HOPE v. SAUL

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF NORTH CAROLINA

ARTHUR JUNIOR HOPE, )

Plaintiff,

v. 1:20CV1146

KILOLO KIJAKAZI,

Acting Commissioner of Social Security, )

Defendant.

MEMORANDUM OPINION AND RECOMMENDATION

OF UNITED STATES MAGISTRATE JUDGE

Plaintiff Arthur Junior Hope (‘Plaintiff’) brought this action pursuant to Sections

205(g) and 1631(c)(3) of the Social Security Act (the “Act’), as amended (42 U.S.C. §§ 405(g)

and 1383(c)(3)), to obtain judicial review of a final decision of the Commissioner of Social

Security denying his claims for Disability Insurance Benefits (“DIB”) and Supplemental

Security Income (“SSI”) under, respectively, Titles II and XVI of the Act. The parties have

filed cross-motions for judgment, and the administrative record has been certified to the Court

for review.

I. PROCEDURAL HISTORY

Plaintiff protectively filed applications for DIB and SSI on July 30, 2018, alleging a

disability onset date of July 23, 2018 in both applications. (Ir. at 13, 193-202.)? His

| Kilolo Kijakazi was appointed as the Acting Commissioner of Social Security on July 9, 2021. Pursuant to

Rule 25(d) of the Federal Rules of Civil Procedure, Kilolo Kijakazi should be substituted for Andrew M. Saul

as the Defendant in this suit. Neither the Court nor the parties need take any further action to continue this

suit by reason of the last sentence of section 205(g) of the Social Security Act, 42 U.S.C. § 405(g).

2 Transcript citations refer to the Sealed Administrative Record [Doc. #9].

applications were denied initially (Tr. at 52-73, 100-04) and upon reconsideration (Tr. at 74-

99, 113-28). Thereafter, Plaintiff requested an administrative hearing de novo before an

Administrative Law Judge (“ALJ”). (Tr. at 129-32.) On April 8, 2019, Plaintiff, along with his

attorney, attended the subsequent telephonic hearing, during which both Plaintiff and an

impartial vocational expert testified. (Tr. at 13.) Following the hearing, the ALJ concluded

that Plaintiff was not disabled within the meaning of the Act (Tr. at 21-22), and on October

30, 2020, the Appeals Council denied Plaintiffs request for review of the decision, thereby

making the AL]’s conclusion the Commissionet’s final decision for purposes of judicial review

(Tr. at 1-5).

I. LEGAL STANDARD

Federal law “authorizes judicial review of the Social Security Commissionet’s denial of

social security benefits.” Hines v. Barnhart, 453 F.3d 559, 561 (4th Cir. 2006). However, the

scope of review of such a decision is “extremely limited.” Frady v. Harris, 646 F.2d 143, 144

(4th Cir. 1981). “The courts are not to try the case de novo.” Oppenheim v. Finch, 495 F.2d

396, 397 (4th Cir. 1974). Instead, “a reviewing court must uphold the factual findings of the

AL) if they are supported by substantial evidence and were reached through application of the

correct legal standard.” Hancock v. Asttue, 667 F.3d 470, 472 (4th Cir. 2012) (Gnternal

quotation omitted).

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

as adequate to support a conclusion.”” Hunter v. Sullivan, 993 F.2d 31, 34 (4th Cir. 1993)

(quoting Richardson vy. Perales, 402 U.S. 389, 390 (1971)). “It consists of mote than a mete

scintilla of evidence but may be somewhat less than a preponderance.” Mastro v. Apfel, 270

F.3d 171, 176 (4th Cir. 2001) (internal citations and quotation marks omitted). “If there is

evidence to justify a refusal to ditect a verdict were the case before a jury, then there is

substantial evidence.” Hunter, 993 F.2d at 34 (internal quotation marks omitted).

“In reviewing for substantial evidence, the court should not undertake to re-weigh

conflicting evidence, make credibility determinations, or substitute its judgment for that of the

[AL]].” Mastro, 270 F.3d at 176 (internal brackets and quotation marks omitted). “Where

conflicting evidence allows reasonable minds to differ as to whether a claimant is disabled, the

responsibility for that decision falls on the ALJ.” Hancock, 667 F.3d at 472. “The issue before

[the reviewing court], therefore, is not whether [the claimant] is disabled, but whether the

AL)’s finding that [the claimant] is not disabled is supported by substantial evidence and was

reached based upon a correct application of the relevant law.” Craig v. Chater, 76 F.3d 585,

589 (4th Cir. 1996).

In undertaking this limited review, the Court notes that “[a] claimant for disability

benefits bears the burden of proving a disability.” Hall v. Hartis, 658 F.2d 260, 264 (4th Cir.

1981). In this context, “disability” means the “‘inability to engage in any substantial gainful

activity by reason of any medically determinable physical or mental impairment which can be

expected to result in death or which has lasted or can be expected to last for a continuous

petiod of not less than 12 months.” Id. (quoting 42 U.S.C. § 423(d)(1)(A))3

Social Security Act comprises two disability benefits programs. The Social Security Disability Insurance

Program (SSDI), established by Title II of the Act as amended, 42 U.S.C. § 401 et seq., provides benefits to

disabled persons who have contributed to the program while employed. The Supplemental Security Income

Program (SSI), established by Title XVI of the Act as amended, 42 U.S.C. § 1381 et seq., provides benefits to

indigent disabled persons. The statutory definitions and the regulations promulgated by the Secretary for

determining disability, see 20 C.F.R. pt. 404 (SSDI); 20 CFR. pt. 416 (SSI), governing these two programs are,

in all aspects relevant here, substantively identical.” Craig, 76 F.3d at 589 n.1.

“The Commissioner uses a five-step process to evaluate disability claims.” Hancock,

667 F.3d at 472 (citing 20 C.F.R. §§ 404.1520(a)(4); 416.920(a)(4)). “Under this process, the

Commissionet asks, in sequence, whether the claimant: (1) worked during the alleged period

of disability; (2) had a severe impairment; (3) had an impairment that met or equaled the

requitements of a listed impairment; (4) could return to her past relevant work; and (5) if not,

could perform any other work in the national economy.” Id.

A finding adverse to the claimant at any of several points in this five-step sequence

forecloses a disability designation and ends the inquiry. For example, “[t]he first step

determines whether the claimant is engaged in ‘substantial gainful activity.’ If the claimant is

working, benefits are denied. The second step determines if the claimant is ‘severely’ disabled.

If not, benefits are denied.” Bennett v. Sullivan, 917 F.2d 157, 159 (4th Cir. 1990).

On the other hand, if a claimant carries his or her burden at the first two steps, and if

the claimant’s impairment meets or equals a “listed impairment” at step three, “the claimant

is disabled.” Mastro, 270 F.3d at 177. Alternatively, if a claimant clears steps one and two,

but falters at step three, i.e., “[i]f a claimant’s impairment is not sufficiently severe to equal ot

exceed a listed impaitment,” then “the AL] must assess the claimant’s tesidual functional

capacity (RFC’).” Id. at 179.4 Step four then requires the ALJ to assess whether, based on

4 “REC is a measurement of the most a claimant can do despite [the claimant’s] limitations.” Hines, 453 F.3d

at 562 (noting that administrative regulations require RFC to reflect claimant’s “ability to do sustained work-

related physical and mental activities in a work setting on a regular and continuing basis . . . [which] means 8

hours a day, for 5 days a week, or an equivalent work schedule” (internal emphasis and quotation marks

omitted)). The RFC includes both a “physical exertional or strength limitation” that assesses the claimant’s

“ability to do sedentary, light, medium, heavy, or very heavy work,” as well as “nonexertional limitations

(mental, sensory, or skin impairments).” Hall, 658 F.2d at 265. “RFC is to be determined by the AL] only after

[the ALJ] considers all relevant evidence of a claimant’s impairments and any related symptoms (¢g., pain).”

Hines, 453 F.3d at 562-63.

that REC, the claimant can “perform past relevant work”; if so, the claimant does not qualify

as disabled. Id. at 179-80. However, if the claimant establishes an inability to return to prior

work, the analysis proceeds to the fifth step, which “requires the [Government] to prove that

a significant number of jobs exist which the claimant could perform, despite the claimant’s

impaitments.” Hines, 453 F.3d at 563. In making this determination, the ALJ must decide

“whether the claimant is able to perform other work considering both [the claimant’s RFC]

and [the claimant’s] vocational capabilities (age, education, and past work experience) to adjust

to a new job.” Hall, 658 F.2d at 264-65. If, at this step, the Government cannot catty its

“evidentiary burden of proving that [the claimant] remains able to work other jobs available

in the community,” the claimant qualifies as disabled. Hines, 453 F.3d at 567.

Ill DISCUSSION

In the present case, the ALJ found that Plaintiff had not engaged in “substantial gainful

activity” since his alleged onset date. The ALJ therefore concluded that Plaintiff met his

burden at step one of the sequential evaluation process. (Ir. at 15.) At step two, the AL]

further determined that Plaintiff suffered from the following severe impairments:

chronic kidney disease, stage II]; hypertension; diabetes mellitus; bilateral

diabetic retinopathy with macular edema; vitreous hemorrhage with traction

detachment of the retina in the left eye; and nuclear sclerosis of the bilateral

eyes|.|

(Tr. at 15.) The ALJ found at step three that none of the impairments identified at step two,

individually or in combination, met or equaled a disability listing. (I'r. at 16.) The AL]

therefore assessed Plaintiff's RFC and determined that he could perform light work with the

following, non-exertional limitations:

frequent climbing of ramps and stairs; no climbing of ladders ropes or scaffolds;

occasional balancing and stooping; no kneeling, crouching or crawling; no jobs

requiring full depth perception; and avoid concentrated exposure to dangerous

machinery and heights.

(Tr. at 16.) Based on this determination and the testimony of a vocational expert, the ALJ

determined at step four of the analysis that all of Plaintiffs past relevant work exceeded his

REC. (Tr. at 20.) However, the AL] found at step five that, given Plaintiffs age, education,

work experience, RFC, and the testimony of the vocational expert as to these factors, he could

perform other jobs available in significant numbers in the national economy. (Tr. at 21.)

Therefore, the AL] concluded that Plaintiff was not disabled under the Act. (Tr. at 21-22.)

Plaintiff now contends that “the ALJ never adequately explained how the evidence he

cites supports his decision that [Plaintiffs] allegations were inconsistent with the objective

medical evidence regarding his pain and functional limitations and how the evidence he cites

supports his RFC conclusions. [Plaintiff] further contends that the AL]’s decision cannot be

supported by substantial evidence since the AL] failed to explain how he resolves conflicting

evidence in the record before reaching his [RFC] findings.” (Pl.’s Br. [Doc. #14] at 18.) In

other words, Plaintiff asserts that the ALJ (1) failed to consider Plaintiffs subjective

complaints in accordance with the regulations, and (2) failed to perform a proper function-by-

function analysis in accordance with the Fourth Circuit’s guidance. Notably, Plaintiff presents

these arguments as a single challenge in his brief, and the Court will therefore consider these

contentions together, by first setting out the applicable guidance and then considering the

AL}’s analysis in this case.

Plaintiff principally argues that the ALJ failed to properly explain the basis for his RFC

assessment. In terms of function-by-function analysis, he contends that the AL] “fail[ed] to

provide a ‘logical bridge’ explaining how or why the ALJ reached a conclusion at Step 2 that

[Plaintiffs] . . . chronic kidney disease as well as his visual impairments were severe and

significantly limited his ability to perform basic work activities but then required no

corresponding limitation in the RFC.” (Pl.’s Br. at 8.) Specifically, Plaintiff argues that the

AL] erred by failing to (1) account for Plaintiffs need to elevate his legs to reduce his

documented edema and (2) include visual limitations relating to his “blutred vision and/or

fluctuating visual acuity.” (Pl.’s Br. at 9, 10.)

As Social Security Ruling (“SSR”) 96-8p instructs, “|t]he RFC assessment must first

identify the individual’s functional limitations or restrictions and assess his or her work-related

abilities on a function-by-function basis,” including the functions listed in the regulations. SSR

96-8p: Policy Interpretation Ruling Titles and XVI: Assessing Residual Functional Capacity

in Initial Claims, 1996 WL 374184, at *1. “Only after such a function-by-function analysis

may an AL] express RFC in terms of the exertional levels of work.” Monroe v. Colvin, 826

F.3d 176, 179 (4th Cir. 2016) G@nternal quotations and citations omitted). Further, the “RFC

assessment must include a natrative discussion describing how the evidence supports each

conclusion, citing specific medical facts (e.g., laboratory findings) and nonmedical evidence

(e.g., daily activities, observations).” SSR 96-8p, 1996 WL 374184, at *7. An AL] must “both

identify evidence that supports his conclusion and build an accurate and logical bridge from

[that] evidence to his conclusion.” Woods v. Berryhill, 888 F.3d 686, 694 (4th Cir. 2018)

(emphasis omitted).

The Fourth Circuit has noted that a per se rule requiring remand when the ALJ does not

perform an explicit function-by-function analysis “is inappropriate given that remand would

ptove futile in cases where the AL] does not discuss functions that are ‘irrelevant ot

uncontested.”” Mascio v. Colvin, 780 F.3d 632, 636 (4th Cir. 2015) (quoting Cichocki v.

Astrue, 729 F.3d 172, 177 (2d Cir. 2013) (per curiam)). Rather, remand may be appropriate

“where an AL] fails to assess a claimant’s capacity to perform relevant functions, despite

conttadictory evidence in the record, or where other inadequacies in the AL]’s analysis

frustrate meaningful review.” Id. (quoting Cichocki, 729 F.3d at 177). The court in Mascio

concluded that temand was apptopriate because it was “left to guess about how the AL]

atrived at his conclusions on [the claimant’s] ability to perform relevant functions” because

the ALJ had “said nothing about [the claimant’s] ability to perform them for a full workday,”

despite conflicting evidence as to the claimant’s RFC that the ALJ did not address. Id. at 637.

Here, Plaintiff contends that the ALJ’s failure to include limitations relating to edema

and visual acuity—or to explain their absence from the RFC assessment—tenders his decision

unsupported by substantial evidence. However, as set out below, the ALJ sufficiently relayed

his reasons for discounting the need for these additional restrictions. In particular, the AL]

explained that the record as a whole, including the treatment notes, objective testing, and

medical opinion evidence, failed to substantiate Plaintiffs subjective complaints regarding the

impact of his visual acuity and edema on his RFC.

With respect to the ALJ’s evaluation of Plaintiffs allegations regarding his symptoms,

under the applicable regulations the AL]’s decision must “contain specific reasons for the

weight given to the individual’s symptoms, be consistent with and supported by the evidence,

and be clearly articulated so the individual and any subsequent reviewer can assess how the

adjudicator evaluated the individual’s symptoms.” Social Security Ruling 16-3p, Titles IT and

XVI: Evaluation of Symptoms in Disability Claims, SSR 16-3p, 2017 WL 5180304 (Oct. 25,

2017) (“SSR 16-3p”); see also 20 C.F.R. § 404.1529. Moreover, in Arakas v. Comm’t of Soc.

Sec., 983 F.3d 83 (4th Cir. 2020), the Fourth Circuit recently clarified the procedure an AL]

must follow when assessing a claimant’s statements:

When evaluating a claimant’s symptoms, ALJs must use the two-step

framework set forth in 20 C.F.R. § 404.1529 and SSR 16-3p, 2016 WL 1119029

(Mar. 16, 2016). First, the ALJ must determine whether objective medical

evidence presents a “medically determinable impairment” that could reasonably

be expected to ptoduce the claimant’s alleged symptoms. 20 C.F.R.

§ 404.1529(b); SSR 16-3p, 2016 WL 1119029, at *3.

Second, after finding a medically determinable impairment, the ALJ must assess

the intensity and persistence of the alleged symptoms to determine how they

affect the claimant’s ability to work and whether the claimant is disabled. See 20

C.F.R. § 404.1529(c); SSR 16-3p, 2016 WL 1119029, at *4. At this step,

objective evidence is □□□ required to find the claimant disabled. SSR 16-3p, 2016

WL 1119029, at *4-5. SSR 16-3p recognizes that “[s]ymptoms cannot always

be measured objectively through clinical or laboratory diagnostic

techniques.” Id. at *4. Thus, the AL] must consider the entire case record and

may “not disregard an individual’s statements about the intensity, persistence,

and limiting effects of symptoms solely because the objective medical evidence

does not substantiate” them. Id. at *5.

Arakas, 983 F.3d at 95-96. Thus, the second part of the test requites the AL] to consider all

available evidence, including Plaintiffs statements about his pain, in order to evaluate “the

intensity and persistence of the claimant’s pain, and the extent to which it affects [his] ability

to work.” Craig, 76 F.3d at 595. This approach facilitates the ALJ’s ultimate goal, which is to

accurately determine the extent to which Plaintiffs pain or other symptoms limit his ability to

perform basic work activities. Relevant evidence for this inquity includes Plaintiff's “medical

history, medical signs, and laboratory findings,” Craig, 76 F.3d at 595, as well as the following

factors set out in 20 C.F.R. § 416.929(c)(3) and 20 C.F.R. § 404.1529:

(i) [Plaintiffs] daily activities;

(ii) The location, duration, frequency, and intensity of [plaintifPs] pain or

other symptoms;

(ii) Precipitating and aggravating factors;

(iv) The type, dosage, effectiveness, and side effects of any medication

[Plaintiff] take[s] or [has] taken to alleviate [his] pain or other symptoms;

(v) Treatment, other than medication, [Plaintiff] receive[s] or [has] received

for telief of [his] pain or other symptoms;

(vi) Any measures [Plaintiff] use[s] or [has] used to relieve [his] pain or other

symptoms (e.g., lying flat on [his] back, standing for 15 to 20 minutes

every hour, sleeping on a board, etc.); and

(vii) Other factors concerning [Plaintiffs] functional limitations and

restrictions due to pain or other symptoms.

In the present case, as instructed by the regulations, the ALJ considered the entire case

record and explained the reasons for deviating from Plaintiffs statements regarding the impact

of his symptoms on his ability to work. Whether the AL] could have reached a different

conclusion based on the evidence is irrelevant. The sole issue before the Court is whether

substantial evidence supports the ALJ’s decision. See Blalock v. Richardson, 483 F.2d 773,

775 (4th Cir. 1972) (“[I]he language of § 205(g) precludes a de novo judicial proceeding and

requires that the court uphold the Secretary’s decision even should the court disagree with

such decision as long as it is supported by ‘substantial evidence.”’).

Here, the AL] teviewed the medical evidence, the opinion evidence, Plaintiffs

testimony, and the record, and explained the analysis of Plaintiffs subjective complaints.

Notably, the ALJ did not conclude that Plaintiffs complaints of edema and vision problems

wete unsupported by objective evidence. Rather, he found, based on the record as a whole,

that the extent to which these symptoms limited Plaintiffs ability to work was not as extensive

as Plaintiff alleged. As set out in the administrative decision,

[Plaintiff] alleged the inability to work due to blurred vision, stage III kidney

disease, high blood pressure, heart issues and diabetes. During the hearing,

[Plaintiff] reported that left eyed blurriness prevented him from seeing much,

10

noting that his previous eye surgery helped just a little bit. Further, he reported

symptoms of swelling in the lower extremities and the need to elevate his feet

as well as the medication side effect of weakness. Overall, [Plaintiff] reported

that his chronic impairments limited his activities of daily living such that he

could sit and stand for just 20 minutes; walk 5 minutes before experiencing

shortness of breath; and lift a gallon of milk. [H]e noted that he could not kneel,

reach down or squat; he did not complete household chores; and he stated that

his mother helped to put his socks on.

(Tr. at 17) (internal citation omitted). The ALJ acknowledged that Plaintiff experienced

limitations from his visual, hypertensive, and diabetes-related impairments, including bilateral

pedal edema and significantly impaired vision in his left eye. (Tr. at 18-19.) However, the AL]

also chronicled Plaintiff's ongoing non-compliance with his prescribed treatment throughout

the time at issue, as well as symptomatic improvement during periods of compliance.

In terms of Plaintiffs diabetes, chronic kidney disease, and hypertension, the record

reflects that, just days after his alleged onset date, Plaintiff was hospitalized due to multiple

conditions, including gastroenteritis and complications from uncontrolled diabetes. (Tr. at 18,

372-73.) His symptoms included nausea, vomiting, and diarrhea, which led to acute kidney

injury secondary to dehydration. (Tr. at 18, 372-73.) Hospital records also reflect that, prior

to his hospitalization, Plaintiff was taking no medications to control his diabetes and that he

did not check his blood sugar at home. (Tr. at 18, 381.)

Thereafter, [Plaintiff] continued conservative treatment via medication therapy

with his primaty cate provider and Nephrologist (4F, 5F, 11F). [Plaintiffs]

treatment notes show that he required medication adjustments, including

ptescriptions for Carvedilol, Hydralazine, Lantus SoloStar, Torsemide, Lancets;

and despite episodes of elevated blood pressure with headaches and symptoms

of fatigue, vomiting and weakness, notes show good medication tolerance

(4F/3, 6; 11F/13, 18, 21, 23). Due to [Plaintiffs] pedal edema, he was also

encoutaged to weat compression hose and to take an extra pill on days that

swelling was noticed. Further, he was instructed to monitor and record blood

ptessure at home (7F/16). However, the record evidences noncompliance with

his treatment regimen, with [Plaintiff] reporting the inability to use insulin due

11

to financial concerns; he failed to check his blood pressure at home; and notes

show that he did not follow a diabetic diet (4F/14; 5F/12; 7F/6, 8, 11).

Although [Plaintiffs] Nephrologist noted kidney issues complicated by

uncontrolled diabetes, hypertension and anemia, he did not require dialysis

treatment (3F/1; 5F/14, 23; 7F/8, 13; 8F/1, 13).

In eatly 2019, primary care treatment notes show that [Plaintiffs] sugars

remained high, with laboratory studies showing a hemoglobin A1C at 10.6 and

he was restarted on insulin (10F/3; 11F/8, 12). During this time, [Plaintiff] was

also treated for recurrent pneumonia, edema in the extremities and shortness of

breath. Physical examinations showed that breath sounds were cleat to

auscultation with no wheezes or rhonchi; bilateral 2+ pitting edema; and he was

alert and oriented in all spheres (10F/6, 9, 12; 11F/5; 13F/18, 23; 18F/55).

[Plaintiff] was started on new medication, including hydrocodone-

Acetaminophen for pain and metolazone for short-term treatment of edema;

and his provider stressed leg elevation . . . and sodium restriction (11F/5)....

By April and May 2019, [Plaintiff] also reported that medication greatly help

with leg swelling; laboratory studies remained stable and blood pressure was

improved; and he failed to keep a pulmonary appointment, noting improved

breathing such that he was able to mow his yard without dyspnea (9F/2, 5;

11F/2; 18F/94, 144).

For the remainder of the televant period, notes show that the claimant’s

[chronic kidney disease] improved and his treatment regimen was adjusted

accordingly; and he continued hypertension medication (12F/4, 7).

(Tr. at 18-19); (see also Tr. at 887, 884-85, 1009, 996, 1003, 1006).

In addition to treatment non-compliance, the above discussion reflects that, although

Plaintiff required regular medical appointments and treatment adjustments to control

symptoms telated to his non-visual impairments, his symptoms improved with these

adjustments, particularly after April 2019, when Plaintiff resumed using insulin. Plaintiff

testified at his hearing that he spent most of the day with his legs elevated due to pedal edema.

(See Tr. at 40-42, 45-46.) He now points to treatment notes in which his providers

recommended leg elevation, diuretics, compression socks, and restricted sodium intake to

support the ongoing severity and limiting effects of this symptom. However, nothing in the

12

treatment notes cited by Plaintiff and recounted by the ALJ indicates that Plaintiffs provider

intended leg elevation to be a full-time, long-term directive. Rather, the treatment records

reflect that Plaintiff's primary care provider Dr. Parachuri recommended leg elevation in April

2019 when Plaintiff had increased symptoms (T'r. at 898), but Dr. Parachuri was able to address

the symptoms with medication which “greatly helped the leg swelling” (Tr. at 898, 881, 955),

such that for the remainder of 2019 the notes from Dr. Parachuri’s office reflect that Plaintiff

was doing well, his diabetes symptoms were relieved by medication, and he felt well overall

with no complaints (Tr. at 881, 955, 957, 994, 996). Plaintiffs nephrologist Dr. Igwemezle

treated Plaintiff regularly in 2018 and 2019 but did not mention leg elevation and instead

repeatedly set out a plan of care that involved medications, a controlled diet, and compression

hose for any swelling (Tr. at 835, 831-32, 828-29, 876-77, 873-74, 1009). The notes from Dr.

Igwemezle’s office also reflect the effectiveness of the medication with no pedal edema on

examination after April 2019 (Tr. at 869-71, 950-52, 948, 1008, 1005, 1002). In addition, Dr.

Igwemezie’s notes reflect that some swelling may be expected, and Dr. Igwemezie stressed the

importance of Plaintiff taking his medication as prescribed, following a diabetic diet, testing

regularly at home, and using compression hose/socks for swelling. (See Tr. at 1009.) The

ALJ considered these medical records at length, noted the conservative nature of the

treatment, noted Plaintiff's improvement when complying with the medication tegimen, and

relied on the records in concluding that the intensity of Plaintiffs symptoms was not as

limiting as Plaintiff alleged.

The ALJ also considered the relevant medical opinion evidence in finding Plaintiffs

edema less limiting than alleged. In particular, the ALJ relied on the findings of the State

13

agency medical consultants, Dr. Pyle and Dr. Cox, both of whom found that, despite Plaintiff's

symptoms related to his non-visual impairments, he remained capable of light work. (I'r. at

19, 57, 81.) The State agency consultants also found Plaintiff able to frequently stoop, kneel,

crouch, ctawl, and climb ramps and stairs, and to occasionally balance and climb ladders,

topes, ot scaffolds. (Ir. at 19, 58, 81.) Notably, neither consultant indicated any need for leg

elevation. The ALJ found the State agency opinions persuasive, but ultimately concluded that,

in terms of postural limitations, Plaintiff was more limited than the consultants opined. (Tr.

at 16, 19.) Accordingly, the AL] included further limitations to “no climbing of ladders ropes

or scaffolds; occasional balancing and stooping; [and] no kneeling, crouching or crawling” in

PlaintifPs RFC assessment. (Tr. at 16.)

Whether the ALJ could have reached a different conclusion based on the evidence is

irrelevant. ‘The sole issue before the Coutt is whether substantial evidence supports the AL]’s

decision. See Blalock, 483 F.2d at 775 (“[T]he language of § 205(g) precludes a de novo judicial

proceeding and requires that the court uphold the Secretary’s decision even should the court

disagree with such decision as long as it is supported by ‘substantial evidence.”’). As recently

noted by the Supreme Court in Biestek v. Berryhill, 139 S. Ct. 1148 (2019), “whatever the

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

high. Substantial evidence, this Court has said, is ‘more than a mete scintilla.’ . . .t means—

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

support a conclusion.” Biestek, 139 8. Ct. at 1154. Here, the ALJ reviewed the medical

evidence, the opinion evidence, Plaintiffs testimony, and the record as a whole. He explained

his analysis of Plaintiff's subjective complaints, including Plaintiffs assertions that he required

14

leg elevation, as well as his tationale for excluding such a limitation from the RFC finding.

Because the ALJ “both identiffied] evidence that supports his conclusion and buil[t] an

accurate and logical bridge from [that] evidence to his conclusion,” Woods, 888 F.3d at 694,

the Court finds no basis for remand.

The same holds true for Plaintiffs visual limitations. Although Plaintiff contends that

the ALJ failed to include limitations relating to his alleged blurred vision, as with Plaintiff's

ptevious challenge, the ALJ adequately explained why he discounted Plaintiffs subjective

complaints when formulating his RFC assessment. As set out above, Plaintiff “reported that

left eyed blurriness prevented him from seeing much, noting that his previous eye surgery

helped just a little bit.” (Tr. at 17.) The AL] noted that, prior to Plaintiffs alleged onset date,

“he was assessed with moderate nonproliferative diabetic neuropathy and evidence of a

vitreous hemorrhage was found in [Plaintiffs] left eye. Accordingly, he was started on right

eye macular photocoagulation treatment for his macular edema and left eye retinal coagulation.

... During that time, [Plaintiff] was instructed to sleep upright, limit daily activities and remain

out of work.” (Tr. at 17) (citing Tr. at 307). However, the AL] noted that “the assessment

that [Plaintiff] should remain out of work was time-limited in nature, as evidence[d] by later

treatment notes showing improvement with therapy.” (Tr. at 17) (citing Tr. at 307, 351).

Nevertheless, the ALJ acknowledged that Plaintiff continued to have “slightly blurred vision

in the left eye.” (Tr. at 17) (citing Tr. at 351).

On October 29, 2018, [Plaintiff] underwent a retinal evaluation that revealed

left eye diabetic macular edema (6F/1). He was also assessed with right eye

proliferative diabetic retinopathy, a left eye vitreous hemorrhage, nuclear

sclerosis in both eyes and left retina traction detachment (6F/6, 7). With respect

to treatment, [Plaintiff] began intravitreal Avastin injections and on December

4, 2018, he underwent a right eye pan-retinal photocoagulation laser treatment

15

(6F/7, 19). Post-operative notes show that he was instructed to avoid any

strenuous exetcise or heavy lifting following the procedure (6F/31, 41).

(Tr. at 18.) As with Plaintiffs earlier procedure and related limitations, the ALJ again noted

that “the limitation[s] [were] time-limited in nature and later notes show that [Plaintiffs] vision

improved.” (Tr. at 18) (citing Tr. at 814). Indeed, the records reflect that following the

procedures in late 2018, Plaintiffs vision was “improving” in Match 2019 and had “improved

tremendously” by April 2019. (Tr. at 1081, 1145.) In addition, specifically with regard to

Plaintiff's visual acuity, the ALJ recounted that, “[i]n June 2019, an eye examination showed

that [Plaintiff's] visual acuity was 20/25 in the right eye and 20/80 in the left eye.” (Tr. at 19)

(citing Tr. at 988). While Plaintiff does point to testing reflecting 20/200 vision (Pl. Br. at 11),

that testing was prior to Plaintiff's surgeries (Tr. at 1042), and the post-surgical testing reflects

the improvement cited by the ALJ (Tr. at 1166, 1015, 1023, 1031, 1040, 1042), with Plaintiff

repeatedly refusing offers for an updated prescription for glasses (Tr. at 1081, 1019, 1036).

Most significantly for purposes of Plaintiff's present challenge, the ALJ related that,

in October 2019, [Plaintiff] reported blurry vision in both eyes and was referred

for further evaluation due to suspected glaucoma (17F/5; 18F/128). However,

notes show only mild symptoms of glaucoma despite [Plaintiffs] failure to take

eye drops as directed. In early 2020, [Plaintiff] inquired about disability and his

ptovider advised that he did not meet the visual criteria for disability. [The AL]

found] this opinion persuasive, as supported by tests showing that [Plaintiffs]

vision was stable (17F/31).

(Tr. at 19; see also Tr. at 1042 (“[V]ision stable. .. . Patient inquiring about disability. I advised

him he does not meet visual criteria for disability.”))

The AL] further relied on the opinions of the State agency medical consultants, Dr.

Pyle and Dr. Cox, who found that Plaintiff had limited depth perception, but specifically

concluded that Plaintiff required no further visual limitations. (Tr. at 19) (citing Tr. at 68-69,

16

81-82). In making this finding, the consultants, like the ALJ, relied upon “treatment notes

showing visual acuity was 20/25 in the right eye and 20/80 in the left eye.” (Tr. at 19, 68-69,

81-82.) Notably, Plaintiff points to no other evidence, other than his own testimony,

suggesting a need for additional, vision-related limitations. The AL] explained that he omitted

limitations addressing Plaintiffs alleged blurty vision in light of the record as a whole, which

reflected that, despite Plaintiffs failure to fully comply with treatment, his symptoms remained

mild and did not result in significantly impaired vision problems upon testing, as set out above.

Accordingly, as with Plaintiffs previous contention regarding leg elevation, the ALJ “both

identiffied] evidence that supports his conclusion and buil[t] an accurate and logical bridge

from [that] evidence to his conclusion.” Woods, 888 F.3d at 694. As such, substantial

evidence supports his decision.

IT IS THEREFORE RECOMMENDED that the Commissionet’s decision finding

no disability be AFFIRMED, that PlaintifPs Motion for Summaty Judgment [Doc. #13] be

DENIED, that Defendant’s Motion for Judgment on the Pleadings [Doc. #16] be

GRANTED, and that this action be DISMISSED with prejudice.

This, the 15% day of February, 2022.

/s/ Joi Elizabeth Peake

United States Magistrate Judge

17