PARKER v. KIJAKAZI

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF NORTH CAROLINA

GENA P., )

)

Plaintiff, )

)

v. ) 1:22CV256

)

MARTIN J. O7PMALLEY;,! )

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION AND ORDER

OF UNITED STATES MAGISTRATE JUDGE

Plaintiff Gena P. (“Plaintiff’) brought this action pursuant to Sections 205(g) and

1631(¢)(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 her claims for Disability Insurance Benefits (“DIB”) and Supplemental Security

Income (“SSI”) under, respectively, Titles HT 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 June 28, 2017, alleging a

disability onset date of January 1, 2006 in both applications. (Tr. at 13, 208-20.)? Her

applications were dented initially (Tr. at 58-85, 126-30) and upon reconsideration (Tr. at 86-

1 On December 20, 2023, Martin J. O’Malley was sworn in as Commissioner of Social Security, replacing Acting

Commissioner Kilolo Kijakazi. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure, Martin J.

O’Malley should be substituted for Kilolo Kijakazi as Defendant in this suit. No further action need be taken

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

405(g).

? Transcript citations refer to the Sealed Administrative Record [Doc. #10].

125, 133-41). Thereafter, Plaintiff requested an administrative hearing de novo before an

Administrative Law Judge (“ALJ”). (Tr. at. 144-45.) On May 15, 2019, Plaintiff, along with

her attorney, attended the subsequent video hearing, at which both Plaintiff and an impartial

vocational expert testified. (Tr. at 13.) Following this hearing, on August 1, 2019, the ALJ

concluded that Plaintiff was not disabled within the meaning of the Act (Tr. at 29), and on

June 24, 2020, the Appeals Council denied Plaintiffs request for review of the decision,

thereby making the ALJ’s conclusion the Commissionet’s final decision for purposes of

judicial review (Tr. at 5-9). Plaintiff did not file an action in this Court for nearly two years

following the Appeals Council’s decision. However, on Match 7, 2022, the Council granted

her request for additional time to file a civil action (Tr. at 1). Accordingly, PlainufPs Complaint

[Doc. #2] was timely filed.

Il. 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 ate supported by substantial evidence and were reached through application of the

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

and 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)

(internal quotation omitted). “It consists of more 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 brackets and quotation omitted). “If there is evidence to justify a refusal to direct a

verdict were the case before a juty, then there is substantial evidence.” Hunter, 993 F.2d at 34

(internal quotation 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 omitted). “Whete 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 (internal brackets

and quotation omitted). “The issue before [the reviewing court], therefore, is not whether [the

claimant] is disabled, but whether the ALJ’s finding that [the claimant] is not disabled is

supported by substantial evidence and was reached based upon a cortect 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. Harris, 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

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

3 “The 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 ef seg., provides benefits to

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

“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

Commissioner 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

requirements 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 inquity. 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, ie., “[i]f a claimant’s impairment is not sufficiently severe to equal or

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

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

Program (SSI), established by Title XVI of the Act as amended, 42 U.S.C. § 1381 ef seg., 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 (SSDJ); 20 C.F.R. pt. 416 (SSI), governing these two ptograms ate,

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

+ “RFC 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 omitted)).

The RFC includes both a “physical exertional or strength limitation” that assesses the claimant’s “ability to do

that RFC, 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

wotk, 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 clatmant’s]

impairments.” 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 carry 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.

I. DISCUSSION

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

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

burden at step one of the sequential evaluation process. (Ir. at 16.) However, in assessing

Plaintiffs claims, the ALJ further noted that there were two separate relevant periods at issue

in this case. First, with respect to Plaintiffs claim for Disability Insurance Benefits under Title

II, the ALJ noted that Plaintiff had “sufficient quarters of coverage to remain insured through

December 31, 2010. Thus, [Plaintiff] must establish disability on or before that date in order

to be entitled to a period of disability and disability insurance benefits.” (Ir. at 14.) Thus, the

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 ALJ only after [the ALJ] considers

all relevant evidence of a claimant’s impairments and any related symptoms (e.g, pain).” Hines, 453 F.3d at

562-63.

relevant period for Plaintiffs Title IT claim is her alleged onset date of January 2, 2006 through

December 31, 2010, her Date Last Insured. Second, with respect to Plaintiffs claim for SSI

under Title XVI, the ALJ noted that the relevant period was her Application Date of June 28,

2017, through the date of the decision on August 1, 2019. (Tr. at 14, 16.) Therefore, at step

two of the sequential evaluation process, the ALJ determined that Plaintiff suffered from a

single severe impairment, lumbar degenerative disc disease, between her alleged onset date,

January 1, 2006, and her date last insured, December 31, 2010. (Tr. at 16.) The ALJ further

found that, from her application date, June 28, 2017, through the date of the decision, Plaintiff

had the following severe impairments:

lumbar degenerative disc disease, polycythemia vera, diabetes mellitus type II,

hypertension, and chronic narcotic usage[.]

(Tr. at 16.) The AL] determined at step three that none of the impairments identified at step

two, individually or in combination, met or equaled a disability listing. (Ir. at 17-18.) She

therefore assessed Plaintiffs RFC and determined that Plaintiff could perform light work with

the following, non-exertional limitations:

[Plaintiff] could lift-carry twenty pounds occasionally and ten pounds

frequently. She could sit eight of eight hours, four hours at a time; she could

stand/walk ‘six of eight hours, three hours at a time. [Plaintiff] could

occasionally climb ramps/staits, balance, stoop, kneel, crouch, and crawl. She

should avoid work on laddets/scaffolds and work at unprotected heights.

[Plaintiff] could occasionally work with moving mechanical parts and operate a

motor vehicle.

(Tr. at 18.) Based on this determination and the testimony of a vocational expert, the AL]

determined at step four of the analysis that Plaintiff's past relevant work as a sewing machine

operator, as generally performed, did not exceed her RFC. (Tr. at 27.) The ALJ also found at

step five that, given Plaintiffs age, education, work experience, RFC, and the testimony of the

vocational expert as to these factors, she could perform other jobs available in significant

numbers in the national economy. (Tr. at 27-29.) The ALJ therefore concluded that Plaintiff

was not disabled under the Act. (Tr. at 29.)

Plaintiff now contends that the ALJ failed to account for time off task and absences

Plaintiff would incur “due to her significant fatigue from polycythemia vera, a form of chronic

leukemia.” (Pl’s Br. [Doc. #16] at 1.) In raising this challenge, Plaintiff argues that “[t]here

ate several problems with the AL]’s treatment of [Plaintiffs] fatigue.” (PL’s Br. at 5.) First,

she asserts that the ALJ erred by relying on the opinions of the medical expert, Dr. Eric

Puestow, tather than the statements of Plaintiffs treating hematologist oncologist, Dr. Dmitry

Betenzon. (PL’s Br. at 5-7.) Second, Plaintiff contends that “the ALJ did not adequately

consider how, regardless of the positive effects of [Plaintiffs] Pegasys interferon infusions

(chemotherapy) on her platelet and hematocrit levels, fatigue is also a side effect of this

medication used to treat her polycythemia vera.” (PL’s Br. at 7.) Third, Plaintiff argues that

her other impairments, including cardiomyopathy, “further complicat[ed] her fatigue.” (PL.’s

Br. at 9.) After a thorough review of the record in this case, the Court finds that none of

Plaintiffs contentions merit remand.

Turning first to the treatment of the opinion evidence, Plaintiff contends that the ALJ

erred by relying on the opinion of Dr. Puestow, who is Board Certified in internal medicine

and endocrinology, rather than the statements of Dr. Berenzon, who is Plaintiffs treating

hematologist oncologist, and therefore has greater familiarity with both polycythemia vera

generally and its effects on Plaintiff. (PL’s Br. at 5-7.) With respect to Dr. Puestow, the AL]’s

decision reflects that after the hearing, the ALJ referred all of the record evidence to Dr.

Puestow for his medical opinion. (Tr. at 13.) As summarized by the AL]:

As mentioned above, the [ALJ] requested review of the file evidence by a

medical expert. On June 8, 2019, Dr. Puestow, M.D., medical expert, analyzed

the record evidence (Ex. 30F). Dr. Puestow stated, “Major problems are

Polycythemia vera and cardiomyopathy. These ate well controlled. Fatigue is

not explained. I see no objective bases for the use of narcotics” (Ex. 30F/7).

Dr. Puestow, M.D., completed a Medical Statement of Ability to Do Work-

Related Activities (Physical) for both the Title II and Title XVI applications.

Dr. Puestow tendered identical opinions for both applications. The claimant

could perform a range of light work: she could sit eight of eight hours, four

hours at a time and stand/walk six of eight hours in combination, three hours

at atime. The claimant could occasionally climb stairs/ramps, and occasionally

perform posturals; she should not climb ladders /scaffolds nor work at

unprotected heights; she could occasionally work with moving mechanical parts

and operate a motor vehicle (Ex. 30F). This considers the claimant’s severe and

nonsevete impaitments alone and in combination, which would not require

further work limitation.

Dr. Puestow’s opinion is consistent with a longitudinal review of the objective

record and the overall evidence. He is Board Certified in Internal Medicine and

Endocrinology and is a medical expert recognized by the Commissioner of

Social Security. Dr. Puestow’s opinion is persuasive and is adopted in the

residual functional capacity.

(Tr. at 26-27) (internal brackets omitted). Plaintiff argues that Dr. Betenzon “is significantly

mote qualified than Dr. Puestow to comment on the symptoms and side effects from infusion

therapies for [Plaintiff's] polycythemia vera.” (PI.’s Br. at 7.) She further asserts that, “[a]t the

very least, the AL] needed to discuss Dr. Berenzon’s statements regarding the consistency

between [Plaintiffs] repeated reports of fatigue and her diagnosis and treatment for

polycythemia vera when assessing the supportability of [Plaintiffs] testimony — but she did

not.” (PL’s Br. at 7.)

However, the AL] did include a review and assessment of Dr. Berenzon’s treatment

records, so this is not a case where the ALJ failed to consider or address a treating physician’s

records. (Tr. at 18, 20, 21, 22, 23, 26.) Moreover, as Defendant correctly notes, the treatment

records cited by Plaintiff actually reflect that Dr. Berenzon routinely assigned Plaintiff an

“ECOG Performance Status” of 1. (Def.’s Br. [Doc. #20] at 15.)5 These treatment records

by Dr. Berenzon reflect his assessment that Plaintiff remained “ambulatory and able to carry

out work of a light or sedentary nature, e.g., light house work, office work” under the ECOG

criteria (I'r. at 1076, 1128, 1145, 1179, 1498, 1511, 1530, 1539, 1552, 1565, 1579, 1589, 1602),

which is consistent with Dr. Puestow’s opinion that Plaintiff could perform a range of light

work, and directly undercuts Plaintiffs claim that the AL] committed reversible error based

on Dr. Berenzon’s treatment records.°

Moreover, the statements relied upon by Plaintiff only state that “fatigue 1s a common

symptom of polycythemia vera.” (PI.’s Br. at 5-6) (citing Tr. at 1485 (“Fatigue is a common

presenting symptom in patients with myeloproliferative neoplasms secondaty to increased

5 In this regard, the ECOG Performance Status Scale is an assessment tool of the Eastern Cooperative

Oncology Group that “describes a patient’s level of functioning in terms of their ability to care for themselves,

daily activity, and physical ability (walking, working, etc.)” in order to provide hospitals and cancer centers a

“standard criteria for measuring how the disease impacts a patient’s daily living abilities.” See ECOG

Performance Status Scale, ECOG-ACRIN Cancer Research Group, https://ecog-acrin.org/resources/ecog-

petformance-status/. The ECOG Performance Scale uses the following values:

0 Fully active, able to carry on all pre-disease performance without restriction

1 Restricted in physically strenuous activity but ambulatory and able to carry out work

of a light or sedentary nature, e.g., light house work, office work

2 Ambulatory and capable of all selfcare but unable to carry out any work activities; up

and about more than 50% of waking hours

3 Capable of only limited selfcare; confined to bed or chair more than 50% of waking

hours

4 Completely disabled; cannot carry on any selfcare; totally confined to bed or chair

6 Plaintiff's other oncologist, Dr. Magrinat, similarly evaluated Plaintiff with an ECOG Performance Status of

1. (Ir. at 589.) Plaintiff does not point to any contrary conclusions.

levels of poor inflammation site.”); T'r. at 1503 (“Fatigue is a common present symptom in

patients with myeloproliferative neoplasms secondary to increased levels of proinflammatory

cytokines.”)). These statements do not indicate, as Plaintiff suggests, that Plaintiffs own

fatioue limited her functioning to an extent inconsistent with Dr. Puestow’s opinion or the

RFC assessment, particularly in light of Dr. Berenzon’s reports that Plaintiff remained capable

of a Level 1 ECOG Performance Status.

In her related second argument, Plaintiff contends that the ALJ did not adequately

consider the side effects of Plaintiffs interferon infusions, which include fatigue. (Pl.’s Br. at

7-8) (citing Benfield v. Saul, 827 F. App’x 297, 300-01 (4th Cir. Sept. 24, 2020); 20 C-F.R.

§ 404.1529(c)(3) (explaining that because side effects of medication can impair an individual’s

ability to function just as the medical conditions themselves, ALJs ate requited to consider

their effects when crafting the RFC)). Here again, Plaintiff relies on the statements of Dr.

Berenzon, who stated in June 2016 that “systematic symptoms ate faitly common in patients

with polycythemia vera, and I suspect that interferon might contribute to [Plaintiffs] fatigue

and night sweats. Because of this, I decided not to increase the dose of Pegasys at this point

but monitor her.” (Pl.’s Br. at 6) (quoting Tr. at 1607). As recounted by the ALJ, subsequent

treatment notes show that Plaintiffs hematocrit and platelet levels improved significantly with

treatment, and Dr. Berenzon reduced Plaintiffs Pegasys dosage. (Tr. at 20-23.) Notably,

Plaintiffs hematology oncology treatment notes reflect that, in March 2017, Plaintiff was

placed in the “non acute pool” of patients after she cancelled all appointments from October

2016 forward and indicated that she did not plan on scheduling an appointment until she ran

out of medication. (Ir. at 1285.) One of Dr. Berenzon’s collegues, Dt. Rupali Bhave, noted

10

that Plaintiffs blood counts were stable as of March 2017, and noted that Dr. Berenzon had

prescribed 3-months-worth of Pegasys in November 2016 with 3 refills. (Tr. at 1285.) These

records indicate that he reduced Plaintiffs dosage by phone in August 2018, and subsequent

lab reports wete reviewed and were “basically normal.” (Tr. at 1296, 1314.) This effective,

conservative, and remotely-monitored treatment history does not reflect any relevant side-

effects from Plaintiffs interferon therapy, let alone side effects that would undermine the

ALJ’s analysis of Plaintiffs functioning.

Further, as reflected in both the administrative decision and Plaintiffs own brief,

Plaintiffs fatigue contentions largely rely on evidence from 2012 through mid-2017. (See PL.’s

Br. at 8-10); (Ir. at 20-21, 22, 23.) As set out above and emphasized in the AL]’s decision,

three distinct time periods ate involved in this case. The first, spanning from Plaintiffs 2006

alleged onset date to her date last insured of December 31, 2010, predates her diagnosis of

polycythemia vera by nearly three years, and therefore is inapposite to her arguments regarding

fatigue from that condition. (Ir. at 18, 23.) The second period, from Plaintiff's December

31, 2010 date last insured for DIB to her application for SSI on June 28, 2017, is not directly

at issue, except as evidence may relate to Plaintiff s condition after that time. Only Plaintiff's

abilities during the third time period, from her June 28, 2017 application date to the ALJ’s

decision date of August 1, 2019, are directly relevant in this case. Accordingly, the documented

stabilization and improvement of Plaintiffs condition prior to her SSI application date

undermines Plaintiffs arguments regarding fatigue from both polycythemia vera and its

treatment. (See Tr. at 20-21, 22, 23.)

11

To the extent that Plaintiffs contention relies on her own testimony and fatigue

complaints to her providers, the Court again finds no error in the AL]’s analysis. 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

atticulated so the individual and any subsequent reviewer can assess how the adjudicator

evaluated the individual’s symptoms.” Social Security Ruling 16-3p, Titles IJ 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. In Arakas v. Commissioner, Social Security

Administration, 983 F.3d 83 (4th Cir. 2020), the Fourth Circuit clarified the procedure an ALJ

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 AL] must determine whether objective medical

evidence presents a “medically determinable impairment” that could reasonably

be expected to produce 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 □□□ requited to find the claimant disabled. SSR 16-3p, 2016

WL 1119029, at *4-5. SSR 16-3p recognizes that “symptoms cannot always be

measuted 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.

983 F.3d at 95 (internal brackets omitted). Thus, the second part of the test requires the AL]

to consider all available evidence, including Plaintiffs statements about her pain, in order to

evaluate “the intensity and persistence of the claimant’s pain, and the extent to which it affects

12

her 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

her ability to perform basic work activities. Relevant evidence for this inquiry includes

PlaintifPs “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) [Plaintiff's] daily activities;

(11) The location, duration, frequency, and intensity of [Plaintiffs] 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 [her] pain or other symptoms;

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

for telief of [her] pain or other symptoms;

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

symptoms (e.g., lying flat on [her] 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 ot other symptoms.

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

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

of her 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 AL]’s decision. See Blalock v. Richardson, 483 F.2d 773,

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

requites that the court uphold the Secretaty’s decision even should the court disagree with

such decision as long as it is supported by ‘substantial evidence.”’ (internal footnote omitted).

Here, the ALJ’s decision reflects that she (1) thoroughly reviewed the medical evidence,

the opinion evidence, and Plaintiffs testimony and (2) sufficiently explained her analysis of

13

Plaintiffs subjective complaints. Significantly, during the hearing, Plaintiff extensively

described her fatigue and the limitations it caused in response to questions from both the AL]

and Plaintiffs counsel. The ALJ recounted this testimony in her decision, including Plaintiff's

reports that she spends “fourteen to fifteen hours” per day in bed and receives help from her

mother with household chores and childcare for her 2-year-old daughter. (Ir. at 19.)

However, the ALJ also relied upon Plaintiff contemporaneous reports of her daily activities,

which reflected that, from her application date forward, Plaintiff was able to prepare simple

meals, drive, shop, attend church, perform weekly chores, and care for both her daughter and

her dog. (See Tr. at 19, 24.) Specifically, the ALJ explained that:

In terms of daily activities, the claimant testified to rather limited functioning,

stating some days she did not get out of bed, and was home every day. Other

information included rather normal functioning. The claimant reported in July

2017, she took cate of her baby, prepared meals daily (usually frozen dinners),

did laundty once a week, drove, shopped for groceries once a week for thirty

minutes, talked on the phone, and went to church sometimes (Ex. 3E). In April

2018, the claimant reported she took care of her baby and her mini-dachshund,

ptepated simple meals daily, put clothes in the washer and dryer once a week,

drove, and went to the grocery store once a week for an hour (Ex. 6E). The

claimant declined dietary changes in October 2017, as the next week they were

going on vacation (Ex. 9F/82). The claimant testified she cared for her

daughter, age 2, attended church weekly, watched TV, used social media, and

read to her daughter. The claimant appears to be a full time homemaker of a

toddler.

(Tr. at 24.) The AL] concluded that these “[r]eported activities are not inconsistent with a

tange of light work.” (Tr. at 24.) In making this finding, the ALJ also relied in large part upon

Dr. Puestow’s medical evaluation, which, as set out above, was consistent with the ECOG

performance status consistently assigned by Dr. Berenzon. (See Tr. at 26-27, 1145, 1179, 1498,

1530, 1539, 1552, 1565, 1579, 1589, 1602, 1782-99.)

14

As the AL] also stressed throughout her decision, Plaintiff lived a “very sedentary

lifestyle, due to fear of her condition,” rather than due to limitations from her impairments.

(Tr. at 24, 1023, 1755.) ‘These impairments included peripartum cardiomyopathy and lumbar

degenerative disc disease as well as polycythemia vera. (Tr. at 16.) Although Plaintiff suggests,

in her third argument, that her additional impairments “further complicat[ed] her fatigue”

Br. at 9), she again points to no evidence supportive of specific, fatigue-based limitations

such as time off task or absenteeism. Notably, a “cardiopulmonary exercise test on May 3,

2018 indicated no functional impairment and no apparent signs of circulatory, pulmonary, or

mixed limitation to exercise.” (Tr. at 22) (citing Tr. at 986-87, 989). On that date, Plaintiff

“reported that she lived a sedentary life and that [the exercise test] was the most exercise she

had done in quite some time.” (Tr. at 22, 1023.) As noted by the AL], these records note that

“her fatigue was out of proportion” to what was reflected in the cardiac tests. (T't. at 22.) In

fact, Plaintiff's providers regularly noted that some of her fatigue was due to deconditioning

and encouraged her to increase her physical activity and make dietary changes to better manage

her conditions, and “stay active and get more exercise.” (See Tr. at 21, 22; Tr. at 408

(encouraging Plaintiff to “increase exercise”); Tr. at 650-51 (Plaintiff encouraged to start

walking as some of her fatigue was due to deconditioning, and Plaintiff “was not that interested

in making changes, despite her anxiety regarding [her] diagnoses”); Tr. at 652 (Plaintiff had

increased fasting blood sugar levels and reported being fatigued and “quite sedentary,” but

had “not made any changes to her diet”); Tr. at 661 (“I encouraged her to start walking as I

am sute some of her fatigue is deconditioning.”); Tr. at 675-76, 810, 860-62 (advising on diet

changes and to “walk for exercise”); Tr at 703-04, 715 (recommending increasing exercise);

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Tr. at 1025 (Plaintiff encouraged “to increase physical activity with daily walking”)). However,

Plaintiff declined to make recommended changes to improve her fatigue. (I'r. at 21.)’

Ultimately, the ALJ found that Plaintiffs “statements concerning the intensity,

persistence and limiting effects of these symptoms are not entirely consistent with the medical

evidence and other evidence in the record for the reasons explained in [the] decision.” (Tr. at

22.) The ALJ then concluded that:

Nothing in the claimant’s clinical signs suggest that the residual function

capacity assessment is unreasonable. Nor does the record reflect a treatment

regimen inconsistent with such limitations. In sum, the above tesidual

functional capacity assessment is supported by the medical evidence of record,

ongoing conservative cate, the opinion of State agency medical consultant, Dr.

Clayton, M.D., the opinions of State agency psychological consultants, the

opinion of medical expert Dr. Puestow, M.D., reported activities, and

inconsistencies in the claimant’s statements with the record evidence.

(Ir. at 27.) Plaintiff presents no valid basis to disturb the ALJ’s RFC assessment.® As set out

in the administrative decision and outlined above, substantial evidence supports the AL]’s

findings regarding Plaintiffs fatigue, and the path of the AL]’s reasoning is easily traceable.

To the extent that Plaintiff essentially asks the Court to reconsider and tre-weigh the evidence

presented, it is not the function of this Court to re-weigh the evidence or reconsider the AL]’s

determinations if they are supported by substantial evidence. As noted above, “[w]here

7 As noted by the ALJ, Dr. Puestow noted that Plaintiffs peripartum cardiomyopathy resolved after the

postpattum period. (Ir. at 16, 1783). To the extent Plaintiff attributed her fatigue to depression, the ALJ

considered that testimony (Tr. at 19), but concluded that her depression did not cause “more than minimal

limitations” and was nonsevere. (Tr. at 16-17.) In addition, the ALJ noted that her hypertension and diabetes

were well controlled with medications. (Tr. at 18, 23, 24.)

8 The Coutt also notes that the ALJ specifically considered the hypothetical question posed to the Vocational

Expert regarding the effect of being off task 25% of the day and being absent three or four days per month,

but concluded that, for the reasons previously stated, “the overall record evidence did not support [Plaintiffs]

allegations, and this further hypothetical has been rejected.” (Tr. at 28.) Thus, the AL] specifically considered

PlaintifPs contentions but concluded that she was not as limited as alleged.

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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 (internal brackets

and quotation omitted). Thus, the issue before the Court is not whether a different fact-finder

could have drawn a different conclusion, or even “whether [Plaintiff] is disabled,” but rather,

“whether the ALJ’s finding that [Plaintiff] is not disabled is supported by substantial evidence

and was reached based upon a correct application of the relevant law.” Craig, 76 F.3d at 589.

Here, the ALJ reviewed the evidence, explained her decision, and clearly explained the reasons

for her determination. That determination is supported by substantial evidence in the record.

Plaintiff has not identified any errors that require remand, and Plaintiffs Motion to Reverse

the Decision of the Commissioner should therefore be denied.

IT IS THEREFORE ORDERED that the Commissionet’s decision finding of no

disability is AFFIRMED, that Plaintiffs Dispositive Brief [Doc. #16] is DENIED, that

Defendant’s Motion for Judgment on the Pleadings [Doc. #19] is GRANTED, and that this

action is DISMISSED with prejudice.

This, the 25tt day of March, 2024.

/s/ Joi Elizabeth Peake

United States Magistrate Judge

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