Cawley v. Colvin, No. 5:2016cv02216 - Document 18 (S.D.W. Va. 2017)
Court Description: MEMORANDUM OPINION: After a careful consideration of the evidence of record, the Court finds that the Commissioner's decision is supported by substantial evidence. Therefore, the Court DENIES Plaintiff's 13 Motion for Judgment on the Plea dings, GRANTS Defendant's 14 Request that the Commissioner's decision be affirmed, and DISMISSES this action from the docket of the Court. Signed by Magistrate Judge Cheryl A. Eifert on 01/26/2017. (cc: attys; any unrepresented party) (msa)
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Cawley v. Colvin Doc. 18 IN TH E U N ITED STATES D ISTRICT COU RT FOR TH E SOU TH ERN D ISTRICT OF W EST VIRGIN IA BECKLEY D IVISION PAU LA K. CAW LEY, Plain tiff, v. Cas e N o .: 5:16 -cv-0 2 2 16 CAROLYN W . COLVIN , Actin g Co m m is s io n e r o f th e So cial Se cu rity Ad m in is tratio n , D e fe n d an t. MEMORAN D U M OPIN ION This is an action seeking review of the decision of the Com m issioner of the Social Security Adm inistration (hereinafter the “Com m issioner”) denying Plaintiff’s application for disability insurance benefits (“DIB”) and supplem ental security incom e (“SSI”) under Titles II and XVI of the Social Security Act, 42 U.S.C. §§ 40 1-433, 1381-1383f. The case is presently before the Court on the parties’ m otions for judgm ent on the pleadings as articulated in their briefs. (ECF Nos. 13, 14). Both parties have consented in writing to a decision by the United States Magistrate J udge. (ECF Nos. 4, 5). The Court has fully considered the evidence and the argum ents of counsel. For the reasons that follow, the Court finds that the decision of the Com m issioner is supported by substantial evidence and should be affirm ed. I. Pro ce d u ral H is to ry Plaintiff, Paula K. Cawley (“Claim ant”), com pleted applications for DIB and SSI on May 8, 20 13, alleging a disability onset date of April 30 , 20 13, (Tr. at 312, 316), due to 1 Dockets.Justia.com “nerve dam age in left arm and neck, depression, bad nerves.” (Tr. at 358). The Social Security Adm inistration (“SSA”) denied the applications initially and upon reconsideration. (Tr. at 63). Claim ant filed a request for a hearing, which was held on May 13, 20 15, before the Honorable Scott J ohnson, Adm inistrative Law J udge (“ALJ ”). (Tr. at 82-120 ). By written decision dated J une 4, 20 15, the ALJ determ ined that Claim ant was not disabled. (Tr. at 63-76). The ALJ ’s decision becam e the final decision of the Com m issioner on February 5, 20 16, when the Appeals Council denied Claim ant’s request for review. (Tr. at 8-11). On March 9, 20 16, Claim ant filed the present civil action seeking judicial review of the adm inistrative decision pursuant to 42 U.S.C. § 40 5(g). (ECF No. 2). The Com m issioner filed an Answer and a Transcript of the Proceedings on May 12, 20 16. (ECF Nos. 10 , 11). Thereafter, the parties filed their briefs in support of judgm ent on the pleadings. (ECF Nos. 13, 14). Accordingly, this m atter is fully briefed and ready for disposition. II. Claim an t’s Backgro u n d Claim ant was 53 years old at the tim e of her alleged onset of disability and 55 years old at the tim e of the ALJ ’s decision. (Tr. at 63, 312). She com pleted the eleventh grade in school and com m unicates in English. (Tr. at 357, 359). Claim ant previously worked as an assistant m anager at a fast food restaurant. (Tr. at 359). III. Su m m ary o f ALJ’s Fin d in gs Under 42 U.S.C. § 423(d)(5), a claim ant seeking disability benefits has the burden of proving a disability. See Blalock v. Richardson, 483 F.2d 773, 775 (4th Cir. 1972). A disability is defined as the “inability to engage in any substantial gainful activity by reason of any m edically determ inable physical or m ental im pairm ent which can be expected to 2 result in death or which has lasted or can be expected to last for a continuous period of not less than 12 m onths.” 42 U.S.C. § 423(d)(1)(A). The Social Security Regulations establish a five step sequential evaluation process for the adjudication of disability claim s. If an individual is found “not disabled” at any step of the process, further inquiry is unnecessary and benefits are denied. 20 C.F.R. §§ 40 4.1520 (a)(4), 416.920 (a)(4). First, the ALJ determ ines whether a claim ant is currently engaged in substantial gainful employm ent. Id. §§ 40 4.1520 (b), 416.920 (b). Second, if the claim ant is not gainfully em ployed, then the inquiry is whether the claim ant suffers from a severe im pairm ent. Id. §§ 40 4.1520 (c), 416.920 (c). Third, if the claim ant suffers from a severe im pairm ent, the ALJ determ ines whether this im pairm ent m eets or equals any of the im pairm ents listed in Appendix 1 to Subpart P of the Adm inistrative Regulations No. 4 (the “Listing”). Id. §§ 40 4.1520 (d), 416.920 (d). If the im pairm ent does m eet or equal a listed im pairm ent, then the claim ant is found disabled and awarded benefits. However, if the im pairm ent does not m eet or equal a listed impairm ent, the adjudicator m ust determ ine the claim ant’s residual functional capacity (“RFC”), which is the m easure of the claim ant’s ability to engage in substantial gainful activity despite the lim itations of his or her im pairm ents. Id. §§ 40 4.1520 (e), 416.920 (e). In the fourth step, the ALJ ascertains whether the claim ant’s im pairm ents prevent the perform ance of past relevant work. Id. §§ 40 4.1520 (f), 416.920 (f). If the im pairm ents do prevent the perform ance of past relevant work, then the claim ant has established a prim a facie case of disability and the burden shifts to the Com m issioner to prove the final step. McLain v. Schw eiker, 715 F.2d 866, 868-69 (4th Cir. 1983). Under the fifth and final inquiry, the Com m issioner m ust dem onstrate that the claim ant is able to perform other form s of substantial gainful activity, while taking into account the claim ant’s rem aining physical 3 and m ental capacities, age, education, and prior work experiences. 20 C.F.R. §§ 40 4.1520 (g), 416.920 (g); see also Hunter v. Sullivan, 993 F.2d 31, 35 (4th Cir. 1992). The Com m issioner m ust establish two things: (1) that the claim ant, considering his or her age, education, skills, work experience, and physical shortcom ings has the capacity to perform an alternative job, and (2) that this specific job exists in significant num bers in the national econom y. McLam ore v. W einberger, 538 F.2d 572, 574 (4th Cir. 1976). When a claim ant alleges a m ental im pairm ent, the ALJ “m ust follow a special technique” when assessing disability. 20 C.F.R. §§ 40 4.1520 a, 416.920 a. First, the ALJ evaluates the claim ant’s pertinent signs, sym ptom s, and laboratory results to determ ine whether the claim ant has a m edically determ inable m ental im pairm ent. Id. §§ 40 4.1520 a(b), 416.920 a(b). If such im pairm ent exists, the ALJ docum ents the findings. Second, the ALJ rates and docum ents the degree of functional lim itation resulting from the im pairm ent according to criteria specified in the Regulations. Id. §§ 40 4.1520 a(c), 416.920 a(c). Third, after rating the degree of functional lim itation from the claim ant’s im pairm ent(s), the ALJ determ ines the severity of the lim itation. Id. §§ 40 4.1520 a(d), 416.920 a(d). A rating of “none” or “m ild” in the first three functional areas (activities of daily living, social functioning, and concentration, persistence or pace) and “none” in the fourth (episodes of decom pensation) will result in a finding that the im pairm ent is not severe unless the evidence indicates that there is m ore than m inim al lim itation in the claim ant’s ability to do basic work activities. Id. §§ 40 4.1520 a(d)(1), 416.920 a(d)(1). Fourth, if the claim ant’s im pairm ent is deem ed severe, the ALJ com pares the m edical findings about the severe im pairm ent and the degree of functional lim itation against the criteria of the appropriate listed m ental disorder to determ ine if the severe im pairm ent m eets or is equal to a listed m ental disorder. Id. §§ 40 4.1520 a(d)(2), 416.920 a(d)(2). 4 Finally, if the ALJ finds that the claim ant has a severe m ental im pairm ent that neither m eets nor equals a listed m ental disorder, then the ALJ assesses the claim ant’s residual function. 20 C.F.R. §§ 40 4.1520 a(d)(3), 416.920 a(d)(3). In this case, the ALJ determ ined as a prelim inary m atter that Claim ant m et the insured status requirem ents of the Social Security Act through Decem ber 31, 20 18. (Tr. at 65, Finding No. 1). The ALJ acknowledged that Claim ant satisfied the first inquiry because she had not engaged in substantial gainful activity since April 30 , 20 13, the alleged disability onset date. (Id., Finding No. 2). Under the second inquiry, the ALJ found that Claim ant suffered from severe im pairm ents of “degenerative disc disease of the lum bar and cervical spine; degenerative joint disease of the bilateral knees, status-post arthroscopic surgery on the right knee; chronic obstructive pulm onary disease (COPD); history of left wrist fracture, status-post open reduction internal fixation (ORIF); history of bilateral carpal tunnel syndrom e, status-post left carpal tunnel release; and osteoarthritis of the right shoulder, status-post surgery (20 CFR 40 4.1520 (c) and 416.920 (c)).” (Tr. at 65-68, Finding No. 3). Claim ant also had several non-severe im pairm ents, including m ajor depressive disorder and generalized anxiety disorder. (Id.). Under the third inquiry, the ALJ concluded that Claim ant’s im pairm ents, either individually or in com bination, did not m eet or m edically equal the severity of any listed im pairm ent. (Tr. at 68-69, Finding No. 4). Therefore, the ALJ determ ined that Claim ant had the RFC to: [P]erform a range of light work as defined in 20 CFR 40 4.1567(b) and 416.967(b) except she can occasionally clim b ram ps and stairs, but never clim b ladders, ropes, and scaffolds. She can occasionally balance, stoop, kneel, crouch, and crawl. She can perform frequent reaching overhead bilaterally. She could frequently handle and finger perform ing gross and fine m anipulation bilaterally. She should avoid concentrated exposure to extrem e cold, wetness, hum idity, excessive vibration, and pulm onary 5 irritants such as fum es, odors, dusts, and gases as well as poorly ventilated areas, chem icals, and hazards such as m oving m achinery and unprotected heights. (Tr. at 69-75, Finding No. 5). At the fourth step of the analysis, the ALJ found that Claim ant was capable of perform ing past relevant work as an assistant m anager at a fast food restaurant. The ALJ explained that this occupation did not require the perform ance of work-related activities precluded by Claim ant’s RFC. (Tr. at 75-76, Finding No. 6). In reaching this conclusion, the ALJ considered the testim ony of a vocational expert, who noted that Claim ant’s past work under the Dictionary of Occupational Titles (DOT) was classified at the skilled, light exertional level. Taking into account the vocational expert testim ony and com paring the Claim ant’s RFC with the physical and m ental dem ands of that work, the ALJ determ ined that Claim ant was able to perform her past relevant work as generally perform ed in the national econom y. Therefore, the ALJ concluded that Claim ant was not disabled under the Social Security Act. (Tr. at 76, Finding No. 7). IV. Claim an t’s Ch alle n ge s to th e Co m m is s io n e r’s D e cis io n Claim ant asserts that the ALJ failed to afford controlling weight to her treating physicians’ opinions of her functional capacity without proper analysis and support as required by the applicable Social Security regulations and ruling (20 C.F.R. §§ 40 4.1524 and 416.927(d)(2)-(6) and SSR 96-2p). (ECF Nos. 13 at 1-18). In response, the Com m issioner argues that substantial evidence supports the ALJ ’s finding that Claim ant could perform a lim ited range of light work. The Com m issioner adds that, even if additional m ental or physical lim itations were warranted, the vocational expert testified that there were still light level jobs that Claim ant could perform despite certain additional restrictions. (ECF No. 14 at 6-7). 6 V. Sco p e o f Re vie w The issue before this Court is whether the final decision of the Com m issioner denying Claim ant’s application for benefits is supported by substantial evidence. In Blalock v. Richardson, the Fourth Circuit Court of Appeals defined substantial evidence as: Evidence which a reasoning m ind would accept as sufficient to support a particular conclusion. It consists of m ore than a m ere scintilla of evidence but m ay be som ewhat less than a preponderance. If there is evidence to justify a refusal to direct a verdict were the case before a jury, then there is “substantial evidence.” 483 F.2d 773, 776 (4th Cir. 1972) (quoting Law s v. Celebrezze, 368 F.2d 640 , 642 (4th Cir. 1966)). Additionally, the Com m issioner, not the court, is charged with resolving conflicts in the evidence. Hay s v. Sullivan, 90 7 F.2d 1453, 1456 (4th Cir. 1990 ). The Court will not re-weigh conflicting evidence, m ake credibility determ inations, or substitute its judgm ent for that of the Com m issioner. Id. Instead, the Court’s duty is lim ited in scope; it m ust adhere to its “traditional function” and “scrutinize the record as a whole to determ ine whether the conclusions reached are rational.” Oppenheim v. Finch, 495 F.2d 396, 397 (4th Cir. 1974). Thus, the ultim ate question for the Court is not whether the Claim ant is disabled, but whether the decision of the Com m issioner that the Claim ant is not disabled is well-grounded in the evidence, bearing in m ind that “[w]here conflicting evidence allows reasonable m inds to differ as to whether a claim ant is disabled, the responsibility for that decision falls on the [Com m issioner].” W alker v. Bow en, 834 F.2d 635, 640 (7th Cir. 1987). VI. Re le van t Me d ical Re co rd s The court has reviewed the Transcript of Proceedings in its entirety, including the m edical records in evidence, and sum m arizes below Claim ant’s m edical treatm ent and 7 evaluations that are m ost relevant to the issues in dispute. A. M e d ica l R e co r d s In J anuary 20 11, prior to her alleged onset of disability, Claim ant fractured her left wrist in a fall at work; the fracture was surgically repaired that m onth. (Tr. at 498). She subsequently developed carpal tunnel syndrom e and underwent carpal tunnel release surgery in May 20 12. (Id.). Also prior to her alleged onset of disability, Claim ant was diagnosed with m ajor depressive disorder and generalized anxiety disorder. (Tr. at 653, 669). She was treated by psychiatrist, Safiullah Syed, M.D., and prescribed Xanax, Celexa, and Am bien. (Tr. at 653, 654, 669). In J anuary 20 13, Claim ant saw internist, Wadih Kabbara, M.D., for follow-up; Dr. Kabbara docum ented that he had not seen Claim ant in a couple of years. (Tr. at 621). On this visit, she com plained of pain radiating from the left side of her neck to her left wrist and noted that her left arm som etim es becam e tense. (Id.). She had decreased range of m otion in her left wrist. (Id.). Dr. Kabbara believed Claim ant’s left wrist pain could be secondary to her prior fracture, from other causes, or could be neuropathic. (Tr. at 622). He recomm ended an x-ray, a nerve conduction study, and blood work. He also planned to obtain approval for a pain relief cream . (Id.). Claim ant’s x-ray showed degenerative changes in her wrist and the m etallic plate and screw from her prior surgery, but no acute fracture or dislocation. (Tr. at 672). Claim ant saw Dr. Kabbara again the following m onth. She had decreased m otion in her left thum b and wrist, but no significant swelling. (Tr. at 623). Also that m onth, Claim ant presented to Beckley Appalachian Regional Healthcare with lightheadness and blurry vision. (Tr. at 541). An exam ination revealed no issues with regard to her extrem ities, and she had norm al range of motion, m otor strength, and sensation. (Tr. at 8 542). In March 20 13, Dr. Kabbara referred Claim ant to neurologist, Barry K. Vaught, M.D., for evaluation of her left arm pain and tingling. (Tr. at 498). Claim ant stated that she had been doing well until recently. (Id.). She reported pain and occasional weakness in her arm , residual pain in her left wrist and arm , and m ild reduced grip strength. (Id.). Claim ant was slightly hyperreflexic on exam ination, but stated that she had always been that way. (Id.). Her m otor strength was 5/ 5 in all extrem ities and her m uscles were of norm al bulk and tone. (Id.). Claim ant reported reduced sensation in her left hand, but her reflexes were norm al throughout. (Id.). Her nerve conduction study showed no evidence of radial neuropathy, but there was m edian neuropathy on the left and m ild bilateral carpal tunnel syndrom e. Claim ant was instructed to begin wearing nighttim e wrist splints. (Tr. at 499-50 1). Later that m onth, Claim ant reported to Dr. Syed’s office that she was “doing ok with her m edications,” but still had a lot of problem s with her wrist and did not feel like her job was “treating her right” over it. (Tr. at 668). Claim ant’s objective psychiatric exam ination was norm al, and her psychological diagnoses and m edications rem ained the sam e. (Id.). In April 20 13, the m onth that she allegedly becam e disabled, Claim ant presented to Dr. Kabbara. She appeared to be very anxious and upset over losing her job. (Tr. at 626). Claim ant reported that she had been “setup” at work and “had to be fired.” (Id.). However, she denied having any sym ptom s of depression. (Id.). Claim ant’s m usculoskeletal examination revealed no tenderness or joint swelling. (Id.). She also saw Dr. Syed in April and stated she was “not doing well,” was stressed out, anxious, nervous, depressed, irritable, and angry. (Tr. at 666). She elaborated that an em ployee that she was training to be her assistant “set her up for a $ 50 theft” and had told others that he was 9 going to do it. (Id.). Dr. Syed wrote a note, stating that Claim ant could not work secondary to her physical and psychiatric condition for about a year. (Id.). Nevertheless, Claim ant’s psychological diagnoses and m edications rem ained the sam e. (Id.). In May 20 13, Claim ant reported to Dr. Kabbara that she still had anxiety and pain in different joints, but denied depression. (Tr. at 628). Dr. Kabbara’s im pression was arthritis in different joints and anxiety. (Id.). Claim ant was given refills for Norco and Xanax and was also prescribed Citalopram . (Tr. at 629). In J une 20 13, Claim ant reported to Dr. Syed’s office that she was “doing okay with her m edicine when she could afford to get it.” (Tr. at 652). She stated that she was under a lot of stress and trying to get disability and a m edical card. (Id.). She said that she had a lot of problem s with her arm . (Id.). Her diagnoses and m edications were unchanged. (Id.). Claim ant also saw Dr. Vaught in J une and continued to com plain of hand pain, with burning and tingling in her hand and arm . (Tr. at 50 5). Dr. Vaught stated that som e m easure of Claim ant’s hand pain was due to a m edian nerve injury, but the nerve conduction study showed that her condition was im proving. (Id.). To reduce the neuropathic com ponent, Dr. Vaught started Claim ant on Neurontin. (Id.). Claim ant’s nerve conduction study showed m ild m edian neuropathy at the wrists consistent with carpal tunnel syndrom e. (Tr. at 50 6). In J uly 20 13, Claim ant reported to Dr. Kabbara that she still had pain in her wrist. She had seen an orthopedic surgeon, who stated that he could not do anything for her, but she also saw Dr. Vaught, who put her on Neurontin. (Tr. at 630 ). Claim ant had arthralgia and decreased m otion in her left wrist, but no arthritis or other m usculoskeletal issues. (Id.). Dr. Kabbara planned was to continue Claim ant’s Norco for pain control. (Tr. at 631). 10 During her visit with Dr. Kabbara in August 20 13, Claim ant denied having any anxiety, but reported that she did have depression. (Tr. at 633). She also reported arthralgia, but no arthritis, joint tenderness, or swelling. (Id.). Dr. Kabbara concluded that Claim ant’s chronic wrist pain was potentially caused by a neuropathy. (Tr. at 634). His plan was to continue Norco for pain. (Id.). In Septem ber, Claim ant saw Dr. Kabbara for back pain. (Tr. at 635). She had no arthralgia or arthritis, and no other m usculoskeletal issues were noted. (Id.). Claim ant was advised not to carry heavy objects or crawl. (Tr. at 636). Norco was continued for pain relief. (Id.). The sam e m onth, Claim ant saw Dr. Syed and again stated that she was “not doing well” and had been depressed, anxious, and nervous. (Tr. at 670 ). She related that she had financial problem s and her daughter was experiencing health problem s. (Id.). She was seeking a m edical card and social security disability and had retained a lawyer to sue her form er em ployer Kentucky Fried Chicken (“KFC”). (Id.). Dr. Syad decided to wean Claim ant off Celexa within a week, start Viibryd, and continue Am bien and Xanax. (Id.). She was told to return to the clinic in three m onths. (Id.). In October 20 13, Claim ant presented to Dr. Vaught’s office. (Tr. at 50 7). She stated that her left hand was the sam e, and she still had tingling in her wrist, as well as soreness and som etim es swelling in that area. (Id.). Claim ant was tolerating Neurontin well and felt it helped reduce her pain. (Id.). She still had norm al m otor strength, bulk, and tone in all extrem ities, as well as norm al reflexes, but she reported reduced sensation in her left hand. (Id.). Since her left hand pain sym ptom s had not worsened, her EMG and nerve conduction study were not repeated, but the dosage of Neurontin was increased. (Tr. at 50 8). In December 20 13, Claim ant presented to the Thom as Mem orial Hospital 11 Em ergency Room com plaining of right shoulder pain. (Tr. at 522). She stated that it started two years prior, but recently becam e worse after she fell at hom e. (Id.). On exam ination, Claim ant had m oderate tenderness and lim ited range of m otion due to pain in her right shoulder, but her extrem ities were otherwise negative for any other issues. (Tr. at 523). Claim ant stated that she had x-rays at her prim ary care provider the prior week and was told that she had arthritis. She was given Ultram , but it was not helping with the pain. (Id.). Claim ant was discharged the sam e day with a prescription for Flexeril to take as needed for m uscle spasm . She was instructed to apply ice, lim it lifting, not work for two days, and continue her present m edications. (Tr. at 524). In J anuary 20 14, Claim ant was referred by Dr. Vaught to Lana D. Christiano, M.D., at Neurological Associates, Inc. for a m usculoskeletal exam ination. (Tr. at 515). Claim ant com plained of pain in her right shoulder that extended into her neck and upper arm . (Id.). She had no num bness, tingling, weakness, or pain in her lower portions of her arm s. (Id.). She had norm al strength, tone, sensation, and reflexes in all of her extrem ities. (Tr. at 517). Several m onths later, in March 20 14, Claim ant underwent arthroscopic shoulder surgery. (Tr. at 525). By May 20 14, Claim ant stated that her shoulder was “doing great.” (Tr. at 651). She was released from physical therapy into a hom e exercise program and was pleased with her progress. (Id.). However, that sam e m onth, Claim ant presented to Dr. Syed’s office for follow-up and stated that she continued to have a lot of problem s with chronic pain and her psychiatric conditions. (Tr. at 675). Claim ant again m entioned that she was trying to obtain social security disability benefits and requested a m ental assessm ent form to subm it. (Id.). She stated that she could not deal with large crowds or the public and when she felt stressed, she tended to “blow up” and had a lot of anger issues 12 and irritability. (Id.). Despite Claim ant’s statem ents, Dr. Syad noted that Claim ant’s anxiety seem ed to be well controlled. (Id.). He decided to continue Claim ant’s prescriptions of Viibyrd, Xanax, and Am bien, and add Abilify. (Id.). She was instructed to return in three m onths. (Id.). Also in May 20 14, Claim ant presented to Dr. Vaught’s office, reporting continued tingling in her left wrist and fingers and weak grip on the left. (Tr. at 511). She stated that she was wearing the neutral position splints at night. (Id.). On exam ination, Claim ant had norm al m otor strength, bulk, and tone in all extrem ities and norm al reflexes, but had reduced sensation in her left hand. (Id.). She was to continue taking Neurontin as it was helping and to continue wearing her wrist splints at night. (Tr. at 512). In August 20 14, Claim ant presented to Dr. Syed’s office for follow-up and reported that her m edications were “working out alright,” and she was better since starting Abilify. (Tr. at 689). She had financial stressors, but was calm er, had no m ajor m ood swings, her depression was im proved, and she was able to stay up and stay busy. (Id.). She was to continue the sam e m edications and follow-up in three m onths, or sooner, if needed. (Id.). In Septem ber 20 14, Claim ant presented to a neurosurgeon for evaluation of her neck pain that she stated began two years earlier after a fall at work. (Tr. at 682). Claim ant denied pain or num bness in her arm s and denied electric shock-like sensations, but com plained of weakness and tingling in her left hand and reported dropping objects. (Id.). She confirm ed that she wore neutral position splints at night. (Id.). Claim ant alleged that any type of activity exacerbated pain, and nothing im proved it, although her recent shoulder surgery had im proved her shoulder pain and range of m otion. (Id.). Claim ant denied decreased interest/ pleasure in doing things or feeling down, depressed, or hopeless, and her m ental status was norm al. (Tr. at 684). Claim ant’s m usculoskeletal 13 exam ination showed no swelling, deform ity, or tenderness, and her range of m otion was norm al in all joints except her neck. (Tr. at 685). Her strength was norm al throughout, and her hand grips were strong and equal bilaterally. (Id.). Claim ant was assessed with neck pain and trem ors for which she was to receive follow-up testing. (Id.). Surgery was not recomm ended for her neck pain, but interventional pain therapy was suggested. (Id.). Later that m onth, Claim ant saw Dr. Vaught for neck pain. (Tr. at 699). As far as carpal tunnel syndrom e, Claim ant continued to wear her splints and stated that driving or talking on the telephone worsened her sym ptom s. (Id.). She exhibited norm al m uscle strength, bulk, and tone; reduced sensation in left hand; and had norm al reflexes throughout with no Babinski sign. (Id.). Dr. Vaught questioned whether the trem or was related to Claim ant taking Abilify. (Tr. at 70 0 ). She was to continue taking Neurotin for pain and was referred to Dr. Bowm an for pain control. (Id.). On the sam e date, Claim ant presented to Dr. Syed’s office for an early visit to discuss Abilify and its capacity to cause tremors, at Dr. Vaught’s request. (Tr. at 690 ). She had a trem or in her head and neck, but none in her hands. (Id.). Dr. Syed discontinued Abilify, although he cited to a m edical note suggesting that she had the trem ors before starting Abilify. Dr. Syed believed that Claim ant’s trem or was possibly caused by anxiety. (Id.). Cogentin was added to help with the trem or and stiffness-related issues. (Id.). Claim ant was to continue taking Am bien, Viibryd, and Xanax. (Id.). By the following m onth, Claim ant’s head trem or had im proved, and her jaw trem or was no longer present. (Tr. at 70 1). Claim ant’s carpal tunnel syndrom e was stable. (Id.). In J anuary 20 15, Claim ant presented to Dr. Syed’s office earlier than her scheduled appointm ent and again stated that she was “not doing well.” (Tr. at 692). She reported that she was arguing a lot with her husband and that he tore up her prescriptions. (Id.). 14 She was instructed to continue taking Viibryd, Xanax, and Am bien and to return for her regularly scheduled appointm ent in a m onth or sooner, if needed. (Id.). Also that m onth, Claim ant reported to Dr. Kabbara that she still had trem ors, but no m usculoskeletal issues were noted on exam ination. (Tr. at 710 -11). In February 20 15, Claim ant saw Dr. Syed and reported that she was doing “fair.” (Tr. at 693). She reported m ultiple stressors; including, her and her husband’s health problem s, a dispute with her brother, financial issues, and trying to obtain social security disability benefits. (Tr. at 693). Claim ant was worried, but had fair m em ory, insight, and judgm ent. (Id.). She was to continue her present m edications. (Id.). In March 20 15, Claim ant presented to Dr. Vaught’s office for follow-up; since her last visit, Claim ant had injections in her cervical spine, which im proved her range of m otion. (Tr. at 70 3). She continued wearing her wrist splints and had no worsening of her carpal tunnel syndrom e. (Id.). Claim ant exhibited norm al m otor strength, bulk, and tone and norm al reflexes, but reduced sensation in her left hand. (Id.). Her trem ors had com pletely resolved. (Id.). Claim ant also saw Dr. Kabbara that m onth. Her depression and anxiety were under control. (Tr. at 717). No issues were noted with regard to her m usculoskeletal examination during that visit or the following m onth. (Id.; Tr. at 727). Also in March 20 15, Claim ant had a psychotherapy session with Nancy Sotak. (Tr. at 723). Claim ant reported that she was overwhelm ed by stressors such as health problem s and fam ily issues. (Id.). Her m ood was depressed and anxious, and her affect was tearful. (Id.). In May 20 15, Claim ant reported to Dr. Syed’s office that she was “doing okay with her m edications.” (Tr. at 724). She was arguing with her husband, but they had been getting along better the past couple of days. (Id.). Claim ant was told to continue Viibyrd, Xanax, and Am bien. (Id.). Later that m onth, Claim ant presented to Dr. Syed’s office, 15 com plaining of stress over the outcom e of her disability hearing. (Tr. at 725). She also reported that she continued to struggle with pain and lim itations. (Id.). Her m ood was depressed and anxious, and her affect was flat. (Id.). She also saw Dr. Kabbara and had no m usculoskeletal issues other than edem a in her legs. (Tr. at 729). In J une 20 15, Claim ant saw Dr. Kabbara. (Tr. at 30 ). Her depression and anxiety were under control, and she was seeing a psychiatrist. (Id.). Her m usculoskeletal exam ination showed no m isalignm ent, tenderness, or joint swelling. (Id.). Claim ant also had a psychotherapy session. (Tr. at 19). Her chief com plaints were depression, anxiety, and irritable m ood. (Id.). She was confused and upset that her social security disability claim was denied. (Id.). She stated that she could not work due to her back, neck, wrist, and knee problem s. (Id.). Her diagnoses were recurrent, m oderate m ajor affective illness and anxiety disorder. (Id.). She reported that her psychotropic m edications were beneficial. (Id.). In August 20 15, Claim ant saw Dr. Kabbara for follow-up, noting that she stopped Abilify due to side effects. (Tr. at 32). Her m usculoskeletal exam ination showed no m isalignm ent, tenderness, or joint swelling. (Id.). Her m ajor problem s were depression and anxiety. (Tr. at 33). She was to continue taking her depression and anxiety m edication. (Id.). During a psychotherapy session that m onth, Claim ant reported issues with her spouse. (Tr. at 21). Her diagnoses rem ained the sam e. (Id.). In Septem ber 20 15, Claim ant presented to Dr. Vaught’s office, reporting increased num bness and tingling in the first, second, and third digits of her right hand, but no weakness. (Tr. at 44). She had norm al m otor strength in her extrem ities, reduced sensation in left hand, and norm al reflexes. (Id.). During her psychotherapy session that m onth, Claim ant stated that things were better at hom e, which helped. (Tr. at 23). She 16 stated that she could not work due to physical issues “as well as her m ind,” also stating that she was unable to handle stress. (Id.). She expressed anger over not being able to work. (Id.). The following m onth, Claim ant reported during a psychotherapy session that she was experiencing increased pain, which, in turn, was increasing her anxiety and depression. (Tr. at 24). She stated that she changed her m ind about having neck surgery because she could not hold her head up and was desperate for relief. (Id.). Her m ood was anxious and her affect was pleasant. (Id.). The diagnoses were m ajor depressive disorder and anxiety. (Id.). Also in October 20 15, Claim ant saw Dr. Vaught. Her nerve conduction study showed bilateral carpel tunnel syndrom e that was m ild and had not worsened significantly since the previous study. (Tr. at 46). She was told to continue using her wrist splints and follow up in six m onths. (Id.). In Novem ber 20 15, Claim ant saw Dr. Kabbara and still had no m isalignm ent, tenderness, or joint swelling on her m usculoskeletal exam ination. (Tr. at 38). During her m onthly psychotherapy session, Claim ant reported that she was worried about her m edical issues, had up and downs with her spouse, and had lim itations that affected her daily living and caused frustration. (Tr. at 25). The next m onth, Claim ant reported during psychotherapy that she was devastated over the death of her younger brother who died in his sleep. (Tr. at 26). However, her diagnoses rem ained the sam e. (Id.). Finally, in J anuary 20 16, Claim ant continued to express grief regarding her brother’s death, as well as anxiety over the possibility that her spouse’s cancer was recurring. (Tr. at 27). Her diagnoses rem ained the sam e. (Id.). 17 B. Co n s u lt a t iv e As s e s s m e n t s a n d Ot h e r Op in io n s Prior to Claim ant’s alleged onset of disability, on October 20 , 20 11, Claim ant had an independent m edical exam ination by Robert P. Kropac, M.D., following a work-related injury. (Tr. at 427). She com plained of left wrist pain and interm ittent num bness in her left thum b. (Id.). She related that on J anuary 9, 20 11, she sustained an injury at work in which she fell and fractured her left wrist. (Tr. at 427-28). After seven weeks, she returned to her job as an assistant m anager at KFC in a light duty capacity with a cast on her wrist. (Id.). After her cast was rem oved, she developed num bness and tingling in her left hand. (Tr. at 428). Her neurologist diagnosed her with carpal tunnel syndrom e and perform ed a carpal tunnel release on Septem ber 2, 20 11. (Id.). After two weeks, she returned to work on light duty and continued to the present tim e. (Id.). She was on no m edication. (Id.). Her exam ination revealed deform ity of the left wrist because of the fracture. (Tr. at 429). She had norm al range of m otion in her fingers and thum b, but she had lim ited range of m otion of the left wrist and forearm . She did not com plain of pain in her wrist when the range of m otion was passively extended, and she had no crepitation on ranging of the wrist, although she had som e tenderness to palpation in her left wrist. (Id.). She had norm al m uscle strength in her extrem ities, including in her left hand, wrist, and forearm . (Tr. at 430 ). She did com plain of pain when her left wrist was tested against resistance. (Id.). Her reflexes were norm al and her sensation was grossly intact, including in her left hand. (Id.). Her Phalen and Allen tests were negative, and there was no Tinel’s sign in her left wrist. (Id.). Grip strength was reduced in her left hand with com plaints of wrist pain. (Id.). Her x-ray showed a healed left wrist fracture. (Id.). Dr. Kropac’s diagnosis was a healed left wrist fracture with secondary carpal tunnel syndrom e that was resolved by release surgery. (Tr. at 433). 18 On J uly 22, 20 13, J oseph Richard com pleted a Psychiatric Review Technique (PRT) based upon a review of Claim ant’s records. He assessed that Claim ant had no restriction in activities of daily living; m ild restriction in social functioning and concentration, persistence, or pace; and no episodes of decom pensation of extended duration. (Tr. at 145). He opined that Claim ant should be able to participate in work-like activities in a low stress work environm ent that m ade accom m odations for her physical lim itations. (Tr. at 146). He found Claim ant only partially credible, because her statem ents of pain and functioning seem ed exaggerated in relation to the evidence. (Tr. at 146-47). On August 16, 20 13, consultative exam iner Mustafa Rahim , M.D., exam ined Claim ant in connection with her claim for social security benefits. (Tr. at 489). She was taking Neurontin for nerve damage. (Id.). Claim ant’s grip was 4/ 5 in her left hand and 5/ 5 in her right hand. (Tr. at 490 ). Her reflexes and sensation were intact. (Id.). All of her joints had full range of m otion except that her wrist joints were “a little restricted.” (Id.). The assessm ent was, inter alia, posttraum atic arthritis of the left wrist, carpal tunnel syndrom e status post surgery, neuropathy in the left upper extrem ity per her description, depression, and anxiety. (Id.). Upon a review of Claim ant’s records, Narendra Parikshak, M.D., assessed on October 14, 20 13 that Claim ant had the RFC to perform light work with postural and environm ental lim itations. (Tr. at 147-48). Dr. Parikshak noted that there was clinical evidence of lim itations in Claim ant’s left wrist, but she had no m anipulative lim itations. (Tr. at 148). Dr. Parikshak opined that Claim ant could perform her past relevant work as an assistant m anager as she actually perform ed it. (Tr. at 149). Dr. Parikshak also found Claim ant only partially credible because her statem ents of pain and functioning seem ed 19 exaggerated in relation to the evidence. (Tr. at 146-47). On J anuary 7, 20 14, Caroline William s, M.D., affirm ed Dr. Parikshak’s assessm ent and findings. (Tr. at 20 8-11). Dr. William s noted that Claim ant was not fully credible in that the alleged sym ptom s and subsequent alleged disability were inconsistent with the m edical evidence in the file. (Tr. at 20 8). At the reconsideration level, J am es W. Bartee, Ph.D., found on J anuary 3, 20 14 that Claim ant had m ild restriction in activities of daily living and agreed with the previous assessm ent that she had m ild restriction in social functioning and concentration, persistence, or pace, and no episodes of decom pensation of extended duration. (Tr. at 20 7). He agreed that Claim ant could work in a low stress environm ent that accom m odated her physical lim itations. (Id.). He found that Claim ant’s lim ited m ental allegations seem ed m ostly credible. (Tr. at 20 8). On J anuary 30 , 20 14, Dr. Syed com pleted a Medical Assessm ent of Ability To Do Work-Related Activities (Mental) form . (Tr. at 519-21). On a scale of “unlim ited, good, fair, poor, and none,” he opined that Claim ant had a fair ability to follow work rules; use judgm ent; function independently; understand, rem em ber, and carry out sim ple instructions; m aintain personal appearance; and relate predictably in social situations, but had a poor ability to relate to co-workers; deal with the public; interact with supervisor(s); deal with work stresses; m aintain attention/ concentration; understand, rem em ber, and carry out detailed or com plex job instructions; behave in an em otionally stable m anner; and dem onstrate reliability. (Tr. at 519-20 ). He noted that Claim ant had ongoing sym ptom s of m ajor depression and generalized anxiety that affected her reliability and dependability, had poor concentration that negatively affected her ability to participate in sustained activities, and had ongoing em otional issues. (Tr. at 520 -21). 20 Further, he opined that her psychological conditions associated with her chronic pain severely affected her ability to engage in substantial gainful activity. (Tr. at 521). VII. D is cu s s io n Claim ant asserts that the ALJ im properly analyzed the evidence in this case and failed to afford controlling weight to her treating physicians’ opinions of her functional capacity without proper analysis and support as required by the applicable Social Security regulations and ruling (20 C.F.R. §§ 40 4.1524 and 416.927(d)(2)-(6) and SSR 96-2p). (ECF Nos. 13 at 1-18). Specifically, Claim ant argues that the ALJ im properly rejected (1) the findings of her psychiatrist, Dr. Syed, regarding the functional effects of her depression and anxiety as stated in the Medical Assessm ent of Ability to do Work-Related Activities (Mental) and (2) the opinions of Drs. Levin, Kabbara, and Soulsby relating to her m anipulative im pairm ents. (Id.). When evaluating a claim ant’s application for disability benefits, the ALJ “will always consider the m edical opinions in [the] case record together with the rest of the relevant evidence [he] receives.” 20 C.F.R. §§ 40 4.1527(b), 416.927(b). Medical opinions are defined as “statem ents from physicians and psychologists or other acceptable m edical sources that reflect judgm ents about the nature and severity of [a claim ant’s] im pairm ent(s), including [her] sym ptom s, diagnosis and prognosis, what [she] can still do despite [her] im pairm ent(s), and [her] physical or m ental restrictions.” Id. §§ 40 4.1527(a)(2), 416.927(a)(2). The regulations outline how the opinions of accepted m edical sources will be weighed in determ ining whether a claim ant qualifies for disability benefits. Id. §§ 40 4.1527(c), 416.927(c). In general, the ALJ should give m ore weight to the opinion of an exam ining m edical source than to the opinion of a non-exam ining source, and even greater weight to the opinion of a treating physician, because that 21 physician is usually m ost able to provide a detailed, longitudinal picture of a claim ant’s alleged disability. Id. §§ 40 4.1527(c)(1)-(2), 416.927(c)(1)-(2). A treating physician’s opinion on the nature and severity of an im pairm ent may be afforded controlling weight when the following two conditions are m et: (1) the opinion is well-supported by clinical and laboratory diagnostic techniques and (2) the opinion is not inconsistent with other substantial evidence. Id. When a treating physician’s opinion is not supported by clinical findings, or is inconsistent with other substantial evidence, the ALJ m ay give the physician’s opinion less weight. Mastro v. Apfel, 270 F.3d 171, 178 (4th Cir. 20 0 1). If the ALJ determ ines that a treating physician’s opinion should not be afforded controlling weight, the ALJ m ust analyze and weigh all the m edical opinions of record, taking into account the following factors: (1) length of the treatm ent relationship and frequency of evaluation, (2) nature and extent of the treatm ent relationship, (3) supportability, (4) consistency, (5) specialization, and (6) various other factors. 20 C.F.R. §§ 40 4.1527(c)(2)-(6), 416.927(c)(2)-(6). The ALJ m ust provide “specific reasons for the weight given to the treating source’s m edical opinion, supported by the evidence in the case record.” SSR 96-2p, 1996 WL 374188, at *5 (S.S.A. 1996). “Adjudicators m ust rem em ber that a finding that a treating source m edical opinion is not well-supported by m edically acceptable clinical and laboratory diagnostic techniques or is inconsistent with other substantial evidence in the case record m eans only that the opinion is not entitled to ‘controlling weight,’ not that the opinion should be rejected ... In m any cases, a treating source’s opinion will be entitled to the greatest weight and should be adopted, even if it does not m eet the test for controlling weight.” Id. at *4. On the other hand, when there is persuasive contrary evidence in the record, a treating physician’s opinion m ay be rejected in whole or in part. Coffm an v. Bow en, 829 F.2d 514, 517 (4th Cir. 1987). Generally, the 22 m ore consistent a physician’s opinion is with the record as a whole, the greater the weight an ALJ will assign to it. Id. §§ 40 4.1527(c)(4), 416.927(c)(4). Ultim ately, it is the responsibility of the ALJ , not the court, to evaluate the case, m ake findings of fact, weigh opinions, and resolve conflicts of evidence. Hay s, 90 7 F.2d at 1456. Medical source statem ents on issues reserved to the Com m issioner, however, are treated differently than other m edical source opinions. SSR 96-5p, 1996 WL 374183 (S.S.A. 1996). In both the Regulations and SSR 96-5p, the SSA explains that “som e issues are not m edical issues regarding the nature and severity of an individual's im pairm ent(s) but are adm inistrative findings that are dispositive of a case; i.e., that would direct the determ ination or decision of disability;” including the following: 1. Whether an individual's im pairm ent(s) m eets or is equivalent in severity to the requirem ents of any im pairm ent(s) in the listings; 2. What an individual's RFC is; 3. Whether an individual's RFC prevents him or her from doing past relevant work; 4. How the vocational factors of age, education, and work experience apply; and 5. Whether an individual is “disabled” under the Act. Id. at *2. “The regulations provide that the final responsibility for deciding issues such as these is reserved to the Com m issioner.” Id. As such, a m edical source statem ent on an issue reserved to the Com m issioner is never entitled to controlling weight or special significance, because “giving controlling weight to such opinions would, in effect, confer upon the [m edical] source the authority to m ake the determ ination or decision about whether an individual is under a disability, and thus would be an abdication of the Com m issioner’s statutory responsibility to determ ine when an individual is disabled.” Id. 23 at *2. Still, these opinions m ust always be carefully considered, “m ust never be ignored,” and should be assessed for their supportability and consistency with the record as a whole. Id. at *3. If conflicting m edical opinions are present in the record, the ALJ m ust resolve the conflicts by weighing the m edical source statem ents and providing an appropriate rationale for accepting, discounting, or rejecting the opinions. See Diaz v. Chater, 55 F.3d 30 0 , 30 6 (7th Cir. 1995). A m inim al level of articulation of the ALJ ’s assessm ent of the evidence is “essential for m eaningful appellate review;” otherwise, “‘the reviewing court cannot tell if significant probative evidence was not credited or sim ply ignored.’” Zblew ski v. Schw eiker, 732 F.2d 75, 79 (7th Cir. 1984) (citing Cotter v. Harris, 642 F.2d. 70 0 , 70 5 (3rd Cir. 1981)). Although 20 C.F.R. §§ 40 4.1527(c),416.927(c) provide that in the absence of a controlling opinion by a treating physician, all of the m edical opinions m ust be evaluated and weighed based upon the various factors, the regulations do not explicitly require the ALJ to regurgitate in the written decision every facet of the analysis. Instead, the regulations m andate only that the ALJ give “good reasons” in the decision for the weight ultim ately allocated to m edical source opinions. Id. §§ 40 4.1527(c)(2), 416.927(c)(2). A. M e n t a l Im p a ir m e n t s In this case, Claim ant’s psychiatrist Dr. Syed opined in April 20 13 that Claim ant was “unable to work secondary to her physical and psychiatric condition for about a year.” (Tr. at 666). Dr. Syed also later com pleted a Medical Assessm ent of Ability to do WorkRelated Activities (Mental) form in J anuary 20 14 (“m edical assessm ent form ”). (Tr. at 519-21). On the scale of “unlim ited, good, fair, poor, and none,” Dr. Syed opined that Claim ant had a fair ability to follow work rules; use judgm ent; function independently; 24 understand, rem em ber, and carry out sim ple instructions; m aintain personal appearance; and relate predictably in social situations, but had a poor ability to relate to co-workers; deal with the public; interact with supervisor(s); deal with work stresses; m aintain attention/ concentration; understand, rem em ber, and carry out detailed or com plex job instructions; behave in an em otionally stable m anner; and dem onstrate reliability. (Tr. at 519-20 ). He noted that Claim ant had ongoing sym ptom s of m ajor depression and generalized anxiety that affected her reliability and dependability, had poor concentration that negatively affected her ability to participate in sustained activities, and had ongoing em otional issues. (Tr. at 520 -21). Further, he stated that her psychological conditions associated with her chronic pain severely affected her ability to engage in substantial gainful activity. (Tr. at 521). In the decision, the ALJ discussed Dr. Syed’s above opinions, but ultim ately determ ined to afford them little weight on the basis that they were not consistent with the record as a whole or supported by the relevant evidence. (Tr. at 74). The ALJ further determ ined that Dr. Syed’s progress notes did not support the lim itations described in the m edical assessm ent form , and his opinion about Claim ant’s inability to work pertained to an issue that was reserved to the Com m issioner. (Tr. at 75). Although not directly included in the paragraph discussing Dr. Syed’s opinions, the ALJ cited the specific evidence that inform ed his decision regarding Claim ant’s m ental im pairm ents. The ALJ noted that while Claim ant was diagnosed with m ajor depressive and generalized anxiety disorders, she received only m edication m anagem ent, her sym ptom s appeared adequately controlled, and she did not require any em ergency room visits or inpatient hospitalizations for sym ptom exacerbations. (Tr. at 66). The ALJ also cited that Claim ant reported in August 20 14 that she no longer had m ood swings, and she 25 was able to stay up and stay busy. (Tr. at 66-67). Further, the ALJ pointed out that in Septem ber 20 14, Claim ant denied any decreased interest or pleasure in doing things and did not feel down, depressed, or hopeless. (Tr. at 67). Accordingly, the ALJ found that Claim ant’s m ental im pairm ents did not cause m ore than m inim al work-related lim itations. (Id.). The ALJ acknowledged that Claim ant was treated for anxiety and depression since 20 0 9, but noted that she only saw her psychiatrist six tim es per year for m edication m anagem ent, did not receive counseling until the m onth prior to the decision, and she denied having panic attacks. (Tr. at 70 ). The undersigned finds that ALJ ’s decision articulates sufficient justification for affording little weight to Dr. Syed’s opinions. The ALJ was not required to explicitly discuss his analysis of each factor listed in 20 C.F.R. §§ 40 4.1527(c)(2)-(6), 416.927(c)(2)(6), but rather, he was obligated to provide “good reasons” in the decision for the weight ultim ately allocated to m edical source opinions. Id. §§ 40 4.1527(c)(2), 416.927(c)(2); see, e.g., Hay slett v. Colvin, No. 7:14CV0 0 631, 20 16 WL 12960 80 , at *7 (W.D. Va. Mar. 30 , 20 16) (A “point-by-point analysis” of the treating physician factors is not required; rather, the ALJ m ust provide appropriate reasons for the weight given to the treating physician’s opinions and the court’s role is to defer to those decision unless they are unsupported by substantial evidence); Burch v. Apfel, 9 F. App'x 255, 259 (4th Cir. 20 0 1) (no error where the ALJ ’s “order indicates consideration of all the pertinent factors”); Seneca v. Colvin, No. TMD12– 1183, 20 13 WL 6713182, at *2 (D. Md. Dec. 18, 20 13) (declining to find error where the ALJ ’s reasoning reflected consideration of the factors despite his failure to engage in a “form ulaic recitation”); Foster v. Colvin, No. J KS– 12– 1957, 20 13 WL 34480 36, at *4 (D.Md. J uly 8, 20 13) (“[T]here is no requirem ent to analyze opinions factor-by-factor so long as the ALJ applied the proper legal standard substantively”); and 26 Hooks v. Astrue, No. SKG– 11– 423, 20 12 WL 2873944, at *8 (D. Md. J uly 12, 20 12) (finding that im plicit consideration of the factors sufficed to satisfy Fourth Circuit precedent). Undoubtedly, the ALJ provided well-supported reasons for the weight that he gave to Dr. Syed’s opinions. The ALJ referenced the length and nature of Claim ant’s treatm ent, noting that Claim ant went to Dr. Syed’s office six tim es per year to receive m edication, but only began receiving counseling just prior to the ALJ ’s decision. Further, the ALJ concluded that Dr. Syed’s opinion was unsupported by the evidence of record, including Dr. Syed’s own treatm ent records, and the ALJ ’s decision refers to specific pieces of evidence that supported those findings. The United States Court of Appeals for the Fourth Circuit (“Fourth Circuit”) recently considered a case in which an ALJ afforded little weight to a treating physician’s opinion of the claim ant’s lim itations on the basis that the opinion not supported by the physician’s office notes or the other evidence. Sharp v. Colvin, _ _ F. App’x_ _ , 20 16 WL 6677633 at *4-*5 (4th Cir. 20 16). The Fourth Circuit held that such rationale was a sufficient basis to discredit the treating physician’s opinion, noting that while the ALJ did not cite specific pages in the record that were inconsistent with the treating physician’s opinion, the ALJ ’s explanation relied on and identified a particular category of evidence [the office notes] and the record indeed contained substantial evidence supporting the ALJ ’s conclusion that the treating physician’s opinion did not m erit controlling weight. Id. at *5. The Fourth Circuit emphasized that it is not the province of the court to reweigh evidence; instead, the court m ust defer to the ALJ ’s determ ination when, as in Sharp’s case, conflicting evidence m ight lead reasonable m inds to disagree whether a claim ant is disabled. Id. (citations om itted). 27 Like the ALJ in Sharp, the ALJ in this case “did not sum m arily conclude” that Dr. Syed’s opinions m erited little weight, but undertook an analysis of Claim ant’s treatm ent notes and the other evidence in the record to determ ine whether Dr. Syed’s opinions of Claim ant’s m ental lim itations were substantiated. Also like Sharp, the ALJ ’s conclusion that Dr. Syed’s opinions should not be accorded controlling weight is supported by substantial evidence. Claim ant’s records reflect diagnoses of m ajor depressive disorder and generalized anxiety disorder; however, she was treated conservatively with only m edications, which were generally repeatedly continued on the sam e course and noted to be beneficial. (Tr. at 19, 652, 666, 668, 670 , 675, 689, 692, 693, 724). As the ALJ pointed out, Claim ant did not begin receiving m ental health counseling until at least two years after her alleged onset of disability, although she was treating with Dr. Syed during that tim e. Further, throughout the relevant period, Claim ant’s anxiety and depression were noted m any tim es to be well controlled or nonexistent. (Tr. at 487, 628, 633, 675, 684, 717, 724). In addition, two consulting state agency psychologists reviewed Claim ant’s records and opined that Claim ant was no m ore than m ildly lim ited in activities of daily living; social functioning; and m aintaining concentration, persistence, or pace; and had no episodes of decom pensation of extended duration (the “paragraph B” criteria). (Tr. at 145, 20 7). They agreed that Claim ant could work in a low stress work environm ent that m ade accom m odations for any of her physical lim itations. (Tr. at 146, 20 7). The ALJ assigned these opinions great weight and utilized the opinions and other evidence in thoroughly analyzing Claim ant’s functioning with respect to each of the paragraph B criteria. (Tr. at 67-68). The Court recognizes that the ALJ did not include in Claimant’s RFC a lim itation to a low stress environm ent despite giving great weight to the state psychologists’ 28 opinions. Although the ALJ accorded great weight to the opinions, “he was not required to adopt every single opinion set forth in their reports.” Laing v. Colvin, No. SKG-122891, 20 14 WL 671462, at *10 (D. Md. Feb. 20 , 20 14) (citing Bruette v. Com m 'r Soc. Sec., No. SAG– 12– 1972, 20 13 WL 2181192, at *4 (D.Md. May 17, 20 13) (stating that, where an ALJ has considered the entire record, he is not required to adopt every finding of a doctor to whose opinion he assigned “significant weight”). In light of the state psychologists’’ opinions, com pounded by Dr. Syed’s opinions, the ALJ could have better explained his determ ination to not include a lim itation to a low stress environm ent. Nevertheless, in this case, the discrepancy was at m ost harm less error. See generally Fisher v. Bow en, 869 F.2d 10 55, 10 57 (7th Cir. 1989) (citations om itted) (“No principle of adm inistrative law or com m on sense requires us to rem and a case in quest of a perfect opinion unless there is reason to believe that the rem and m ight lead to a different result.”). The vocational expert testified during the hearing that a hypothetical individual with a RFC even m ore lim ited than what the ALJ assigned to Claim ant could still perform several light level positions even if she was additionally restricted to a low stress environm ent; occasional contact with co-workers, supervisors, and the public; no fast-paced production; sim ple, routine, repetitive tasks with sim ple decision m aking; and few occupational changes in the work setting. (Tr. at 117). In fact, the expert stated that the hypothetical individual could still work in two of the jobs even if she were lim ited to no contact with the public. (Tr. at 118). Overall, the ALJ thoroughly analyzed and weighed all of the available evidence and provided well-grounded reasons for his determ inations. The record supports his conclusions. The evidence indicates that Claim ant som etim es reported depressive sym ptom s, anxiety, and other psychological sym ptom s in relation to conventional 29 situational stressors such as health and fam ily issues, as well as stress over trying to obtain social security benefits. (Tr. at 19, 25, 26, 27, 652, 670 , 675, 689, 692, 693, 723, 724). However, her psychological sym ptom s and conditions were not so severe such as to result in m edication adjustm ents, m ore intensive treatm ent, hospitalizations, or anything else that would dem onstrate that the ALJ ’s analysis of Dr. Syed’s opinion was unsupported by substantial evidence. In fact, not only could reasonable m inds differ regarding the interpretation of the evidence in this case, but the record m ost strongly supports the ALJ ’s findings as opposed to Claim ant’s allegations. Having thoroughly reviewed the evidence and the opinions of Dr. Syed, the Court finds that the ALJ fully com plied with the applicable regulations and rulings in assigning little weight to Dr. Syed’s opinions. B. M a n ip u la t iv e Im p a ir m e n t s Claim ant next argues that the ALJ purportedly disregarded the opinions of her treating physicians Drs. Levin, Kabbara, and Soulsby regarding her lim ited ability to perform fine and gross m anipulation. (ECF No. 13 at 16-17). However, Claim ant does not cite any specific medical records or opinions that the ALJ supposedly rejected, or even a category of evidence to support this assertion. (Id.). In the decision, the ALJ acknowledged Claim ant’s wrist fracture in 20 11 and subsequent carpal tunnel syndrom e; he also noted her shoulder surgery and com plaints of pain, weakness, tingling, difficulty reaching, and reduced grip strength in her nondom inant left hand. (Tr. at 70 , 72). However, the ALJ discussed and cited evidence that Claim ant’s carpal tunnel release surgery in May 20 12 appeared successful, she had only m ild carpal tunnel syndrom e, and was repeatedly docum ented to have norm al strength. (Tr. at 71-73). In addition, the ALJ cited that Claim ant extensively braided her hair daily, which dem onstrated preserved dexterity in both hands. (Tr. at 71). Although Claim ant 30 dem onstrated reduced grip strength of 4/ 5 in her left hand during her consultative exam ination in August 20 13, her grip strength was norm al on exam ination in Septem ber 20 14. (Tr. at 71-72). As far as her treatm ent, Claim ant was only advised to wear wrist splints and take m edication as needed for pain following her carpal tunnel release surgery. (Tr. at 72-73). The Court finds that substantial evidence supports the ALJ ’s above analysis. As noted by the ALJ , following her carpal tunnel release surgery, Claim ant was treated conservatively with pain m edication and neutral position wrist splints at night. Although Claim ant endorsed reduced grip strength at various tim es, her m uscle strength tested norm al throughout and her grip strength was norm al bilaterally in Septem ber 20 14. (Tr. at 685). Her nerve conduction studies as late as October 20 15 showed only m ild carpal tunnel syndrom e that had not worsened over tim e. (Tr. at 46). The state agency physician that reviewed her records opined in October 20 13 that while Claim ant had som e clinical indication of lim itations in her left wrist, she had no m anipulative lim itations. (Tr. at 148). A second state agency physician affirm ed such findings. (Tr. at 20 8-11). Consequently, based upon a review of the evidence, the Court finds that substantial evidence supports the ALJ ’s analysis and findings regarding Claim ant’s alleged m anipulative im pairm ents. VIII. Co n clu s io n After a careful consideration of the evidence of record, the court finds that the Com m issioner’s decision is supported by substantial evidence. Therefore, the court D EN IES Plaintiff’s m otion for judgm ent on the pleadings, GRAN TS Defendant’s request that the Com m issioner’s decision be affirm ed, and D ISMISSES this action from the docket of the Court. A J udgm ent Order shall be entered accordingly. 31 The Clerk of this Court is directed to transm it copies of this Mem orandum Opinion to counsel of record. EN TERED : J anuary 26, 20 17 32
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