VRANA v. DUDEK

IN THE UNITED STATES DISTRICT COURT

FOR THE WESTERN DISTRICT OF PENNSYLVANIA

PITTSBURGH

REGINA V., )

)

Plaintiff ) 2:24-CV-01661-RAL

)

vs. ) RICHARD A. LANZILLO

) Chief United States Magistrate Judge

FRANK BISIGNANO!, COMMISSIONER )

OF SOCIAL SECURITY; ) MEMORANDUM OPINION

)

Defendant ) ECF NO. 7, 9

)

I. Introduction

Regina (“Plaintiff or “Regina”) brings this action pursuant to 42 U.S.C. § 405(g) and

42 U.S.C. § 1383(c)(3), seeking review of the final determination of the Commissioner of Social

Security (“Defendant” or “Commissioner”) denying her application for disability insurance

benefits (“DIB”) and supplemental security income (“SSI”) under Titles II and XVI of the Social

Security Act, 42 U.S.C. §§ 401 et seq., 1381, et seq. (“the Act”). Presently pending are cross

motions for summary judgment. ECF Nos. 7, 9. All Parties have consented to the jurisdiction of

a United States Magistrate Judge in these proceedings. See 28 U.S.C. § 636(c))(1). For the

following reasons, Plaintiff's Motion for Summary Judgment (ECF No. 7) will be DENIED, and

Defendant’s Motion for Summary Judgment (ECF No. 9) will be GRANTED.

In accordance with Federal Rule of Civil Procedure 25(d), Frank Bisignano, Commissioner of the Social Security

Administration, is substituted as Defendant for Leland Dudek, the former Acting Commissioner.

2 To protect the Plaintiff's privacy interests, the Court will follow the recommendation of the Judicial Conference of

the United States and refer to her by first name and last initial.

Il. Procedural History

Plaintiff applied for DIB and SSI on February 23, 2022. See ECF No. 5-2 at 18. Plaintiff's

alleged disability onset date was February 11, 2022. Jd. These claims were denied initially on

October 24, 2022, and upon reconsideration on February 26, 2023. Jd. Plaintiff filed a written

request for a hearing before an administrative law judge (“ALJ”). Jd. The designated

Administrative Law Judge (“ALJ”), Guy E. Fletcher, held a telephonic hearing on July 18, 2023.

Id. at 18. Plaintiff was represented at the hearing by counsel, Candra Stewart, Esq. Id. Mr. D. T.

North, an impartial vocational expert, also appeared at the hearing and testified. Jd. at 49-51.

In a decision dated February 16, 2024, the ALJ denied Plaintiff's claims for DIB and SSI

benefits. ECF No. 4-2 at 15-26. Plaintiff requested review of the ALJ’s decision by the Appeals

Council but review was denied on October 22, 2024, making the ALJ’s decision the final decision

of the Commissioner. ECF No. 4-2 at 2-4. Plaintiff filed her Complaint in this Court on December

11, 2024. ECF No. 3. Defendant filed an Answer on February 6, 2025. ECF No. 5. On March

6, 2025, Plaintiff filed a Motion and Brief in Support of Summary Judgment. ECF Nos. 7, 8.

Defendant then filed a Motion for Summary Judgment and a Brief in Support on April 5, 2025.

ECF Nos. 9, 10. Plaintiff filed a Reply Brief on April 18, 2025. ECF No. 14. This matter has

been fully briefed and is ripe for disposition.

Factual Background

A. Hearing Transcript—General Background; Employment History

Plaintiff was born on September 22, 1965, and was fifty-seven years old at the time of the

hearing.> ECF No. 5-3, p. 2. Plaintiff reported that from 2011 until 2021, she worked as a

cashier/manager for a pizza restaurant. See ECF No. 5-6, p. 4. She also reported working from

The SSA regulations define “person closely approaching advanced age” as a person who is age 50-54 years old. 20

CFR. § 1563(d). See, e.g. Galloway v. Dudek, 2025 WL 2021918, at *1 (W.D. Pa. July 18, 2025).

one month as an office clerk at a medical clinic from January until February of 2021. /d. In 2022,

Plaintiff was in a car accident. ECF No. 5-2, at 35. She testified that, as a result of injuries she

sustained from the accident, “I had to have an operation on my neck. My right arm is all numb.

My hands are like needles. No feeling in my hands and in my shoulder.” Jd. at 35-36. She also

reported injuries to her back. /d. Plaintiff testified that physicians told her “vertebrae was

slightly —it was—it slid up against my spinal cord.” Jd. at 36. She had surgery in August of 2022,

during which vertebrae were removed and a rod was inserted. ECF No. 5-7, at 11-12.

In July of 2023, Regina was seen for a psychological consultive examination during which

she reported increased anxiety and depression since the automobile accident in 2022. Jd. at 38-43.

In November of 2023, Plaintiff was seen for a physical examination by PA-C Douglas Denney.

Id. at 46. She described suffering from chronic headaches, neck pain, back pain and bilateral hip

pain. Jd. Plaintiff indicated that her neck pain remained chronic post-surgery, and that she was

additionally experiencing pain which radiated down her right arm and into her hand. Jd.

At the hearing, she testified that she lives with her son. ECF No. 5-2, at 40. Plaintiff

testified that because of excruciating pain, she is unable to perform many household tasks such as

cleaning, cooking, sweeping, and laundry. Jd. She has not worked at all since February of 2022.

Id. at 18. She explained that she can only comfortably stand for 20 minutes and walk no more

than half of a city block before needing to sit. Jd. at 40. She further testified that her daily activities

are typically limited to “lay[ing] around, watch[ing] TV, playing on my phone, sleep.” Jd. at 41.

Plaintiff also testified that is continues to use anti-depressive medications, as prescribed,

and that she sees a psychologist for therapy approximately once a month. Jd. at 42. Anxiety

prevents the Plaintiff from leaving the house, noting that before her accident, she was able to

interact with people but not since. Jd. at 44. Plaintiff's anxiety is also triggered when she gets into

an automobile. Jd. Regina stated that her anxiety with social situations and inability to remain

on her feet for long periods of time prevents her from returning to her job with the medical practice

as “it would be dealing with people and being on my feet all the time.” Jd. at 45. Likewise,

Plaintiff testified she could not resume her work at the pizza restaurant because she would be

required to lift objects and “being on my feet all the time. I mean, I would go eight hours without

a break there.” Jd.

Next, vocational expert, D. T. North was called as a witness. ECF No. 5-2, at 49-52. North

classified Plaintiff's previous work as a fast food worker, based on her testimony and other

evidence of record. Jd. at 49. In characterizing Plaintiff as a fast food worker, North referenced:

“DOT code 311.472-010” and noted that that classification connotes “light, unskilled [labor] with

an SVP of 2.” Jd. He further characterized Plaintiffs brief work for the medical practice as akin

to a “patient transporter, 355.677-014.” Jd. For these purposes, he also classified this position as

“light” duty. Jd.

The ALJ proceeded to pose a hypotheticals to North. The ALJ instructed him to consider

whether a person of Plaintiff's age, education, work experience, capable of light work, and limited

to no more than frequent use of the primary hand for reaching, handling, or fingering would be

able to perform her past work. North responded that she could not. Jd. at 50.

Plaintiffs counsel then asked whether, after adding further restrictions such as needing a

sit/stand option and alternating between sitting/standing at a 20 minute interval, would eliminate

all past work. Jd. at 51. The vocational expert opined that it would. Jd.

B. Medical Treatment History

The medical record regarding Regina’s impairments revealed the following. She was

involved in an automobile accident on January 8, 2022. ECF No 5-7. p. 2. She refused treatment

at the scene but later presented at Stat Care Medical Services in Mesa, Arizona, complaining of

back and neck pain as a residual effect of the accident. Jd. Plaintiff was examined, prescribed

pain medication, and referred for appropriate radiological studies. Jd.

Plaintiff returned to Stat Care on February 11, 2022, subsequent to the radiological studies.

Id. p.4. The medical records note that her symptoms were unchanged and that she presented with

moderate discomfort in her thoracic region. Jd. Plaintiff also reported experiencing some mild

memory loss and lateral paresthesia. Jd. She experienced only minimal relief from the

medications. Jd. Plaintiff was given trigger point injunctions of Kenalog and Bupivacaine and

referred for a neurological consultation. Jd.

On March 11, 2022, Regina was seen by Dr. Timothy Luke at Valley Surgical Resources.

Id. p. 7. Dr. Luke memorialized Plaintiff's need of surgery for:

medical necessity for this symptomatic patient with pain associated

with C2-C3 2mm disc bulge, C3-C4 Imm disc bulge with complex

causing indentation of thecal sac with bilateral neural foraminal

narrowing with abutment of right exiting nerve root, C4-05 3mm

disc bulge with complex causing compression of thecal sac with

abutment of both traversing nerve roots, bilateral neural foraminai

narrowing with abutment of right exiting nerve root, C5-C6 2mm

with complex causing compression of thecal sac with abutment of

the right traversing nerve roots with bilateral neural foraminal

narrowing with abutment of the right exiting nerve root, C6-C7

broad-based disc protrusion 5mm with complex causing

compression of thecal sac and both traversing nerve roots.

Compression of spinal cord without evidence of

oedema/myelomalacia at present. Obliteration of both neural

foramina with compression of both existing nerve roots. Grade 1

retrolisthesi of C6-C7, C7-T1 disc bulge Imm, as evidence by MRI,

dated, 02/09/2022.

Id. p. 7. Then, on August 11, 2022, Dr. Luke performed the following surgical procedures on the

Plaintiff: Arthrodesis C6/7 interbody; anterior approach with aid. of the intraoperative microscope,

C617 placement cage construct; anterior approach with aid of the intraoperative microscope,

Anterior instrumentation independent stabilization and is not considered integral to the

intervertebral device: C6/7 plate and screws; anterior approach with aid of the intraoperative

microscope, an Allograft placement C6/7 anterior approach, intraoperative neuromonitoring, and

intraoperative use of the operative microscope. Jd. p. 11. Plaintiff had several items implanted in

her body including Cage SaberC Body: C6/7 14x17x6 and 6 degrees, instrumentation; C6/7

independent stabilization and is not considered integral to the intervertebral device: Saber C Plate;

17x6 and 3 Spikes 2 Cephalad and 1 Caudal, and Allograft: C6/7 incite Cortical Fibers 2.5 cc. Id.

On August 31, 2022, Regina underwent post-operative imaging. Jd. p. 22. These

procedures revealed the presence of fusion hardware and grade 1 spondylolisthesis.* Id. p. 12.

Plaintiff was seen by Dr. Luke on September 6, 2022, and he prescribed a

“spinal electrical osteogenesis stimulator” for Plaintiff's use. Id. p.25. Noting the absence of any

medical records from Regina’s general practitioner and/or psychologist, the ALJ kept the record

open for,an additional forty-five days to permit supplementation. See ECF No. 5-2, p. 51. The

ALJ indicated that “without [additional records], I don’t have medically determinable impairment

in terms of anxiety or depression.” Jd. p. 45.

Post-hearing, Plaintiff was seen by Dr. T. Scott Hotchkiss for a psychological examination. _-

See ECF No., 5-7, p. 38. The psychological examination revealed her to be suffering from

increased symptoms of anxiety and depression since her automobile accident a year and a half

earlier. Jd. p. 39. She reported difficulties with memory. Jd. Plaintiff's Patient Health

Questionnaire for Depression (“PHQ-9”’) was scored at 17, indicative of severe depression. Id. p.

40. Her responses to the General Anxiety Disorder Questionnaire (“GAD-7”) amounted to a score

4 Spondylolysis is defined as the dissolution of a vertebra, whereas spondylolisthesis is the forward displacement of

one vertebra over another. Blosser v. Colvin, 2015 WL 4410084, at *2 (M.D. Pa. July 20, 2015) (citing Dorland’s

Illustrated Medical Dictionary 1754 (32nd ed. 2012)).

of 15, which connoted severe anxiety. Jd. Posttraumatic Checklist for DSM-5 (“PCL-5”)

screenings indicated severe depression, anxiety, and PTSD. /d. Dr. Hotchkiss diagnosed Plaintiff

to suffer from major depressive disorder (moderate), generalized anxiety disorder, PTSD

(provisional) and mild neurocognitive impairment. Jd. p. 38.

In November of 2023, Regina was seen for a physical examination. She reported

symptoms of headache, neck pain, back pain, and bilateral hip pain. Jd. p. 46. On examination,

she was found to have slightly decreased range of motion in the cervical spine. Jd. pp. 49-50.

IV. Standard of Review

To be eligible for Social Security benefits under the Act, a claimant must demonstrate that

he or she cannot engage in “substantial gainful activity” because of a 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 at least twelve months. 42 U.S.C. § 423(d)(1)(A);

Brewster v. Heckler, 786 F.2d 581, 583 (3d Cir. 1986). When reviewing a claim, the ALJ must

utilize a five-step sequential analysis to evaluate whether a claimant has met the requirements for

disability. 20 C.F.R. §§ 404.1520, 416.920. The ALS must determine: (1) whether the claimant

is currently engaged in substantial gainful activity; (2) if not, whether the claimant has a severe

impairment or a combination of impairments that is severe; (3) whether the medical evidence of

the claimant’s impairment or combination of impairments meets or equals the criteria listed in 20

C.F.R., Pt. 404, Subpt. P, App. 1; (4) whether the claimant’s impairments prevent him from

performing his past relevant work; and (5) if the claimant is incapable of performing his past

relevant work, whether he can perform any other work which exists in the national economy. 20

C.F.R. §§ 404.1520(a)(4), 416.920(a)(4); see Barnhart v. Thomas, 540 U.S. 20, 24-25 (2003). If

the claimant is determined to be unable to resume previous employment, the burden shifts to the

Commissioner at Step 5 to prove that, given claimant’s mental or physical limitations, age,

education, and work experience, he or she is able to perform substantial gainful activity in jobs

available in the national economy. Doak v. Heckler, 790 F.2d 26, 28 (3d Cir. 1986).

Judicial review of the SSA’s final decision on disability claims is provided by statute and

is plenary as to all legal issues. 42 U.S.C. §§ 405(g)6, 1383(c)(3)7. See also Schaudeck v. Comm’r

of Soc. Sec., 181 F.3d 429, 431 (3d Cir. 1999). The SSA’s factual findings are judicially

reviewable to determine whether they are supported by substantial evidence, and the court reviews -

the record as a whole. 42 U.S.C. § 405(g); 5 U.S.C. § 706. See also Burns v. Barnhart, 312 F.3d

113, 118 (3d Cir. 2002); Kent v. Schweiker, 710 F.2d 110 (3d Cir. 1983). Substantial evidence is

defined as evidence that would satisfy a “reasonable mind” as adequate to support a conclusion.

Ventura v. Shalala, 55 F.3d 900, 901 (3d Cir. 1995) (quoting Richardson v. Perales, 402 U.S. 389,

401 (1971)). The ALJ must build an accurate and logical bridge between the evidence and his

conclusions. See Galloway v. Dudek, 2025 WL 2021918, at *5 (W.D. Pa. July 18, 2025) (citations

omitted). In reviewing the ALJ’s, a court may not “ ‘substitute its judgment for that of the

Agency.’” FCC v. Fox Television Stations, Inc., 556 U.S. 502, 513 (2009). But it must ensure,

among other things, that the agency has offered “a satisfactory explanation for its action[,]

including a rational connection between the facts found and the choice made.” Motor Vehicle

Mfrs. Assn. of United States, Inc. v. State Farm Mut. Automobile Ins. Co., 463 U.S. 29, 43 (1983).

Further, the ALJ cannot “simply ignore an important aspect of the problem.” Galloway, 2025 WL

2021918, at *5. See also Ohio v. EPA, 603 U.S. 279, 292-93 (2024) (parallel citations omitted);

Gamret v. Colvin, 994 F. Supp. 2d 695, 698 (W.D. Pa. 2014).

If the ALJ’s findings of fact are supported by substantial evidence, they are conclusive. 42

USS.C. § 405(g); Richardson, 402 U.S. at 390. A district court cannot conduct a de novo review

of the Commissioner’s decision nor re-weigh the evidence of record; the court can only judge the

propriety of the decision in reference to the grounds invoked by the Commissioner when the

decision was rendered. Palmer vy. Apfel, 995 F. Supp. 549, 552 (E.D. Pa. 1998) (citation omitted).

See also S.E.C. v. Chenery Corp., 332 U.S. 194, 196-97 (1947).

V. Discussion and Analysis

A. The ALJ’s Decision

The ALJ rendered an unfavorable decision on Plaintiff's claim on February 16,2024. ECF

No. 5-2, p. 18. The ALJ first concluded that Plaintiff met the insured status requirement through

June 30, 2027. Jd. p. 20. Further, the ALJ noted that she had not engaged in substantial gainful

employment since February 11, 2022, her alleged onset date. Id. At Step 2 of the sequential

analysis, the ALJ found Plaintiff suffered from a single severe impairment: degenerative disc

disease.° Id. (citing 20 C.F.R. § 416.920(c)). At Step Three, the ALJ found that she did not meet

or equal any of the Listings. Jd. p. 22. At Step Four, the ALJ found that she retained the residual

5 Also at Step 2, the ALJ assessed Plaintiff's psychological impairments. ECF No. 5-2, p. 21. The ALJ applied a

“special technique” to evaluate mental impairments. See, e.g., Deanna S. v. Dudek, Acting Comm’r of the Soc. Sec.

Admin., 2025 WL 1510659, at *6 (S.D.W. Va. May 7, 2025), report and recommendation adopted sub nom. Deanna

S. v. Bisignano, 2025 WL 1507022 (S.D.W. Va. May 27, 2025). Here, the ALJ concluded that Regina’s mental

impairments (major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder (“PTSD”) and

mild neurocognitive impairment) did not cause more than a minimal limitation on her ability to perform basic mental

work and thus, were non-severe. Jd. The ALJ provided a detailed analysis of the relevant criteria in reaching her

determination that her mental impairments—considered singly and in combination——did not meet or medically equal

the criteria of listings set out in 20 C.F.R. Part 404, Subpart P, Appendix 1 (the “Paragraph B Criteria”). Jd. The ALJ

explained that the record showed that Plaintiff had mild limitations in all four broad functional areas of mental

functioning, or “Paragraph B” criteria, but that because there were no more than mild limitations in these areas, these

impairments were considered mild and non-severe. Indeed, the ALJ specifically noted: “the medical records in this

care are minimal and the records available contain no evidence of any ongoing mental health treatment, no evidence

of mental health counseling, and no psychiatric hospitalizations.” Jd. p. 21. Thus, the ALJ concluded that any

limitations caused by Regina’s mental impairments were “so slight that they do not cause any measurable loss of

function in the mental ability to understand, remember, or carry out instructions, to make work related decisions, or

to respond appropriately to supervisors, coworkers, usual work situations, changes in work setting, or work pressures

in a work setting” Jd. Accordingly, the ALJ acknowledged that the Plaintiff's mild limitations would not be reflected

in his residual functional capacity assessment. The ALJ then fashioned an RFC that included no limitations for

Plaintiff's mild impairments in mental functioning. Jd. Plaintiff does not appeal this determination.

functional capacity to perform the full range of light work. Jd. Further, the ALJ also found that

the Plaintiff has no past relevant work.

At step five, the ALJ determined, based on the testimony of a vocational expert, that there

are jobs existing in significant numbers in the national economy which the claimant can perform,

consistent with his medical impairments, age, education, past work experience, and residual

functional capacity. The ALJ concluded that Plaintiff has not been disabled within the meaning

of the Act and denied both DIB and SSI benefits. Jd. p. 26. ,

Plaintiff raises two arguments on appeal. First, she contends that the ALJ failed to properly

evaluate the medical opinion of the physician assistant who examined her post-hearing, Physician

Assistant Denney. ECF No. 8, p. 10. Specifically, she argues that the ALJ failed to articulate how

he considered the consistency factors when determining the persuasiveness of the PA’s opinion,

particularly as it relates to Plaintiffs alleged work-preclusive limitations. Jd.

Second, Plaintiff argues that the ALJ’s persuasiveness finding is “not based on substantial

evidence.” Jd. She contends that this alleged deficiency was not harmless because the ALJ’s RFC

did not adequately reflect her work-preclusive limitations. Jd. p. 12.

B. The ALJ Provided a Sufficient and Supported Explanation for Discounting the

Medical Opinion of PA Denney.

After examining Regina post-hearing, Denney concluded she suffered from “chronic neck

pain, chronic headaches, back pain, and bilateral hip pain. ECF No. 5-7, p. 46. He also concluded

that Plaintiff could only stand for two hours out of an eight-hour work day. Jd. p.51. Additionally,

Denney determined that Regina could lift/carry 21-50 pounds on occasion and 11-20 pounds with

more frequency. Jd. She could also sit for four hours and walk for two hours during an eight-hour

work day. Jd. Denney also noted that Plaintiff could climb ladders, scaffolds, stairs, stoop, kneel,

crouch, and crawl. Jd. She also was found able to tolerate exposure to unprotected heights,

10

operating a motor vehicle, loud (heavy traffic) noises, and could, on occasion, be exposed to

heights, operate a motor vehicle, and tolerate exposure to other substances such as dust, fumes,

and pulmonary irritants. Jd. The ALJ disregarded this opinion. ECF No. 5-2 p. 25. He concluded

that Denney’s determinations were not supported by the record and were inconsistent given the

larger medical record.

Plaintiff first argues that the ALJ’s consideration of the opinion provided by PA Denney

post-hearing was flawed because he erred in his consistency analysis. This court finds that the

ALJ sufficiently addressed the consistency factors.

Because Plaintiff filed her disability claim after March 27, 2017, the ALJ was required to

apply new regulations when evaluating medical opinions. 20 C.F.R. §§ 404.1520c, 416.920c.

Under new regulations, the ALJ need not defer to or give any specific evidentiary weight to

medical opinions from treating sources. Id. at §§ 404.1520c(a), 416.920c(a). Rather, when an

ALJ considers medical opinions in the record, new governing regulations indicate that

supportability and consistency are the two most important factors. Jd. at §§ 404.1520c(b)(2),

416.920c(b)(2). Indeed, those are the only two factors an ALJ must consider explicitly. Jd.

Supportability refers to the objective medical evidence and accompanying explanation that the

medical source provides to justify those medical opinions. Jd. at §§ 404.1520c(c)(1),

416.920c(c)(1). Consistency refers to whether, and how consistent, the medical source’s opinion

is with evidence from other medical and nonmedical sources in the record. Jd. at §§

404.1520c(c)(2), 416.920c(c)(2). This articulation standard does not conflict with the enabling

statute. Zaborowski y. Comm’r of Soc. Sec., 115 F.4th 637, 639 (3d Cir. 2024).

As to consistency, the ALJ’s analysis adequately addressed the opinion’s consistency. The

ALJ was not required to specify whether PA Denney’s opinion was consistent with the overall

11

medical record. However, he was required to provide a sufficient explanation of his consistency

finding that permits this court to conduct a meaningful review. See Fargnoli, 247 F.3d at 42;

Burnett v. Comm’r of Soc. Sec. Admin., 220 F.3d 112, 120 (3d Cir. 2000). He did so here, when

he stated that Denney’s opinion was inconsistent with other aspects of the medical record, which

notably revealed the absence of ongoing medical treatment post spinal surgery. Therefore, the

court finds no error in the ALJ’s consistency analysis of PA Denney’s opinion. See, e.g., Christine

F. B. v. Bisignano, 2025 WL 1830603, at *5 (E.D. Pa. June 30, 2025).

On appeal, Plaintiff acknowledges that the ALJ adequately addressed supportability but

contends his consistency analysis was impermissibly “cursory” and “terse.” ECF No. 8, at 11-12

(citing Prodin v. Kijakazi, 2022 WL 973703, at *4 (W.D. Pa. Mar. 31, 2022)). As shown above,

the ALJ explained that Denney’s opinion was inconsistent because Denney found limitations that □

were not consistent with the evidence as a whole. For certain, ALJs “must consider a range of

factors” when they weigh medical opinions, but all they must explain are the reasons for their

decisions.” Zaborowski v. Comm’r Soc. Sec., 115 F.4th 637, 638 (Gd Cir. 2024) (emphasis in

original). For cases such as this one, which are filed on or after March 27, 2017, the regulations

provide that “the two most important factors for determining the persuasiveness of medical

Opinions are consistency and supportability.” 82 Fed. Reg. at 5853; see also 20 C.F.R. §§

416.920c(b) and (c). See also Brown v. Comm’r of Soc. Sec., 2025 WL 1284775, at *1 (W.D. Pa.

May 2, 2025). “[S]upportability relates to the extent to which a medical source has articulated

support for the medical source’s own opinion, while consistency relates to the relationship between.

a medical source’s opinion and other evidence within the record.” Cook v. Comm’r of Soc. Sec.,

2021 WL 1565832, at *3 (M.D. Fla. Apr. 6, 2021), report and recommendation adopted, 2021

WL 1565162 (M.D. Fla. Apr. 21, 2021).

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Plaintiff points to no specific medical findings that the ALJ overlooked. Instead, she offers

only the broad argument that his consistency discussion was inadequate. That type of allegation

is insufficient. Here, the ALJ properly analyzed the consistency of Denney’s opinion and reached

the reasonable conclusion that it was not persuasive. ECF No. 5-2, p. 26. The ALJ specifically

found that the lack of record evidence of ongoing treatment post-surgery was inconsistent with the

PA’s conclusions relating to the limitations he placed on Regina’s abilities. The ALJ used this

absence of evidence from the rest of the record to show inconsistency with PA Denney’s opinion.

This was a proper consistency analysis. See, e.g., Prinzi v. Comm’r of Soc. Sec., 2024 WL

4931946, at *1 (W.D. Pa. Dec. 2, 2024) (citing Cook, 2021 WL 1565832, at *3 (stating

“consistency relates to the relationship between a medical source’s opinion and other evidence

within the record.”). As shown above, the ALJ explained that this opinion was inconsistent with

the evidence because it found limitations that the evidence as a whole did not demonstrate. While

Plaintiff contends this analysis was insufficient because the ALJ did not elaborate or cite any of

the inconsistent evidence, the ALJ explained elsewhere in the opinion that the evidence showed

that she could complete many daily activities and had not received any treatment post-surgery over

the last few years. This explanation is sufficient to facilitate meaningful judicial review. See e.g.,

Jones v. Barnhart, 364 F.3d 501, 505 (3d Cir. 2004) (holding that an ALJ’s decision must be “read

as a whole”).

Moreover, the law imposes no obligation on an ALJ to provide the level of detail Plaintiff

seeks here. Under the Commissioner’s regulations, it is enough that the decision be explained in

a manner that allows a subsequent reviewer to follow the reasoning. See Revisions to Rules

Regarding the Evaluation of Medical Evidence, 82 Fed. Reg. 5844-01, 5858 (Jan. 18, 2017). The

United States Supreme Court has emphasized that an adjudicator’s reasoning need not be

13

“elaborate or even sophisticated,” provided the rationale is “reasonably discernible.” 7-Mobile S.,

LLC v. City of Roswell, 574 U.S. 293, 302 (2015); see also Garland v. Ming Dai, 593 U.S. 357,

369 (2021). Likewise, the Third Circuit has repeatedly explained that the substantial evidence

standard is deferential, requiring only that the ALJ’s path of reasoning be traceable, not that it be

exhaustively detailed. See, e.g., Jones v. Barnhart, 364 F.3d 501, 505 (3d Cir. 2004) (the ALJ “is

not required to supply a comprehensive explanation for the rejection of evidence” if the reviewing

court can discern the rationale); Cotter v. Harris, 650 F.2d 481, 482 Gd Cir. 1981) (the ALJ must

simply identify what evidence was accepted and what was rejected, and why). Thus, it is Plaintiffs

burden to highlight concrete evidence that undermines the ALJ’s conclusions, rather than to rely

on generalized assertions of error. See Woodson v. Comm’r of Soc. Sec., 661 F. App’x 762, 765—

66 (3d Cir. 2016).

C. Substantial evidence supports the ALJ’s conclusion that Regina was able to perform

the mental demands of her past relevant work.

Next, Plaintiff argues that the ALJ’s conclusion she was able to perform the mental

demands of her past relevant work (‘“light,” “unskilled,” “SVP 2” work) was not supported by

substantial evidence. See ECF No. 8, p. 15. She faults the ALJ for not accounting for her mild

mental limitations when he formulated her residual functional capacity (“RFC”). Jd. “In assessing

RFC, the [ALJ] must consider limitations and restrictions imposed by all of an individual’s

impairments, even those that are not ‘severe.’ ” Hess v. Comm’r Soc. Sec., 931 F.3d 198, 209 (3d

Cir. 2019). At the hearing, the ALJ was concerned that there was no expert psychological

functional assessment in the record, specifically noting, “J’Il just state the obvious ... I don’t think

we have anything in the file from her primary care doctor, or from the psychologist, or from the

therapist.” See ECF No. 5-2, p. 45. Without such records, the ALJ stated he was lacking a

“medically determinable impairment in terms of anxiety or depression.” Jd. As a result, the ALJ

14

left the record open for an additional 45 days for the submission of such reports. Jd. When no

such reports were submitted, the ALJ ordered Regina to undergo a psychological consultative

exam.

Dr. T. Scott Hotchkiss performed the psychological exam. See ECF No. 5-7, p. 38.

Although Hotchkiss concluded that Regina suffered from conditions and disorders such as

depression, anxiety, PTSD, and mild neurocognitive disorders, Hotchkiss did not express an

opinion whether those conditions affected Plaintiff's ability to work or identify any functional

work-related limitations. Jd. pp. 38-43. Thus, the psychological records Plaintiff points to are

treatment notes which do not contain an opinion as to what she can still do despite her impairments

or whether she meets or equals a listing. See id. Indeed, the ALJ expressly discussed this in his

decision, noting that Dr. Hotchkiss did not specify any functional work-related limitations. ECF

No. 5-2, p. 22. Given that, the ALJ did not undertake a persuasiveness analysis indicating that she

had considered such statements but not treated them as medical opinions. See, e.g., Johnson v.

Kijakazi, 2023 WL 2500367, at *1 (W.D. Pa. Mar. 14, 2023).

Here, the ALJ reviewed all of the relevant evidence including the medical records,

psychological records, and Plaintiffs own description of her limitations. He relied on the evidence

submitted in reaching his determination that she could perform light work sedentary work as

defined in 20 C.F.R. §§ 404.1567(b) and 416.967(b) and this determination was accompanied by

a thorough explanation and a meaningful discussion of the evidence. Accordingly, the Court finds

that the ALJ’s conclusions are substantially supported by the evidence. Absent from the records

is evidence of ongoing mental health treatment, mental health counseling, or psychiatric

hospitalization. Nothing in the records supports severe or prolonged limitations due to depression,

anxiety, or any other psychological disorder during the relevant times.

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The Court is not persuaded by Plaintiff's contention that the ALJ erred in relying on the

consultative psychological evaluation, which did not delineate any specific work-related

restrictions. The ALJ is charged with assessing a claimant’s RFC based on the entirety of the

record, and need not adopt any medical opinion verbatim. Chandler vy. Comm’r of Soc. Sec., 667

F.3d 356, 361-62 (3d Cir. 2011). Where, as here, a consultative examiner provides narrative

findings but declines to identify functional limitations, courts within this Circuit have recognized

that the omission may reasonably be interpreted as an indication that the claimant suffers no

disabling mental restrictions. See Rutherford y. Barnhart, 399 F.3d 546, 553-54 (3d Cir. 2005);

Titterington v. Barnhart, 174 Fed. Appx 6, 11 (3d Cir. 2006); Kersey v. Comm’r of Soc. Sec., 2016

WL 1271280, at *6 (W.D. Pa. Mar. 31, 2016). Judicial review is confined to determining whether

the ALJ’s RFC finding is supported by substantial evidence, not whether this Court would have

reached a different conclusion. Rutherford, 399 F.3d at 552.

Plaintiff argues that Dr. Hotchkiss’ report found her to be suffering from depression, PTSD,

and anxiety. See ECF No. 14, p. 6; ECF No. 5-7, p. 38. But merely pointing to a diagnosis without

identifying any additional functional limitations not already included in the RFC is insufficient.

Further, she does not provide any explanation as to why this evidence undermines the ALJ’s

treatment of the psychologist’s opinions or otherwise requires remand. Notably, “[a] diagnosis

alone ... does not demonstrate disability.” Foley v. Comm’r of Soc. Sec., 349 Fed. Appx 805, 808

(3d Cir. 2009) (citing Petition of Sullivan, 904 F.2d 826, 845 (3d Cir. 1990). See also Phillips v.

Barnhart, 91 Fed. Appx 775, 780 (3d Cir. 2004) (“[The claimant’s] argument incorrectly focuses

on the diagnosis of an impairment rather than the functional limitations that result from that

impairment. A diagnosis of impairment, by itself, does not establish entitlement to benefits under

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the Act”). The ALJ need only include “credibly established” limitations, i.e., limitations “that are

medically supported and otherwise uncontroverted in the record.” Rutherford, 399 F.3d at 554

Because the ALJ here acknowledged the consultative opinion, explained the weight

afforded to it, and reasonably concluded that the absence of any stated limitations was consistent

with the broader evidentiary record, the ALJ’s decision finding the report unpersuasive was

supported by substantial evidence. The Court finds no error.

VI. Conclusion

For the reasons explained above, the Court concludes that the ALJ’s decision is supported

by substantial evidence. The ALJ did not err in conducting the consistency analysis. Further, it

was not error for the ALJ to conclude that, despite her severe mental impairments, the Plaintiff has

the residual capacity to perform some jobs available in the national economy and is therefore not

disabled. The ALJ’s decision will be AFFIRMED.

For the reasons set out above, the Court concludes Plaintiffs appeal of the Commissioner’s

decision is properly denied. An appropriate Order is filed simultaneously with this Memorandum.

DATED this Dye of Stptemleel . 2025.

BY THE-COURT:

i. a

“fel 2, □

RICHARD A. LANZILL □

CHIEF UNITED STATES MAGISTRATE JUDGE

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