HOFFMAN v. COMMISSIONER OF SOCIAL SECURITY

IN THE UNITED STATES DISTRICT COURT

FOR THE WESTERN DISTRICT OF PENNSYLVANIA

CURTIS JAMES HOFFMAN, )

)

Plaintiff, )

)

v. ) Civil Action No. 23-838

)

COMMISSIONER OF SOCIAL SECURITY, )

)

Defendant. )

O R D E R

AND NOW, this 30th day of September, 2024, upon consideration of the parties’

cross-motions for summary judgment, the Court, after reviewing the Commissioner of Social

Security’s final decision denying Plaintiff’s claim for disability insurance benefits (“DIB”) under

Subchapter II of the Social Security Act, 42 U.S.C. § 401 et seq., finds that the Commissioner’s

findings are supported by substantial evidence and, accordingly, affirms. See 42 U.S.C. §

405(g); Biestek v. Berryhill, 139 S. Ct. 1148, 1153-54 (2019); Jesurum v. Secretary of U.S. Dep’t

of Health & Human Servs, 48 F.3d 114, 117 (3d Cir. 1995) (citing Brown v. Bowen, 845 F.2d

1211, 1213 (3d Cir. 1988)). See also Berry v. Sullivan, 738 F. Supp. 942, 944 (W.D. Pa. 1990)

(if supported by substantial evidence, the Commissioner’s decision must be affirmed, as a federal

court may neither reweigh the evidence, nor reverse, merely because it would have decided the

claim differently) (citing Cotter v. Harris, 642 F.2d 700, 705 (3d Cir. 1981)).1

1 Plaintiff argues that the residual functional capacity (“RFC”) determination of the

Administrative Law Judge (“ALJ”) was not supported by substantial evidence because he relied

only on raw medical data rather than medical opinions in reaching his findings and further that

the ALJ failed to sufficiently develop the administrative record. The Court finds no merit in

Plaintiff’s contentions and further finds that substantial evidence supports the ALJ’s RFC

findings and his determination that Plaintiff is not disabled.

Plaintiff asserts that the ALJ’s RFC findings were insufficient because they were not

based on any medical opinions. Specifically, he argues that although the ALJ found the only

medical opinion in the record – that of state agency medical consultant Stephanie Prosperi, M.D.

– to be persuasive, his RFC findings actually deviated significantly from those set forth in Dr.

Prosperi’s opinion. He argues, therefore, that the ALJ relied on his own lay analysis to craft an

RFC out of whole cloth. However, the Third Circuit Court of Appeals has made clear that “[t]he

ALJ – not treating or examining physicians or State agency consultants – must make the ultimate

disability and RFC determinations.” Chandler v. Comm’r of Soc. Sec., 667 F.3d 356, 361 (3d

Cir. 2011). See also 20 C.F.R. §§ 404.1520b(c)(3), 404.1546(c); SSR 96-5p, 1996 WL 374183

(S.S.A.) (July 2, 1996). “There is no legal requirement that a physician have made the particular

findings that an ALJ adopts in the course of determining an RFC.” Titterington v. Barnhart, 174

Fed. Appx. 6, 11 (3d Cir. 2006). See also Chandler, 667 F.3d at 362 (holding that each fact

incorporated into the RFC need not have been found by a medical expert). As the Circuit Court

explained in Titterington, “[s]urveying the medical evidence to craft an RFC is part of an ALJ’s

duties.” 174 Fed. Appx. at 11. Accordingly, an ALJ is not prohibited from making an RFC

assessment even if no doctor has specifically made the same findings. See Hayes v. Astrue, Civ.

No. 07-710, 2007 WL 4456119, at *2 (E.D. Pa. Dec. 17, 2007).

While an ALJ must, in any event, explain the basis for the RFC findings and set forth the

reasons for crediting or discrediting relevant or pertinent medical evidence, see Burnett v.

Comm’r of Soc. Sec., 220 F.3d 112, 121-22 (3d Cir. 2000); Fargnoli v. Massanari, 247 F.3d 34,

41 (3d Cir. 2001), the ALJ clearly did so here. As Plaintiff acknowledges, the RFC formulated

by the ALJ was significantly less restrictive than the functional limitations set forth in Dr.

Prosperi’s opinion, but the ALJ explained how and why the evidence called for such a finding.

The basis for the ALJ’s findings were therefore clearly explained and supported by substantial

evidence.

Plaintiff is correct that part of the issue in this case is that there was so little evidence

from the relevant time period that other physicians were unable to render an opinion as to his

functional capacity. To qualify for DIB, Plaintiff had to establish that he had disability insured

status at the time he became disabled. See 20 C.F.R. § 404.131. Here, Plaintiff’s date last

insured was June 30, 2018 (R. 15), so he had to prove disability on or before that date. As even

he acknowledges, evidence that would support such a finding was sparse. He suggests that the

paucity of evidence triggered the ALJ’s duty to further develop the record, and indeed, an ALJ

does have a duty to develop a full and fair record in a social security case. See Ventura v.

Shalala, 55 F.3d 900, 902 (3d Cir. 1995); Carmichael v. Barnhart, 104 Fed. Appx. 803, 805 (3d

Cir. 2004); 20 C.F.R. § 416.912(b)(1). It does, however, remain Plaintiff’s burden to supply

evidence in support of his claim. See Ventura, 55 F.3d at 902; Money v. Barnhart, 91 Fed.

Appx. 210, 215 (3d Cir. 2004) (citing Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987)); Hess v.

Sec. of Health, Educ., and Welfare, 497 F.2d 837, 840 (3d Cir. 1974). Under the circumstances,

it is not clear what else the ALJ could have done to help Plaintiff, who was represented

throughout the administrative proceedings, obtain additional relevant evidence.

Plaintiff asserts that the ALJ could have arranged for one or more consultative

examinations to provide further evidence as to his functional capacity. However, while an ALJ

may order a consultative examination to resolve an inconsistency or if the record is insufficient

to render a decision, he or she is generally not required to do so. See 20 C.F.R. §§ 404.1519a,

404.1520b; Thompson v. Halter, 45 Fed. Appx. 146, 149 (3d Cir. 2002). Generally, an ALJ is

authorized to obtain a consultative examination “if the information needed to make a disability

determination, ‘such as clinical findings, laboratory tests, a diagnosis or a prognosis’ cannot be

obtained from the claimant’s medical sources.” Tuulaupua v. Colvin, Civ. No. 14-1121, 2015

WL 5769984, at *6 (W.D. Pa. Sept. 30, 2015) (quoting 20 C.F.R. §§ 404.1519a(a) and (b)).

Such an examination may be ordered “to try to resolve an inconsistency in the evidence or when

the evidence as a whole is insufficient to support a determination or decision on [the claimant’s]

claim.” 20 C.F.R. § 404.1519a(b). The decision whether to order such an examination is within

the sound discretion of the ALJ. See Thompson, 45 Fed. Appx. at 149. This decision “should be

firmly rooted in an assessment of the evidence as a whole.” Woodman v. Berryhill, Civ. No.

3:17-cv-151, 2018 WL 1056401, at *5 (M.D. Pa. Jan. 30, 2018). The Court agrees with the ALJ

that his case did not present a situation calling for a consultative examiner,

As the Commissioner points out, Plaintiff filed his claim for DIB well over a year after

his insured status ended. Any consultative examination, therefore, would have been over a year,

and more likely two years, after the relevant time period. Evidence from after a claimant’s date

last insured is relevant only if it pertains to Plaintiff’s condition during the relevant period.

See Ortega v. Comm’r of Soc. Sec., 232 Fed. Appx. 194, 197 (3d Cir. 2007). Examinations as to

Plaintiff’s functionality years after his date last insured, likely by someone who had no contact

with Plaintiff prior to June 30, 2108, would not qualify as such evidence. Given the ALJ’s broad

discretion in regard to this issue, the Court finds that he did not err in declining to schedule a

consultative examination.

This is, of course, the crux of the issue here; there is little evidence that would establish

that Plaintiff was disabled on or before June 30, 2018. For the most part, any additional evidence

relevant to that period would have had to already be in existence. None of Plaintiff’s

representatives represented to the ALJ that there was more evidence from that period or that

there was anything he could do to help obtain that evidence. This case is not, therefore, one with

an under-developed record, but rather one where Plaintiff has insufficient evidence to establish

that he was disabled prior to his date last insured.

Accordingly, the Court finds that the ALJ applied the correct legal standards and that

substantial evidence supports that decision. It will therefore affirm.

Therefore, IT IS HEREBY ORDERED that Plaintiff’s Motion for Summary

Judgment (Doc. No. 13) is DENIED and that Defendant’s Motion for Summary Judgment (Doc.

No. 18) is GRANTED.

s/Alan N. Bloch

United States District Judge

ecf: Counsel of record