “One such circumstance

. . . [is] when the ‘State agency medical . . . consultant’s opinion is based on review of a complete

case record.’” Blakley v. Comm’r of Soc. Sec., 581 F.3d 399, 409 (6th Cir. 2009) (quoting SSR

96–6p, 1996 WL 374180, at *3).

“[B]efore an ALJ accords significant weight to the opinion of a non-examining source who

has not reviewed the entire record, the ALJ must give ‘some indication’ that he ‘at least considered’

that the source did not review the entire record. In other words, the record must give some

indication that the ALJ subjected such an opinion to scrutiny.” Kepke v. Comm’r of Soc. Sec., 636

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F. App’x 625, 632 (6th Cir. 2016) (quoting Blakely, 581 F.3d at 409). “[A]n ALJ may rely on the

opinion of a consulting or examining physician who did not have the opportunity to review later-

submitted medical records if there is ‘some indication that the ALJ at least considered these facts’

before assigning greater weight to an opinion that is not based on the full record.” Spicer v.

Comm’r of Soc. Sec., 651 F. App’x 491, 493–94 (6th Cir. 2016) (quoting Blakley v. Comm’r of

Soc. Sec., 581 F.3d 399, 409 (6th Cir. 2009)). The Sixth Circuit has found that an ALJ satisfied

Blakley by reviewing the medical evidence that was entered after the nonexamining state agency

consultant’s opinion and explaining why the consultant’s opinion was afforded greater weight

despite the subsequent evidence. Id.

The ALJ’s decision reflects that he made an independent determination based on all the

medical evidence and that his analysis spanned the entire record; thus, it was appropriate to accept

the opinions of the nonexamining state agency consultants. See Gibbens v. Comm’r of Soc. Sec.,

659 F. App’x 238, 247–48 (6th Cir. 2016) (affirming ALJ’s assessment of great weight to the dated

nonexamining state agency consultant’s opinion, rather than the current treating physician opinion

found to be inconsistent with the record, as “the ALJ’s own analysis clearly spanned the entire

record—through the final degenerative changes to [Plaintiff’s] spine that culminated in a cervical

discectomy and fusion, the last medical event included in the record”); accord Mcwhorter v.

Berryhill, No. 3:14-cv-1658, 2017 WL 1364678, at *12 (M.D. Tenn. Apr. 14, 2017); Quinlavin v.

Comm’r of Soc. Sec., No. 15-cv-731, 2017 WL 583722, at *4 (N.D. Ohio Feb. 14, 2017).

Ultimately, an ALJ is responsible for determining a claimant’s RFC after reviewing all the

relevant evidence of record. Rudd v. Comm’r of Soc. Sec., 531 F. App’x 719, 727–28 (6th Cir.

2013). The Court notes that although an ALJ is required to consider every medical opinion in the

record, 20 C.F.R. § 404.1527(c), he is not bound to adopt any particular opinion when formulating

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a claimant’s RFC. See Rudd, 531 F. App’x at 728 (“[T]o require the ALJ to base her RFC finding

on a physician’s opinion, ‘would, in effect, confer upon the treating source the authority to make

the determination or decision about whether an individual is under a disability, and thus would be

an abdication of the Commissioner’s statutory responsibility to determine whether an individual

is disabled.’”) (quoting SSR 96-5p, 1996 WL 374183 (July 2, 1996)). The ALJ is responsible for

weighing medical opinions, as well as resolving conflicts in the medical evidence of

record. Richardson v. Perales, 402 U.S. 389, 399 (1971); see also 20 C.F.R. § 416.946(c) (stating

the final responsibility for assessing a claimant’s RFC rests with the ALJ). The Court finds that

the ALJ appropriately considered the medical opinions of record, and that the ALJ’s RFC

determination is supported by substantial evidence.

B. Credibility Assessment

Plaintiff maintains that the ALJ’s credibility assessment was deficient because of his failure

to acknowledge or discuss Plaintiff’s strong work history in his credibility assessment. Plaintiff

notes that she “began working in 1980 and taught as a public-school teacher for the Carter County

Board of Education” from 1988 “until the onset of disability in 2016,” as well as argues that “she

successfully continued to educate children (with uninterrupted earning quarters) through multiple

physical hardships, including breast cancer with mastectomy and open-heart surgery.” [Doc. 13

at 19]. Plaintiff points to cases within the Sixth Circuit finding that a claimant’s positive work

history may bolster her credibility. [Id. at 20].

The ALJ’s decision postdates Social Security Ruling 16-3p, which eliminates the use of

the term “credibility” from the applicable policy regulation, and clarifies that a “subjective

symptom evaluation is not an examination of an individual’s character.” 2016 WL 1119029, at *1

(Mar. 16, 2016); see also Rhinebolt v. Comm’r of Soc. Sec., No. 2:17-CV-369, 2017 WL 5712564,

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at *8 (S.D. Ohio Nov. 28, 2017) (noting that under SSR 16-3p, “an ALJ must focus on the

consistency of an individual’s statements about the intensity, persistence and limiting effects of

symptoms, rather than credibility”), report and recommendation adopted by, 2018 WL 494523

(S.D. Ohio Jan. 22, 2018). However, “[t]he two-step process and the factors ALJs consider when

assessing the limiting effects of an individual’s symptoms have not changed with the advent of

SSR 16-3p.” Holder v. Comm’r of Soc. Sec., No. 1:17-CV-00186-SKL, 2018 WL 4101507, at *10

n.5 (E.D. Tenn. Aug. 28, 2018).

The ALJ is still tasked with first determining whether there is an “underlying medically

determinable physical or mental impairment(s) that could reasonably be expected to produce an

individual’s symptoms, such as pain.” SSR 16-3p, 2016 WL 1119029, at *2–3. Then, the ALJ is

responsible for determining the intensity, persistence, and limiting effects of an individual’s

symptoms, including assessing their: (1) daily activities; (2) the location, duration, frequency, and

intensity of pain or other symptoms; (3) factors that precipitate and aggravate the symptoms; (4)

the type, dosage, effectiveness, and side effects of any medication an individual takes or has taken

to alleviate pain or other symptoms; (5) treatment, other than medication, an individual receives

or has received for relief of pain or other symptoms; (6) any measures other than treatment an

individual uses or has used to relieve pain or other symptoms; and (7) any other factors concerning

an individual’s functional limitations and restrictions due to pain or other symptoms. Id. at *4–8.

As the Court has already reviewed, in the disability decision, the ALJ found that “the

intensity, persistence, and limiting effects of the claimant’s symptoms are not consistent with or

supported by the evidence of record to the degree alleged.” [Tr. 19]. “Despite the linguistic

clarification, courts continue to rely on pre-SSR 16-3p authority providing that the ALJ’s

credibility determinations are given great weight.” Getz v. Comm’r of Soc. Sec., No. CV 18-

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11625, 2019 WL 2710053, at *3–4 (E.D. Mich. June 10, 2019), report and recommendation

adopted by, 2019 WL 2647260 (E.D. Mich. June 27, 2019) (citing Kilburn v. Comm’r of Soc. Sec.,

No. 1:17-CV-603, 2018 WL 4693951, at *7 (S.D. Ohio Sept. 29, 2018); Duty v. Comm’r of Soc.

Sec., No. 2:17-CV-445, 2018 WL 4442595, at *6 (S.D. Ohio Sept. 18, 2018)).

“It is true that an extensive work history and attempts to continue working despite a

disability will generally lend support to a claimant’s credibility.” Wohler v. Saul, No. 1:19-CV-

56, 2020 WL 1531296, at *16 (N.D. Ohio Mar. 31, 2020) (citing White v. Comm’r of Soc. Sec.,

312 F. App’x 779, 789 (6th Cir. 2009) (“White’s extensive work history and attempts to continue

working despite his disability support his credibility, a factor not even considered by the ALJ.”)).

However, the Sixth Circuit has specifically found that an ALJ is “not required to explicitly

discuss [a claimant’s] work history when assessing [her] credibility” so long as the ALJ provides

substantial justification for his determination of a claimant’s subjective symptoms. Dutkiewicz v.

Comm’r of Soc. Sec., 663 F. App’x 430, 433 (6th Cir. 2016) (finding “[t]he ALJ was not required

to explicitly discuss” the claimant’s alleged “consistent and arduous work history when evaluating

his credibility” as the ALJ’s determination that the claimant’s testimony was not fully credible was

supported by substantial evidence). “While there is no question that a claimant’s positive work

history can bolster her credibility, an ALJ is not required to explicitly discuss that work history,”

but he must consider it along with all the other evidence presented in the record. Maki v. Comm’r

of Soc. Sec., No. 1:18-cv-798, 2019 WL 3082309, at *9 (N.D. Ohio July 15, 2019) (citing

Dutkiewicz, 663 F. App’x at 433).

Plaintiff fails to address the ALJ’s additional reasoning for finding that her statements

concerning the intensity, persistence, and limiting effects of her symptoms were not entirely

consistent with the medical evidence and other evidence of record. The ALJ noted that Plaintiff’s

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“coronary artery disease has been stable by clinical assessment for over 20 years,” that diagnostic

studies following her mechanical aortic valve replacement “have shown a mechanical aortic valve

with normal function,” and that Plaintiff s “treatment record from her cardiologists documents that

she continued to feel well, remained normally active and on the go, and could do housework and

shopping usually without significant limitation.” [Tr. 18-19]. While perhaps it would have been

advisable for the ALJ to specifically mention Plaintiff’s significant work history, any error by the

ALJ in failing to explicitly weigh her work history in the credibility determination is at best

harmless error. Therefore, Plaintiff’s allegation of error does not constitute a basis for remand.

VI. CONCLUSION

Based on the foregoing, Plaintiff's Motion for Summary Judgment [Doc. 12] will be

DENIED, and the Commissioner’s Motion for Summary Judgment [Doe. 14] will be GRANTED.

The decision of the Commissioner will be AFFIRMED. The Clerk of Court will be DIRECTED

to close this case.

ORDER ACCORDINGLY.

ENTER:

Debra C. Poplin WO

United States Magistrate Judge

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