Case Name in Social Security Case - Unavailable

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IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
RICK LARRY CORTESE JR, 	: 	Civil No. 4:24-CV-1830
:
Plaintiff, 	:
: 	(Judge Mehalchick)
v. 	:
:
FRANK BISIGNANO,1 : 	(Magistrate Judge Carlson)
Commissioner of Social Security, 	:
:
Defendant. 	:
REPORT AND RECOMMENDATION
I. 	Introduction
This Social Security appeal illustrates the importance of articulation in the
decision of an Administrative Law Judge (ALJ) and how a well-explained rationale
for the denial of disability benefits can cabin a Court’s review of the case. In
determining whether substantial evidence, which is less than a preponderance of the
evidence but more than a mere scintilla, Richardson v. Perales, 402 U.S. 389, 401
(1971), supports the decision of the ALJ, our review often depends upon the
1 Frank Bisignano became the Commissioner of Social Security on May 6, 2025.
Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure, Frank Bisignano
should be substituted as the defendant in this suit. No further action need be taken to
continue this suit by reason of the last sentence of section 205(g) of the Social
Security Act, 42 U.S.C. § 405(g).
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articulation of the ALJ in highlighting which evidence was credited and which was
rejected. Case law has long placed a duty of articulation upon ALJs when deciding
Social Security disability claims. Thus, the ALJ's decision must be accompanied by
“a clear and satisfactory explication of the basis on which it rests.” Cotter v. Harris,
642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the
ALJ must indicate which evidence was accepted, which evidence was rejected, and
the reasons for rejecting certain evidence. Id. at 706-707. In addition, “[t]he ALJ
must indicate in his decision which evidence he has rejected and which he is relying
on as the basis for his finding.” Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429,
433 (3d Cir. 1999).
These principles apply equally to our review of an ALJ’s consideration of the
medical opinion evidence. On this score, under the new paradigm which governs the
analysis of medical source opinions, the Commissioner has eschewed the treating
physician rule, which created a hierarchy of medical source opinions with treating
sources at the apex of this hierarchy, in favor of a more holistic approach which
examines 	all 	medical 	opinions 	in 	terms 	of 	their 	overall 	consistency 	and
supportability. Under this new paradigm, “the ALJ must . . . articulate how [he or
she] considered the medical opinions and how persuasive [he or she] find[s] all of
the medical opinions,” focusing on the consistency and supportability of each
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opinion. Andrew G. v. Comm'r of Soc. Sec., No. 3:19-CV-0942 (ML), 2020 WL
5848776, at *5 (N.D.N.Y. Oct. 1, 2020) (internal citations omitted). But, provided
that the decision is accompanied by an adequate, articulated rationale, it is the
province and the duty of the ALJ to choose which medical opinions and evidence
deserve greater weight.
The instant appeal aptly illustrates the interplay of these paradigms in our
consideration of whether substantial evidence supports the decision of the ALJ
denying the plaintiff’s disability claim. The plaintiff in this case, Rick Cortese, is a
younger individual with a relatively brief work history who suffers from an array of
physical and psychological impairments which clearly affect his ability to perform
work-related activity. Every treating source who opined on Cortese’s residual
functional capacity (RFC) opined that his off-task time and absenteeism would
render him unable to sustain full-time employment. This treating source consensus
gave us pause, since it appeared that every medical source that actually interacted
with Cortese concluded he would be disabled, a fact which triggers a significant
obligation upon ALJs to articulate why an apparent treating source consensus should
not be adopted. See Fallin v. Bisignano, No. 4:24-CV-180, 2025 WL 1749654, at *1
(M.D. Pa. June 24, 2025); Kenyon v. Kijakazi, No. 1:22-CV-1457, 2023 WL
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5617791, at *13 (M.D. Pa. Aug. 30, 2023); Bentler v. Kijakazi, No. 1:21-CV-913,
2022 WL 3362536, at *11 (M.D. Pa. Aug. 15, 2022).
But, in this case, “we are mindful that we must not substitute our own
judgment for that of the fact finder.” Zirnsak v. Colvin, 777 F.3d 607, 611 (3d Cir.
2014) (citing Rutherford, 399 F.3d at 552). Thus, we are enjoined to refrain from
trying to re-weigh the evidence. Here, the ALJ was presented with an equivocal
medical record which showed that Cortese was seeking treatment for his array of
impairments, and experiencing symptoms of shortness of breath, fatigue, and
anxiety, but that his physical and mental status examinations were frequently
unremarkable and the treatment he sought relatively conservative. Moreover, the
three treating source opinions were issued after the relevant period and presented in
check-box form with virtually no supporting explanation, which “constitutes weak
evidence at best.” Mason v. Shalala, 994 F.2d 1058, 1065 (3d Cir. 1993). In fact,
one treating source acknowledged there were no objective findings to support his
conclusions with regard to Cortese’s reports of pain.
Considering these vague treating source opinions that Cortese would be
completely disabled in light of this equivocal clinical record, the ALJ concluded that
these opinions were, at most, partially persuasive and declined to adopt the
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limitations for off-task time and absenteeism. Nonetheless, the ALJ addressed and
thoroughly explained which parts of the treating source opinions she credited and
which she rejected, explaining that these treating source opinions that Cortese would
be off-task more than 15% of the time and absent from work more than two days per
month were simply not supported by or consistent with the record as a whole.
Ultimately, the ALJ concluded there were jobs that existed in significant numbers in
the national economy that Cortese could perform and denied his claim.
Cortese appeals this decision, arguing that the ALJ erred in failing to adopt
the opinions of Cortese’s treating sources that he would be off-task and absent in
excess of permissible employment standards. While we regard his as a close case,
after an independent review of the record, we conclude that, while there is certainly
evidence in the record which supports the ALJ’s conclusion. Therefore, mindful of
the fact that substantial evidence “means only—‘such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion,’” Biestek, 139 S.
Ct. at 1154, we find that substantial evidence supported the ALJ’s findings in this
case. Accordingly, for the reasons set forth below, we recommend the court affirm
the decision of the Commissioner denying this claim.
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II. 	Statement of Facts and of the Case
A. Background
The administrative record of Cortese’s disability application reveals the
following essential facts: On April 24, 2022, Cortese applied for disability and
disability insurance benefits pursuant to Title II of the Social Security Act alleging
an onset of disability beginning September 18, 2021. (Tr. 111).2 According to
Cortese, he was completely disabled due to the combined effects of bipolar II,
depressive disorder, panic disorder, generalized anxiety disorder, HBP, chronic
migraines, Sarcoidosis, agoraphobia, insomnia and acid reflux disease. (Tr. 111).
Cortese was born on September 13, 1993, and was twenty-eight years old on the date
of the alleged onset of his disability, which is defined as a younger person under the
Commissioner’s regulations. (Id.) He has a high school education and previously
worked as an electronics technician. (Tr. 58).
2 This is Cortese’s second Social Security application. His first application was
denied by an ALJ in March 2019. (Tr. 84-109). He intended to apply again with an
alleged onset date immediately following his previous denial, but, since he had
engaged in substantial gainful activity following the denial, his onset date was
amended to September 18, 2021. (See Tr. 48-49).
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B. Cortese’s Statements Regarding His Impairments
At a hearing on November 9, 2023, Cortese testified that he left his
employment at the American Eagle warehouse due to the combined effects of the
physical symptoms of his sarcoidosis, including fatigue and pain, as well as severe
anxiety and panic attacks. (Tr. 51-52). He testified that he would have difficulty
going into his job due to overwhelming anxiety. (Tr. 58-59). He reported that he
called off numerous times due to his anxiety and his psychiatrist would write him
notes. (Tr. 59). As far as unscheduled breaks, he testified that sometimes he would
need to calm himself down in the bathroom for 5-15 minutes on stressful nights at
work. (Tr. 60). He also testified that he did not do well with changes in his work
setting due to his anxiety. (Tr. 61). He stated that in early 2021 he started noticing a
dry 	cough 	and 	thought 	he 	had 	COVID-19. 	(Tr. 	62). 	Eventually 	he 	began
experiencing symptoms a few times per week and was diagnosed with sarcoidosis.
(Id.) During the relevant period he testified to having 10 to 15 migraines per month
and that he would drop things due to his involuntary movements due to tardive
dyskinesia or TDK, which he treated with Klonopin since he was already taking it
for his panic attacks. (Tr. 64-66). He also testified to joint pain from sarcoidosis that
he treated with biologics. (Tr. 66). But he also testified to travelling to Massachusetts
and Virgina for pleasure and helping a relative move. (Tr. 68-70).
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C. The Clinical Record of Cortese’s Impairments and Activities of Daily
Living
Cortese suffers from an array of physical and psychological impairments, but
his testimony highlighted that he was primarily unable to sustain public facing
employment due to crippling social anxiety as well as symptoms from his sarcoidosis
and medications including pain, fatigue, and shortness of breath. The disability
period at issue in this case is confined to the short one-year period between his
alleged onset date of September 18, 2021, to his date last insured, September 30,
2022.
With regard to the threshold issue in this appeal, his ability to meet regular
attendance requirements, the record does indicate that he had anxiety related to going
to work and that “some days he almost can’t make it into work,” and worried about
losing his job if he missed too many days. (Tr. 767). The record also indicates his
anxiety made it difficult to work around other people. Before the relevant period, he
reported to treating PA Dayna Ruhf working a variety of different jobs but stated he
couldn’t handle public-facing jobs because he felt too anxious when under stress or
around others. (Tr. 713, 719). He started working at the American Eagle Warehouse
around October 2020 but reported fears of social anxiety and getting too anxious.
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(Tr. 743). By January 2021 he reported still doing well at the American Eagle
Warehouse and he was asked to be a trainer. (Tr. 755)
But just before his alleged onset date, on July 27, 2021, he reported to his
treating therapist, Dayna Ruhf, that he had not been at work since July 3 rd , stating he
had been too anxious to go to work and that he had a panic attack and had not been
able to go back. (Tr. 785). He stated that he liked his job and did not want to have to
call out but worried about missing too many days. (Tr. 785). He stated that the night
shift was difficult for him, so Ruhf discussed that he return to work on August 13 th
to a day shift position. (Tr. 789). By November, 2021, he reported leaving his
warehouse job at American Eagle stating he felt too anxious being around so many
people in the warehouse. (Tr. 797).
Nonetheless, it appears Cortese was still interested in finding work in a
position that did not require him to interact with the public. In December 2021 he
reported still having days he did not want to leave the house but was considering
working from home and was looking at classes for IT certification. (Tr. 803). He
stated he was actively seeking work. (Id.) His anxiety was described as “variable,”
and he was prescribed Klonopin to take as needed. (Tr. 807). He stated in September
2022 that he felt he was only capable of part-time work due to his anxiety but also
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indicated he was interested in going to school for computer science noting that
“public facing jobs are triggering for him.” (Tr. 858).
Despite his consistent reports that his anxiety made it difficult for him to work
in positions that required interacting with others, a mental status examination during
the relevant period revealed adequate orientation and memory, normal attention
span, good speech, adequate comprehension, and that he was alert and attentive. (Tr.
379). In July 2022 he reported he was doing better emotionally and was stable on
his psychiatric medications. (Tr. 416). Further, although he was advised that he
should not rely on medication only for his anxiety and should seek therapy, (Tr. 795),
his treating PA regularly reported that he was not attending therapy. (Tr. 725, 731,
737, 743, 755, 767).
With regard to his physical impairments, clinical notes from March 2022 state
he had been experiencing a dry cough and shortness of breath for several months as
well as joint pain and swelling of wrists and hands, knees and feet with pain. (Tr.
442). It was noted that he had similar symptoms a few years prior and saw
rheumatology but no diagnosis was established. (Id.) A CT scan revealed extensive
mediastinal bilateral hilar adenopathy and multiple bilateral pulmonary nodules,
small bilateral pleural effusions, and splenomegaly and he was diagnosed with
sarcoidosis in March 2022. (Tr. 433, 436, 443-44, 982). He was started on
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Prednisone in April 2022 and at the time noted he had no significant side effects.
(Tr. 433). Again in May 2022 his treating pulmonologist, Dr. Blumhof, reported that
the steroids had taken away a lot of pain from sarcoidosis, he was having no
breathing issues and minimal side effects including a little trouble sleeping and
“sometimes feels hot,” but no more joint pain or swelling. (Tr. 429). At a follow-up
from a Covid-19 infection in June 2022, primary care notes stated his migraines were
overall controlled, though he was still having at least five or six per month, and he
was doing well on his psychiatric medication. (Tr. 422, 425).
He was diagnosed with diabetes in July 2022, which seemed to be exacerbated
by the prednisone, along with the migraines. (Tr. 416). On July 25, 2022, he saw
neurologist Dr. Shahzad Khan for evaluation of worsening migraines. Cortese
reported trying at least five medications which produced no benefit. (Tr. 402). A
brain MRI revealed no acute abnormalities. (Tr. 376, 410).
At a September 2022 appointment he reported overall doing well but reported
side effects from the prednisone including increased appetite, weight gain, sweats,
and tachycardia. (Tr. 393). He also reported joint pain all over with swelling and
erythema. (Tr. 393). A physical examination was largely unremarkable. (Tr. 396).
At a September follow-up with Dr. Khan, he reported more than fifteen headache
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days in the past month, reporting three to five per week at up to eight to ten out of
ten severity. (Tr. 376).
In October 2022 he discussed coming off steroids with Dr. Blumhof as he had
been prescribed MTX by his rheumatologist. (Tr. 379). He stated he felt better
overall with no new shortness of breath or cough. (Tr. 379). He noted weight gain
on the steroids but did not report any other symptoms. He was instructed to taper off
steroids. (Tr. 373). Dr. Blumhof reported that he had a flare of sarcoidosis in
December 2022, including symptoms of fatigue and shortness of breath, and he was
restarted on prednisone. (Tr. 884-85). In January 2023 he reported still having
fatigue and wheezing but pulmonary testing showed only a mild respiratory
impairment. (Tr. 1003). At a January neurology appointment he reported that his
migraines improved with monthly Aimovig shots. (Tr. 907). He reported that he was
“doing fine” and that he was pleased with his treatments. (Id.) His mental status
examination was “entirely normal”, exhibited full motor strength and normal
reflexes, and normal gait. (Tr. 908).
After the relevant period, a March 2023 rheumatology note summarized that,
since he had been diagnosed with sarcoidosis one year prior, he had tried three
different medications which he was unable to tolerate due to side effects such as
nausea and was unable to successfully taper prednisone and remained at 30 mg daily.
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(Tr. 1010). The note stated that he was still having significant shortness of breath,
cough, and fatigue despite the medications and had been dealing with palpitations
and tachycardia from the prednisone. (Id.) Remicade infusions were recommended.
(Id.)
In addition to his other impairments, in January 2022 he began reporting tics
and involuntary muscle movements and that he had been dropping things a lot. (Tr.
809). In July and September 2022, neurologist Dr. Khan noted a history of
involuntary movement of his lips, extremities, and face but stated he noted no
abnormal involuntary movement on his evaluation. (Tr. 377, 403). He was diagnosed
with tardive dyskinesia or TDK, (Tr. 878), and at a January 2023 neurology
appointment he reported that involuntary abnormal movements were improved with
Klonopin, which he reported was not causing sedation. (Tr. 907).
Thus, with respect to Cortese’s physical impairments during the limited
relevant period, the clinical 	evidence was 	equivocal. The diagnostic records
confirmed the existence of Cortese’s migraines and sarcoidosis and associated
symptoms of fatigue and shortness of breath, but also noted overall normal clinical
findings of normal gait, strength, and sensation and that many of his symptoms
improved with treatment.
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Moreover, Cortese acknowledged he was capable of performing a range of
activities of daily living during the relevant period. As the ALJ summarized:
The claimant testified he lives with his grandfather, to whom he does
provide some care. The claimant testified he has a driver’s license but
does not go many places due to anxiety and panic. The claimant
testified his cousin is his neighbor and he interacts with her and his
mother. The claimant testified he has one friend with whom he spends
time. The claimant testified he watches movies with others in his home
and has gone to the movies on a few occasions with his cousin. The
claimant testified he was able to travel to Salem, Massachusetts for
three or four days with his mother and aunt in July 2023 and visited
tourist attractions and some restaurants, traveled with family to New
Jersey to get patio furniture and went to Virginia with a friend for two
days to a Hawaiian themed party, although he regretted it. In addition,
the claimant reported he watches television, listens to music, plays
games here and there throughout the day and read the news. The
claimant reported he is able to manage his personal care and take
medication without reminders. The claimant reported he prepares
simple meals and performs some household chores, such as laundry and
cleaning. The claimant reported he shops in stores and online and is
able to pay bills, count change and use a savings and checking account.
The claimant reported he has no problems getting along with family,
friends, neighbors or others and interacts in person and with texting.
The claimant reported getting along with authority figures with mostly
no issues. The claimant reported he goes outside the home a few times
a week and occasionally goes out with family or friends and goes to the
grocery store, movies, pharmacy and medical appointments on a
regular basis. The claimant reported he is able to follow spoken
instruction (Exhibit B6E).
(Tr. 21).
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D. The Expert Opinion Evidence
Given this clinical picture, the ALJ considered the medical opinions of four
state agency consultants and three of Cortese’s treating providers regarding the
severity of his impairments. Notably, none of these medical experts issued their
opinions during the relevant period. Cortese’s treating sources all opined on his
condition over one year after his date last insured. The state agency opinions were
issued in late 2022 and early 2023.
With regard to his mental impairments, the state agency psychological
consultants Drs. William Anzalone and Monica Yeater both opined that, while
Cortese had moderate limitations in interacting with others and managing and
adapting, (tr. 114, 128), he was able to meet the basic mental demands of simple
skills and/or tasks on a sustained basis despite the limitations resulting from his
impairments. (Tr. 120, 133). They both 	opined 	that 	Cortese’s 	psychological
impairments would limit him to unskilled work. (Tr. 121, 134). In December 2022,
Dr. Anzalone opined that Cortese would be moderately limited in interacting
appropriately 	with 	the 	general 	public, 	accepting 	instructions 	and 	responding
appropriately to criticism from supervisors, getting along with coworkers and peers,
maintaining socially appropriate behavior and adhering to basic standards of
neatness and cleanliness, and responding appropriately to changes in the work
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setting but explained he was able to maintain socially appropriate behavior and
perform personal care functions needed to maintain an acceptable level of personal
hygiene. (Tr. 120). The opinion of Dr. Yeater on February 6, 2023, reflected the
same limitations of Dr. Anzalone. (Tr. 133).
Conversely, On October 10, 2023, Cortese’s treating PA-C, Dayna Ruhf,
completed a medical source statement about Cortese’s ability to perform work-
related activity which she alleged dated back to 2016. (Tr. 1213). The checkbox form
provided very little by way of explanation, but noted that Cortese’s impairments
would cause him to be absent from work more than three times a month and that he
would be unable to sustain a full time job in a regular work environment due to his
limitations. (Tr. 1213). PA-C Ruhf opined that Cortese had mild to marked
limitations in understanding, remembering, and carrying out instructions, with
marked impairments in making complex work-related decisions, and marked to
extreme limitations in interacting appropriately with supervisors, coworkers, and the
public and responding to changes in the routine work setting. (Tr. 1212-13). She
opined that Cortese would have extreme limitations in interacting appropriately with
the public and responding appropriately to usual work situations and changes in a
routine work setting and marked limitations in interacting appropriately with
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supervisors and coworkers and that he would frequently have lapses in focus,
attention, and concentration. (Tr. 1213).
As to Cortese’s physical impairments, the state agency consultant opinions
were also in stark contrast to those of Cortese’s treating providers. On this score, in
December 2022, state agency medical consultant Dr. Lelwellyn Antone Raymundo
opined that Cortese was capable of light work, (Tr. 121), including occasionally
lifting and/or carrying up to 20 pounds and frequently lifting and/or carrying 10
pounds, and being able to stand and/or walk and sit about six hours in an eight-hour
workday. (Tr. 117). Dr. Raymundo also opined that, due to 	his pulmonary
impairments and migraines, Cortese should avoid concentrated exposure to all
environmental irritants. (Id.) In February 2023, Dr. Esther Marie Kim confirmed the
limitations opined by Dr. Raymundo and also concluded Cortese was capable of
light work with environmental limitations. (Tr. 130-32, 134).
It was against this medical background that Cortese’s case came to be
considered by the ALJ.
E. The ALJ Decision
A disability hearing was conducted in Cortese’s case on November 9, 2023,
at which Cortese and a vocational expert testified. (Tr. 39-83). At the hearing, the
vocational expert testified that an individual who would be off-task more than 30%
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of the workday would be unable to perform his past work and would be essentially
unemployable in the national economy. (Tr. 80). The VE explained that if someone
is off task 10% at the sedentary level they would be an unacceptable employee and
that, “when you get to 30% of the time, which is practically one-third of the workday,
that would be unacceptable in practically any job in the national economy.” (Id.) The
VE also testified that being absent two days per month, in his experience, is a
“vocational issue” that affects the number of jobs available and would not be an
acceptable employee at any jobs identified by the VE. (Tr. 81-82).
Following this hearing, on January 12, 2024, the ALJ issued a decision in
Cortese’s case. (Tr. 7-31). In that decision, the ALJ first concluded that Cortese last
met the insured status requirements of the Act on September 30, 2022, and did not
engage in substantial gainful activity during the period from his alleged onset date
of September 18, 2021, through his date last insured of September 30, 2022. (Tr.
12). At Step 2 of the sequential analysis that governs Social Security cases, the ALJ
found that Cortese had the following severe impairments: obesity, degenerative disc
disease of the cervical and thoracic spine, sarcoidosis, migraines, mild persistent
asthma, 	interstitial 	lung 	disease, 	lung 	nodules, 	respiratory 	failure 	requiring
extracorporeal 	membrane 	oxygenation, 	chronic 	maxillary 	sinusitis, 	diabetes
mellitus, tardive dyskinesia/tremors of the bilateral hands, cardiomyopathy, sinus
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tachycardia, bipolar disorder, anxiety disorder unspecified and depressive disorder.
(Tr. 12-13).
At Step 3, the ALJ determined that Cortese did not have an impairment or
combination of impairments that met or medically equaled the severity of one of the
disability listing impairments. (Id.) At this step, the ALJ also considered whether the
“paragraph B” criteria were satisfied in determining whether the severity of his
mental impairments met the criteria of any listing and concluded Cortese had a mild
limitation in understanding, remembering or applying information, and moderate
limitations in interacting with others, concentrating, persisting or maintaining pace,
and adapting or managing oneself. (Tr. 14-15).
Between Steps 3 and 4, the ALJ then fashioned a residual functional capacity
(“RFC”) for the plaintiff which considered all of Cortese’s impairments as reflected
in the medical record, and found that:
After careful consideration of the entire record, the undersigned finds
that, through the date last insured, the claimant had the residual
functional capacity to perform light work as defined in 20 CFR
404.1567(b) except the claimant is limited to occupations that require
no more than occasional postural maneuvers, such as stooping, or
kneeling, crouching, or crawling and climbing on ramps and stairs but
must avoid occupations that require climbing on ladders, ropes and
scaffolds. The claimant is limited to occupations that require no more
than 	frequent 	balancing. 	The 	claimant 	must 	avoid 	concentrated
prolonged exposure to fumes, odors, dusts, gases, chemical irritants,
environments with poor ventilation, temperature extremes, vibration,
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extreme 	dampness 	and 	humidity 	or 	hazards 	such 	as 	dangerous
machinery 	and 	unprotected 	heights. 	The 	claimant 	is 	limited 	to
occupations that require the claimant to understand, remember and
carry out simple instructions, and make simple work-related decisions.
The claimant is limited to occupations that require the claimant to deal
with occasional changes in a routine work setting. The claimant is
limited to occupations which require no interaction with members of
the general public. After an initial training period to learn the job, the
claimant 	is 	limited 	to 	occupations, 	which 	require no 	more than
occasional interaction with supervisors and coworkers. The claimant
must avoid exposure to occupations that present noise levels above
level 3 (which is moderate). The claimant is limited to occupations that
require no more than frequent fine fingering or gross handling with the
bilateral upper extremities.
(Tr. 16).
In fashioning this RFC, the ALJ considered the medical evidence, the expert
opinions, and Cortese’s self-described limitations. The ALJ first engaged in a two-
step process to evaluate Cortese’s alleged symptoms, finding that, although the
claimant’s medically determinable impairments could reasonably be expected to
cause his alleged symptoms, the plaintiff’s statements concerning the intensity,
persistence, and limiting effects of those symptoms were not entirely consistent with
the medical evidence and other evidence in the record. (Tr. 17).
In making this determination, the ALJ considered Cortese’s statements and
testimony regarding his impairments and limitations, noting:
The claimant is alleging disability due to Bipolar II, depressive
disorder, panic disorder, generalized anxiety disorder, high blood
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pressure, chronic migraines, Sarcoidosis, agoraphobia, insomnia and
acid reflux disease (Exhibit B3E). The claimant alleges these conditions
affect squatting, walking, stair climbing, memory, completing tasks,
concentration and understanding. The claimant alleges there are few
days that he feels okay and has pain in the chest, back, head and whole
body (Exhibits B56E and B6E). At the hearing in this matter, the
claimant testified that he has difficulty breathing, pain through his body
and severe anxiety. The claimant testified he has brain fog from his
medication. The claimant testified he has mood changes from bipolar
disorder, including racing thoughts, short temper, not wanting to talk
and/or manic behavior. The claimant testified he would not handle
changes in the work setting well and feel panic and anxiety. The
claimant testified he started feeling sarcoidosis symptoms in the
beginning of 2021 with persistent cough. The claimant testified to
having migraines on and off for years. The claimant testified tardive
dyskinesia caused him to drop things (Hearing Testimony).
(Tr. 17). The ALJ cast these statements regarding the severity of his symptoms as
inconsistent with the previously summarized longitudinal medical record which
showed normal clinical findings on examination, reduction of symptoms with
medication, conservative treatment, and activities of daily living which would not
support greater limitations than those outlined in the RFC.
Finally, the ALJ considered the medical opinion evidence. The ALJ credited
parts of the opinions of the state agency consultants and found the opinion of treating
PA-C Dayna Ruhf partially persuasive, but concluded that the opinions of treating
sources Drs. Blumbof and Braconaro were not persuasive. (Tr. 22-23).
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The ALJ found the mental assessments of state agency consultants Drs.
Anzalone and Yeater partially persuasive. The ALJ explained that parts of these
opinions were persuasive to the extent they were supported by and consistent with
the longitudinal record, for example, the opinions that Cortese was moderately
limited in interacting with others were based on anxiety and fluctuating mood noted
throughout the treatment records. But the ALJ also found that the record warranted
moderate limitations to Cortese’s concentration which were not included in the
opinions of the mental consultants. (Tr. 22). Moreover, the ALJ concluded that Dr.
Anzalone and Yeater’s opinion that he had moderate limitations in maintaining
socially appropriate behavior and adhering to standards of neatness and cleanliness
were both not supported by the record and vague and ill-defined in vocational terms.
(Id.)
The ALJ also partially credited the opinion of treating PA-C Dayna Ruhf. The
ALJ found Ruhf’s opinion persuasive to the extent it was supported by and
consistent with the evidence such as Cortese’s ability to perform simple work. (Tr.
22). However, the ALJ 	specifically 	explained 	that 	the 	marked 	and 	extreme
limitations or degree of disruption of absenteeism were not supported by objective
findings and relied on self-reported anxiety symptoms and were inconsistent with
clinical 	findings 	from 	the 	treatment 	records 	including 	normal 	mental 	status
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examinations. (Tr. 22-23). The ALJ also rejected these opinions as inconsistent with
the conservative treatment he received for his mental impairments. (Tr. 23).
As to the physical assessments of State agency consultants Dr. Raymundo and
Dr. Kim, the ALJ found them generally persuasive because they were well supported
by clinical and diagnostic findings and were consistent with the level of treatment
which showed management and improvement in symptoms with medication. (Tr.
22). Nonetheless, the ALJ added more restrictive postural limitations, specifically
with regard to the use of his upper extremities, due to his involuntary movements
from tardive dyskinesia. (Id.)
On the other hand, the ALJ did not find the opinions of treating providers Dr.
Blumbof or Dr. Braconaro persuasive. The ALJ explained that these opinions were
not well explained in terms of objective clinical and diagnostic findings. (Tr. 23). As
to the opinion of Dr. Blumbof, the ALJ highlighted that the opinion relied on reports
of pain and other symptomatology and admits there are no objective findings to
support the limitations. (Id.). Moreover, the ALJ concluded the opinion of Dr.
Blumbof was not consistent with objective clinical findings of normal gait,
movement of extremities, and lack of involuntary movement on evaluation or the
recent clinical findings indicating normal cranial nerves, normal mental status, full
motor strength in all extremities, and normal reflexes, sensation, and gait. (Id.)
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Similarly, the ALJ found the opinion of Dr. Braconaro lacked objective
support, noting that it referenced muscle tenderness and weakness without specific
measurements or location, relied on subjective reports of pain and fatigue, and was
not consistent with normal objective examination and clinical findings. (Id.) In
finding these opinions unpersuasive, the ALJ specifically referenced, and rejected,
their opinions that Cortese would be off-task at least 15%, would have significant
variations in his ability to concentrate, would miss two days of work per month, and
that working full time would aggravate his medical conditions. (Id.)
Having made these findings, the ALJ concluded that Cortese could not
perform his past relevant work, but that considering his age, education, work
experience, and RFC, there were jobs that existed in significant numbers in the
national economy that Cortese could perform. (Tr. 24-25). Therefore, the ALJ found
that Cortese had not met the exacting standard for disability prescribed by law and
denied this claim. (Id.)
This appeal followed. (Doc. 1). On appeal, Cortese advances a single
argument that the ALJ erred in failing to adopt the limitations of his treating sources
that he would be off-task and absent in excess of allowable limits. However, finding
that the ALJ adequately analyzed the medical opinion evidence and articulated the
reasoning for finding these opinions unpersuasive, reasoning that was supported by
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substantial evidence, for the reasons set forth below, we recommend the Court affirm
the decision of the Commissioner.
III. 	Discussion
A. 	Substantial Evidence Review – the Role of this Court
When reviewing the Commissioner’s final decision denying a claimant’s
application for benefits, this Court’s review is limited to the question of whether the
findings of the final decision-maker are supported by substantial evidence in the
record. See 42 U.S.C. §405(g); Johnson v. Comm’r of Soc. Sec., 529 F.3d 198, 200
(3d Cir. 2008); Ficca v. Astrue, 901 F. Supp.2d 533, 536 (M.D. Pa. 2012).
Substantial evidence “does not mean a large or considerable amount of evidence, but
rather such relevant evidence as a reasonable mind might accept as adequate to
support a conclusion.” Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial
evidence is less than a preponderance of the evidence but more than a mere scintilla.
Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not
substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a
conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir.
1993). But in an adequately developed factual record, substantial evidence may be
“something less than the weight of the evidence, and the possibility of drawing two
inconsistent conclusions from the evidence does not prevent [the ALJ’s decision]
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from being supported by substantial evidence.” Consolo v. Fed. Maritime Comm’n,
383 U.S. 607, 620 (1966). “In determining if the Commissioner’s decision is
supported by substantial evidence the court must scrutinize the record as a whole.”
Leslie v. Barnhart, 304 F. Supp.2d 623, 627 (M.D. Pa. 2003).
The Supreme Court has recently underscored for us the limited scope of our
review in this field, noting that:
The phrase “substantial evidence” is a “term of art” used throughout
administrative law to describe how courts are to review agency
factfinding. T-Mobile South, LLC v. Roswell, 574 U.S. ––––, ––––,
135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-
evidence standard, a court looks to an existing administrative record
and asks whether it contains “sufficien[t] evidence” to support the
agency’s factual determinations. Consolidated Edison Co. v. NLRB,
305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis
deleted). And whatever the meaning of “substantial” in other contexts,
the threshold for such evidentiary sufficiency is not high. Substantial
evidence, this Court has said, is “more than a mere scintilla.” Ibid.; see,
e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks
omitted). It means—and means only—“such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.”
Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v.
Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999)
(comparing the substantial-evidence standard to the deferential clearly-
erroneous standard).
Biestek, 139 S. Ct. at 1154.
The question before this Court, therefore, is not whether the claimant is
disabled, but rather whether the Commissioner’s finding that he is not disabled is
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supported by substantial evidence and was reached based upon a correct application
of the relevant law. See Arnold v. Colvin, No. 3:12-CV-02417, 2014 WL 940205,
at *1 (M.D. Pa. Mar. 11, 2014) (“[I]t has been held that an ALJ’s errors of law denote
a lack of substantial evidence”) (alterations omitted); Burton v. Schweiker, 512 F.
Supp. 913, 914 (W.D. Pa. 1981) (“The Secretary’s determination as to the status of
a claim requires the correct application of the law to the facts.”); see also Wright v.
Sullivan, 900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal
matters is plenary); Ficca, 901 F. Supp.2d at 536 (“[T]he court has plenary review
of all legal issues . . . .”).
Several fundamental legal propositions which flow from this deferential
standard of review. First, when conducting this review “we are mindful that we must
not substitute our own judgment for that of the fact finder.” Zirnsak v. Colvin, 777
F.3d 607, 611 (3d Cir. 2014) (citing Rutherford v. Barnhart, 399 F.3d 546, 552 (3d
Cir. 2005)). Thus, we are enjoined to refrain from trying to re-weigh the evidence.
Rather our task is to simply determine whether substantial evidence supported the
ALJ’s findings. However, we must also ascertain whether the ALJ’s decision meets
the burden of articulation demanded by the courts to enable informed judicial
review. Simply put, “this Court requires the ALJ to set forth the reasons for his
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decision.” Burnett v. Comm’r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000).
As the Court of Appeals has noted on this score:
In Burnett, we held that an ALJ must clearly set forth the reasons for
his 	decision. 	220 	F.3d 	at 	119. 	Conclusory 	statements 	. 	. 	. 	are
insufficient. The ALJ must provide a “discussion of the evidence” and
an “explanation of reasoning” for his conclusion sufficient to enable
meaningful judicial review. Id. at 120; see Jones v. Barnhart, 364 F.3d
501, 505 & n. 3 (3d Cir.2004). The ALJ, of course, need not employ
particular “magic” words: “Burnett does not require the ALJ to use
particular language or adhere to a particular format in conducting his
analysis.” Jones, 364 F.3d at 505.
Diaz v. Comm’r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009).
Thus, in practice ours is a twofold task. We must evaluate the substance of the
ALJ’s decision under a deferential standard of review, but we must also give that
decision careful scrutiny to ensure that the rationale for the ALJ’s actions is
sufficiently articulated to permit meaningful judicial review.
B. 	Initial Burdens of Proof, Persuasion, and Articulation for the ALJ
To receive benefits under the Social Security Act by reason of disability, a
claimant must demonstrate an inability to “engage in any substantial gainful activity
by reason of any medically determinable physical or mental impairment which can
be expected to result in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months.” 42 U.S.C. §423(d)(1)(A); see also 20
C.F.R. §404.1505(a). To satisfy this requirement, a claimant must have a severe
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physical or mental impairment that makes it impossible to do his or her previous
work or any other substantial gainful activity that exists in the national economy. 42
U.S.C. §423(d)(2)(A); 20 C.F.R. §404.1505(a). To receive benefits under Title II of
the Social Security Act, a claimant must show that he or she contributed to the
insurance program, is under retirement age, and became disabled prior to the date on
which he or she was last insured. 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
In making this determination at the administrative level, the ALJ follows a
five-step sequential evaluation process. 20 C.F.R. §404.1520(a). Under this process,
the ALJ must sequentially determine: (1) whether the claimant is engaged in
substantial gainful activity; (2) whether the claimant has a severe impairment; (3)
whether the claimant’s impairment meets or equals a listed impairment; (4) whether
the claimant is able to do his or her past relevant work; and (5) whether the claimant
is able to do any other work, considering his or her age, education, work experience
and residual functional capacity (“RFC”). 20 C.F.R. §404.1520(a)(4).
Between Steps 3 and 4, the ALJ must also assess a claimant’s residual
functional capacity (RFC). RFC is defined as “that which an individual is still able
to do despite the limitations caused by his or her impairment(s).” Burnett v. Comm’r
of Soc. Sec., 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted); see also 20 C.F.R.
§§404.1520(e), 404.1545(a)(1). In making this assessment, the ALJ considers all of
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the claimant’s medically determinable impairments, including any non-severe
impairments identified by the ALJ at step two of his or her analysis. 20 C.F.R.
§404.1545(a)(2).
There is an undeniable medical aspect to an RFC determination, since that
determination entails an assessment of what work the claimant can do given the
physical limitations that the claimant experiences. Yet, when considering the role
and necessity of medical opinion evidence in making this determination, courts have
followed several different paths. Some courts emphasize the importance of medical
opinion support for an RFC determination and have suggested that “[r]arely can a
decision be made regarding a claimant’s residual functional capacity without an
assessment from a physician regarding the functional abilities of the claimant.”
Biller v. Acting Comm’r of Soc. Sec., 962 F. Supp. 2d 761, 778–79 (W.D. Pa. 2013)
(quoting Gormont v. Astrue, Civ. No. 11–2145, 2013 WL 791455 at *7 (M.D. Pa.
Mar. 4, 2013)). In other instances, it has been held that: “There is no legal
requirement that a physician have made the particular findings that an ALJ adopts
in the course of determining an RFC.” Titterington v. Barnhart, 174 F. App’x 6, 11
(3d Cir. 2006). Further, courts have held in cases where there is no evidence of any
credible medical opinion supporting a claimant’s allegations of disability that “the
proposition that an ALJ must always base his RFC on a medical opinion from a
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physician is misguided.” Cummings v. Colvin, 129 F. Supp. 3d 209, 214–15 (W.D.
Pa. 2015).
These 	seemingly 	discordant 	legal 	propositions 	can 	be 	reconciled 	by
evaluation of the factual context of these decisions. Those cases which emphasize
the importance of medical opinion support for an RFC assessment typically arise in
the factual setting where a well-supported medical source has identified limitations
that would support a disability claim, but an ALJ has rejected the medical opinion
which supported a disability determination based upon a lay assessment of other
evidence. Biller, 962 F.Supp.2d at 778–79. In this setting, these cases simply restate
the commonplace idea that medical opinions are entitled to careful consideration
when making a disability determination, particularly when those opinions support a
finding of disability. In contrast, when an ALJ is relying upon other evidence, such
as contrasting clinical or opinion evidence or testimony regarding the claimant’s
activities of daily living, to fashion an RFC courts have adopted a more pragmatic
view and have sustained the ALJ’s exercise of independent judgment based upon all
of the facts and evidence. See Titterington v. Barnhart, 174 F. App’x 6, 11 (3d Cir.
2006); Cummings v. Colvin, 129 F. Supp. 3d 209, 214–15 (W.D. Pa. 2015). In either
event, once the ALJ has made this determination, our review of the ALJ’s assessment
of the plaintiff’s RFC is deferential, and that RFC assessment will not be set aside if
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it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d
Cir. 2002); see also Metzger v. Berryhill, No. 3:16-CV-1929, 2017 WL 1483328, at
*5 (M.D. Pa. Mar. 29, 2017), report and recommendation adopted sub nom. Metzgar
v. Colvin, No. 3:16-CV-1929, 2017 WL 1479426 (M.D. Pa. Apr. 21, 2017); Rathbun
v. Berryhill, No. 3:17-CV-00301, 2018 WL 1514383, at *6 (M.D. Pa. Mar. 12,
2018), report and recommendation adopted, No. 3:17-CV-301, 2018 WL 1479366
(M.D. Pa. Mar. 27, 2018).
At Steps 1 through 4, the claimant bears the initial burden of demonstrating
the existence of a medically determinable impairment that prevents him or her in
engaging in any of his or her past relevant work. Mason, 994 F.2d at 1064. Once this
burden has been met by the claimant, it shifts to the Commissioner at Step 5 to show
that jobs exist in significant number in the national economy that the claimant could
perform that are consistent with the claimant’s age, education, work experience and
RFC. 20 C.F.R. §404.1512(f); Mason, 994 F.2d at 1064.
The ALJ’s disability determination must also meet certain basic substantive
requisites. Most significant among these legal benchmarks is a requirement that the
ALJ adequately explain the legal and factual basis for this disability determination.
Thus, in order to facilitate review of the decision under the substantial evidence
standard, the ALJ’s decision must be accompanied by “a clear and satisfactory
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explication of the basis on which it rests.” Cotter v. Harris, 642 F.2d 700, 704 (3d
Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate
which evidence was accepted, which evidence was rejected, and the reasons for
rejecting certain evidence. Id. at 706-07. In addition, “[t]he ALJ must indicate in his
decision which evidence he has rejected and which he is relying on as the basis for
his finding.” Schaudeck v. Comm’r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999).
C. 	Legal Benchmarks for the ALJ’s Assessment of Medical Opinions
The plaintiff filed this disability application after a paradigm shift in the
manner in which medical opinions were evaluated when assessing Social Security
claims. Prior to March 2017, ALJs were required to follow regulations which defined
medical opinions narrowly and created a hierarchy of medical source opinions with
treating sources at the apex of this hierarchy. However, in March of 2017, the
Commissioner’s regulations governing medical opinions changed in a number of
fundamental ways. The range of opinions that ALJs were enjoined to consider were
broadened substantially, and the approach to evaluating opinions was changed from
a hierarchical form of review to a more holistic analysis. As one court as aptly
observed:
The regulations regarding the evaluation of medical evidence have been
amended for claims filed after March 27, 2017, and several of the prior
Social Security Rulings, including SSR 96-2p, have been rescinded.
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According to the new regulations, the Commissioner “will no longer
give any specific evidentiary weight to medical opinions; this includes
giving controlling weight to any medical opinion.” Revisions to Rules
Regarding the Evaluation of Medical Evidence (“Revisions to Rules”),
2017 WL 168819, 82 Fed. Reg. 5844, at 5867–68 (Jan. 18, 2017), see
20 C.F.R. §§ 404.1520c(a), 416.920c(a). Instead, the Commissioner
must consider all medical opinions and “evaluate their persuasiveness”
based 	on 	the 	following 	five 	factors: 	supportability; 	consistency;
relationship with the claimant; specialization; and “other factors.” 20
C.F.R. §§ 404.1520c(a)-(c), 416.920c(a)-(c).
Although the new regulations eliminate the perceived hierarchy of
medical sources, deference to specific medical opinions, and assigning
“weight” to a medical opinion, the ALJ must still “articulate how [he
or she] considered the medical opinions” and “how persuasive [he or
she] find[s] all of the medical opinions.” Id. at §§ 404.1520c(a) and
(b)(1), 416.920c(a) and (b)(1). The two “most important factors for
determining the persuasiveness of medical opinions are consistency and
supportability,” 	which 	are 	the 	“same 	factors” 	that 	formed 	the
foundation of the treating source rule. Revisions to Rules, 82 Fed. Reg.
5844-01 at 5853.
An ALJ is specifically required to “explain how [he or she] considered
the supportability and consistency factors” for a medical opinion. 20
C.F.R. 	§§ 	404.1520c 	(b)(2), 	416.920c(b)(2). 	With 	respect 	to
“supportability,” the new regulations provide that “[t]he more relevant
the objective medical evidence and supporting explanations presented
by a medical source are to support his or her medical opinion(s) or prior
administrative medical finding(s), the more persuasive the medical
opinions or prior administrative medical finding(s) will be.” Id. at §§
404.1520c(c)(1), 416.920c(c)(1). The regulations provide that with
respect to “consistency,” “[t]he more consistent a medical opinion(s) or
prior administrative medical finding(s) is with the evidence from other
medical sources and nonmedical sources in the claim, the more
persuasive the medical opinion(s) or prior administrative medical
finding(s) will be.” Id. at §§ 404.1520c(c)(2), 416.920c(c)(2).
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Under the new regulations an ALJ must consider, but need not
explicitly discuss, the three remaining factors in determining the
persuasiveness of a medical source's opinion. Id. at §§ 404.1520c(b)(2),
416.920c(b)(2). However, where the ALJ has found two or more
medical opinions to be equally well supported and consistent with the
record, but not exactly the same, the ALJ must articulate how he or she
considered those factors contained in paragraphs (c)(3) through (c)(5).
Id. at §§ 404.1520c(b)(3), 416.920c(b)(3).
Andrew G. v. Comm'r of Soc. Sec., No. 3:19-CV-0942 (ML), 2020 WL 5848776, at
*5 (N.D.N.Y. Oct. 1, 2020).
Oftentimes, as in this case, an ALJ must evaluate various medical opinions.
Judicial review of this aspect of ALJ decision-making is still guided by several
settled legal tenets. First, when presented with a disputed factual record, it is well-
established that “[t]he ALJ – not treating or examining physicians or State agency
consultants – must make the ultimate disability and RFC determinations.” Chandler
v. Comm’r of Soc. Sec., 667 F.3d 356, 361 (3d Cir. 2011). Thus, when evaluating
medical opinions “the ALJ may choose whom to credit but ‘cannot reject evidence
for no reason or for the wrong reason.’” Morales v. Apfel, 225 F.3d 310, 317 (3d
Cir. 2000) (quoting Mason, 994 F.2d at 1066). Therefore, provided that the decision
is accompanied by an adequate, articulated rationale, it is the province and the duty
of the ALJ to choose which medical opinions and evidence deserve greater weight.
Further, in making this assessment of medical evidence:
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An ALJ is [also] entitled generally to credit parts of an opinion without
crediting the entire opinion. See Thackara v. Colvin, No. 1:14–CV–
00158–GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015);
Turner v. Colvin, 964 F. Supp. 2d 21, 29 (D.D.C. 2013) (agreeing that
“SSR 96–2p does not prohibit the ALJ from crediting some parts of a
treating source's opinion and rejecting other portions”); Connors v.
Astrue, No. 10–CV–197–PB, 2011 WL 2359055, at *9 (D.N.H. June
10, 2011). It follows that an ALJ can give partial credit to all medical
opinions and can formulate an RFC based on different parts from the
different medical opinions. See e.g., Thackara v. Colvin, No. 1:14–CV–
00158–GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015).
Durden v. Colvin, 191 F.Supp.3d 429, 455 (M.D. Pa. 2016). Finally, where there is
no evidence of any credible medical opinion supporting a claimant’s allegations of
disability “the proposition that an ALJ must always base his RFC on a medical
opinion from a physician is misguided.” Cummings, 129 F.Supp.3d at 214–15.
F. The ALJ’s Decision is Supported by Substantial Evidence.
In this setting, we are mindful that we are not free to substitute our
independent assessment of the evidence for the ALJ’s determinations. Rather, we
must simply ascertain whether the ALJ’s decision is supported by substantial
evidence, a quantum of proof which is less than a preponderance of the evidence but
more than a mere scintilla, Richardson, 402 U.S. at 401, and “does not mean a large
or considerable amount of evidence, but rather such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.” Pierce, 487 U.S.
at 565. Judged against these deferential standards of review, we find that substantial
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evidence supported the decision by the ALJ that Cortese retained the residual
functional capacity to perform light work with the detailed postural, environmental
and mental limitations outlined in the RFC. Therefore, we will affirm this decision.
On appeal, Cortese argues that the ALJ did not adequately assess the treating
source opinions of PA-C Ruhf, Dr. Blumhof, and Dr. Braconaro. Specifically, the
plaintiff argues that the ALJ failed to explain why the opinions were not supportable
and consistent and why the limitations with respect to off-task time and absenteeism
were not accounted for in the RFC. The plaintiff argues that it was error for the ALJ
to credit the testimony of a non-examining physician which conflicts with the
opinion of an examining physician.
As we foreshadowed, an ALJ’s rejection of a treating source consensus should
be carefully reviewed since, while the Commissioner has eschewed any hierarchical
approach to the consideration of medical source opinions in favor of a more holistic
approach which examines all medical opinions in terms of their overall consistency
and supportability, a medical source’s relationship with the claimant is still one
factor the ALJ must consider in assigning persuasive power to the medical opinions.
20 C.F.R. §§ 404.1520c(a)-(c), 416.920c(a)-(c). And common-sense dictates that
those providers that have an existing relationship with a claimant, and have
examined him, would be well-equipped to opine on the claimant’s functional
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abilities. Thus, in the past, we have remanded cases where an ALJ’s rejection of a
treating source consensus was not supported by substantial evidence, or failed to
articulate the rationale for rejecting these opinions. Fallin v. Bisignano, 2025 WL
1749654, at *1; Kenyon v. Kijakazi, 2023 WL 5617791, at *13; Bentler v. Kijakazi,
2022 WL 3362536, at *11.
Nonetheless, as this case illustrates, the scope of the Court’s review is limited
to determining whether the ALJ’s evaluation of the medical opinion evidence
included an adequate explanation, supported by substantial evidence. Indeed, we are
enjoined to refrain from trying to re-weigh the persuasiveness of the medical
opinions. Rather, our review focuses on whether the ALJ adequately articulated the
reasons for finding these opinions unpersuasive.
On this score, we acknowledge that, as the plaintiff points out, “[a]n ALJ is
specifically required to ‘explain how [he or she] considered the supportability and
consistency factors’ for a medical opinion.” Andrew G. v. Comm'r of Soc. Sec. at
*5 (citing 20 C.F.R. §§ 404.1520c (b)(2), 416.920c(b)(2)). But ultimately, provided
that the decision is accompanied by an adequate, articulated rationale, examining
these factors, it is the province and the duty of the ALJ to choose which medical
opinions and evidence deserve greater weight.
Judged against these standards, we conclude that the ALJ’s analysis of the
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medical opinion evidence in this case was supported by substantial evidence. At the
outset, we note that each of the three treating source statements, issued one year after
the date last insured, was set forth in an unpersuasive, and largely unexplained,
manner using a check box form. It is beyond dispute that such “[f]orm reports in
which a physician's obligation is only to check a box or fill in a blank are weak
evidence at best.” Mason v. Shalala, 994 F.2d 1058, 1065 (3d Cir. 1993).
Moreover, the ALJ’s evaluation of these opinions was adequately articulated.
As to the opinion of PA-C Ruhf, who had the longest and most comprehensive
treating relationship with Cortese, the ALJ found her opinion to be partially
persuasive to the extent it indicated Cortese was capable of simple work. However,
the ALJ specifically explained that that the marked and extreme limitations or degree
of disruption of absenteeism were not supported by objective findings and relied on
self-reported anxiety symptoms and were inconsistent with clinical findings from
the treatment records including normal mental status examinations. (Tr. 22-23). The
ALJ also rejected these opinions as inconsistent with the conservative treatment he
received for his mental impairments. (Tr. 23).
Indeed, with regard to the objective clinical evidence during the relevant
period, Cortese’s mental status examination results during the relevant period were
unremarkable and, at one point, characterized as “entirely normal.” (Tr. 379, 908).
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Moreover, as the ALJ pointed out, the plaintiff’s activities of daily living, including
his ability to travel and interact with friends, and statements that he had reported he
no problems getting along with family, friends, neighbors or others, suggest his
social anxiety was not entirely disabling. Further, the record supports the ALJ’s view
that the conservative treatment sought by Cortese for his mental impairments does
not support the disabling limitations opined by Ruhf, since he was being treated for
his anxiety and bipolar by PA-C Dayna Ruhf but frequently reported that he was not
in therapy. (Tr. 725, 731, 737, 743, 755, 767). And, by October 2022, he reported
that he was “doing fine” and that he was pleased with his treatments. (Tr. 907).
Contrary to the arguments of the plaintiff, the ALJ properly considered this
conservative treatment in finding her opinion that he would be totally disabled
partially persuasive. See e.g. Flim v. O'Malley, No. 1:22-CV-1619, 2024 WL
3361646, at *17 (M.D. Pa. July 10, 2024) (affirming an ALJ’s rejection of a treating
source opinion where the record demonstrated the plaintiff’s mental health treatment
of conservative). Finally, two state agency consultants opined that Cortese’s
psychological impairments would limit him to unskilled work, but that he was able
to maintain socially appropriate behavior necessary for employment. (Tr. 120).
Nonetheless, in finding Ruhf’s opinion partially persuasive, the ALJ accommodated
Cortese’s documented struggles with social anxiety and statements that that “public
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facing jobs are triggering for him,” (Tr. 858), by limiting him to occupations which
require no interaction with members of the general public and no more than
occasional interaction with supervisors and coworkers.
As to the opinions of Dr. Blumbof and Dr. Braconaro, the ALJ explained that
these opinions were not well explained in terms of objective clinical and diagnostic
findings. Indeed, while there was objective evidence of the limiting effects of
Cortese’s mental impairments with regard to his ability to perform work-related
activity, specifically that his anxiety made it difficulty for him to interact with others
at his job, the clinical record of his physical impairments, while severe, simply does
not reflect the degree of disabling limitations opined by these providers.
As to the opinion of Dr. Blumbof, he reported that Cortese suffered from poor
coordination, weakness, unstable walking, dizziness, headaches, pain, and fatigue,
which would be aggravated by working at any job on a full-time basis. (Tr. 1403-
04). Yet, despite Dr. Blumbof’s opinion that Cortese would be unable to sustain full-
time employment, there is no additional explanation or support on the form which
would explain this opinion. In fact, Dr. Blumbof 	noted Cortese’s prognosis was
“good,” and reported that there were no objective findings to support Cortese’s pain.
(Tr. 1402-03). In addition to highlighting the internal inconsistency of this opinion
which acknowledged no objective findings supported Cortese’s pain, the ALJ
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concluded the opinion of Dr. Blumbof was not consistent with objective clinical
findings of normal gait, movement of extremities, and lack of involuntary movement
on evaluation or the recent clinical findings indicating normal cranial nerves, normal
mental status, full motor strength in all extremities, and normal reflexes, sensation,
and gait. (Id.) The ALJ similarly rejected the opinion of Dr. Braconaro which she
stated lacked objective support and was not consistent with normal objective
examination and clinical findings. (Id.) The ALJ specifically referenced, and
rejected, their opinions that Cortese would be off-task at least 15%, would have
significant variations in his ability to concentrate, would miss two days of work per
month, and that working full time would aggravate his medical conditions. (Id.)
In our view, not only does the ALJ’s articulation of the reasoning behind
finding these opinions unpersuasive comply with applicable standards, a review of
the record reveals that substantial evidence supports the ALJ’s decision. Indeed,
while the diagnostic records confirmed the existence of Cortese’s migraines and
sarcoidosis and associated symptoms of fatigue and shortness of breath, they also
note overall normal clinical findings of normal gait, strength, and sensation and that
many of his symptoms improved with treatment. Moreover, to the extent the plaintiff
argues he suffered disabling side effects from his medications, the record reflects
that, he noted no significant side effects from prednisone when he started in April
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2022, (tr. 433), in May 2022 he reported “minimal” side effects including a little
trouble sleeping and “sometimes feels hot,” (Tr. 429), and in October 2022 he noted
weight gain on steroids but did not report any other symptoms. (Tr. 379). These
statements do not suggest he would be limited to the extent the plaintiff argues.
Further, while Cortese did testify to experiencing shortness of breath and flu-
like symptoms prior to being diagnosed with sarcoidosis, his testimony reflected that
it was primarily his social anxiety that caused his limitations in the workplace. His
testimony also revealed he was mostly independent physically, noting he was able
to mow his lawn and care for his grandfather during the relevant period.
Moreover, the ALJ’s RFC was not entirely divorced from any medical
opinion, but rather, “credit[ed] parts of [the] opinion[s] . . .[and] formulate[d] an
RFC based on different parts from the different medical opinions.” Durden v.
Colvin, 191 F.Supp.3d at 455. On this score, the ALJ found that the state agency
consultant opinions were persuasive to the extent they suggested Cortese was
capable of light work, but included additional limitations based on his postural and
limitations. Thus, the ALJ fashioned an RFC which adequately considered each of
Cortese’s objectively supported limitations, explaining:
[T]he undersigned considered the combined effects of the severe
impairments, particularly any reduced breathing from sarcoidosis, by
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reducing the claimant to the light exertional level and providing
postural limitations as stated above. However, as referenced above the
generally normal clinical findings on examination, including for gait,
sensation and strength, would not support further limitations. The
undersigned also provided environmental limitations to prevent the
exacerbation of symptoms, including limitations to pulmonary irritants
and noise in consideration of sarcoidosis and migraines, as well as to
prevent potential injury in the workplace. In addition, the undersigned
considered the symptoms of tardive dyskinesia by placing specific
limitation to use the bilateral hands/upper extremities. However, the
records show reduction of symptoms with medication that would not
support even greater limitations. In terms of mental limitations, the
undersigned considered a mild limitation in understand, remember or
apply information combined with a moderate level of limitation in the
concentrate, persist or maintain pace by reducing the claimant to simple
instructions 	and 	decision-making. 	The 	undersigned 	considered 	a
moderate limitation in interacting with others by reducing the claimant
to occasional interaction with people he works with such as coworkers
and supervisors but restricting tandem tasks, and no interaction with the
public in consideration of his panic and anxiety around others. The
undersigned considered a moderate limitation to adapt or mange
oneself by reducing the amount of change in a routine work setting.
However, the clinical findings and conservative level of treatment,
along with the activity level reported and discussed in the above
records, does not support greater limitations. As such, the residual
functional capacity is consistent with and supported by the objective
medical records and the level of impairment alleged by the claimant is
not fully supported by medical evidence.
(Tr. 20).
In sum, this is a close case which cast a treating source consensus, albeit
treating source opinions created after the relevant period and in a weak, check-box
format, against a limited disability period and equivocal medical evidence which
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contained significant clinical evidence suggesting that Cortese retained the ability to
do some work. But the RFC fashioned by the ALJ, as explained in detail above,
adequately accounts for the limitations credibly supported by the objective evidence
and is supported 	by substantial evidence. This is all that the law requires, and all
that a claimant can demand in a disability proceeding. Thus, notwithstanding the
argument that this evidence might have been viewed in a way which would have
also supported a different finding, we are obliged to affirm this ruling once we find
that it is “supported by substantial evidence, ‘even [where] this court acting de novo
might have reached a different conclusion.’” Monsour Med. Ctr. v. Heckler, 806
F.2d 1185, 1190–91 (3d Cir. 1986) (quoting Hunter Douglas, Inc. v. NLRB, 804
F.2d 808, 812 (3d Cir. 1986)). Accordingly, under the deferential standard of review
that applies to appeals of Social Security disability determinations, we recommend
the Court conclude that substantial evidence supported the ALJ’s evaluation of this
case and affirm the decision of the Commissioner.
IV. 	Recommendation
For the foregoing reasons, IT IS RECOMMENDED that the decision of the
Commissioner in this case should be affirmed, and the plaintiff’s appeal denied.
The parties are further placed on notice that pursuant to Local Rule 72.3:
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Any party may object to a magistrate judge's proposed findings,
recommendations or report addressing a motion or matter described in
28 U.S.C. § 636 (b)(1)(B) or making a recommendation for the
disposition of a prisoner case or a habeas corpus petition within
fourteen (14) days after being served with a copy thereof. Such party
shall file with the clerk of court, and serve on the magistrate judge and
all parties, written objections which shall specifically identify the
portions of the proposed findings, recommendations or report to which
objection is made and the basis for such objections. The briefing
requirements set forth in Local Rule 72.2 shall apply. A judge shall
make a de novo determination of those portions of the report or
specified proposed findings or recommendations to which objection is
made and may accept, reject, or modify, in whole or in part, the findings
or 	recommendations 	made 	by 	the 	magistrate 	judge. 	The 	judge,
however, need conduct a new hearing only in his or her discretion or
where required by law, and may consider the record developed before
the magistrate judge, making his or her own determination on the basis
of that record. The judge may also receive further evidence, recall
witnesses, 	or 	recommit 	the 	matter 	to 	the 	magistrate 	judge 	with
instructions.
Submitted this 27 th day of January 2026.
S/ Martin C. Carlson
Martin C. Carlson
United States Magistrate Judge
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