Case Name in Social Security Case - Unavailable

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
ALEXANDRA RUGGIERO, 	: Civ. No. 1:25-CV-604
:
Plaintiff, 	:
: (Chief Judge Brann)
v. 	:
: (Chief Magistrate Judge Bloom)
FRANK BISIGNANO, 	:
Commissioner of Social Security,1 	:
:
Defendant. 	:
REPORT AND RECOMMENDATION
I. 	Introduction
Alexandra Ruggiero filed a Title XVI application for supplementary
security income on April 25, 2022.2 	Following an initial hearing before
an Administrative Law Judge (“ALJ”), the ALJ found that Ruggiero was
not disabled from her alleged onset date of disability of January 1, 2021,
through May 14, 2024, the date of the ALJ’s decision. 3
1 On May 7, 2025, Frank Bisignano became the Commissioner of Social
Security. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure
and 42 U.S.C. § 405(g), Frank Bisignano is substituted as the defendant
in this suit.
2 Tr. 18.
3 Tr. 18, 35.
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Ruggiero now appeals this decision, arguing that the ALJ’s decision
is not supported by substantial evidence. 	After a review of the record,
and mindful of the fact that substantial evidence “means only—‘such
relevant evidence as a reasonable mind might accept as adequate to
support a conclusion,’”4 we conclude that substantial evidence supported
the ALJ’s findings in this case. 	Therefore, we will affirm the decision of
the Commissioner denying this claim.
II. 	Statement of Facts and of the Case
On April 25, 2022, Ruggiero applied for supplemental security
insurance benefits, citing an array of physical and mental impairments,
including 	anxiety 	with 	panic 	attacks, 	depression, 	high 	cholesterol,
obesity, 	obsessive 	compulsive 	disorder, 	pre-diabetes, 	and 	a 	thyroid
condition. 5 	Ruggiero was 51 years old at the time of the alleged onset of
disability, had at least a high school education, and had no relevant past
employment. 6
4
Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019).
5 Tr. 217.
6 Tr. 34.
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With respect to these alleged impairments the record revealed the
following: The earliest relevant records are from Ruggiero’s visit to the
Wright Center for Community Health in April of 2019.7 	There, she
explained to Dr. Enrique Samonte her impairments of general anxiety
and 	claustrophobia, 	and 	that 	she 	took 	levothyroxine 	for
hyperthyroidism. 8
In December of 2021, Ruggiero reported increased panic attacks to
Dr. Kristi Simonetti, who noted these attacks were likely caused by
recent family hardships. 9 	In March of 2022, Dr. Gary Oh prescribed
Buspirone to combat Ruggiero’s worsening anxiety. 10 At a May 2022 visit
with Dr. Mohana Partheeban, the door to the examination room was left
open due to Ruggiero’s anxiety and claustrophobia. 11
In 	December 	of 	2022, 	Ruggiero 	received 	a 	mental 	status
examination 	from 	Ms. 	Gina 	Lombardi, 	M.A., 	at 	IMA 	professional
7 Tr. 780-83.
8 Tr. 780.
9 Tr. 320-22.
10 Tr. 317.
11 Tr. 311.
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Services of PA. 12 Ruggiero reported sad moods, crying spells, loss of usual
interest, 	irritability, 	agitation, 	fatigue, 	concentration 	problems, 	and
social withdrawal.13 	Lombardi also noted anxiety, evinced by worry,
fatigue, 	irritability, 	difficulty 	concentrating, 	and 	avoidance 	of 	social
settings. 14 	She noted Ruggiero was having trouble both falling and
staying asleep, suffered panic attacks, only felt safe when at home, and
was having anxiety about changes in her body. 15 	Ruggiero showed signs
of memory impairment: she was unable to remember three objects after
a delay, which Lombardi attributed to anxiety. 16 	Lombardi diagnosed
major 	depressive 	disorder, 	recurrent 	and 	moderate, 	as 	well 	as
generalized anxiety with panic attack. 17
Lombardi also filled out a form entitled “medical source statement
of 	ability 	to 	do 	work-related 	activities 	(mental)” 	as 	part 	of 	her
12 Tr. 361.
13 Tr. 362.
14 Tr. 362.
15
Id.
16 Tr. 364.
17
Id.
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assessment. 18 	There, Lombardi indicated that Ruggiero had extreme
restrictions to carrying out complex instructions and in her ability to
make judgments on complex work-related decisions.19 	Lombardi also
found marked limitations to Ruggiero’s abilities to understand and
remember 	complex 	instructions 	and 	to 	interact 	appropriately 	with
supervisors and co-workers, and extreme limitations on her abilities to
respond appropriately to typical work situations and to respond to
changes in a routine work setting.20
Ruggiero reported worsening depression to Dr. Brian Grady in
February of 2023.21 	Her symptoms included decreased energy, feeling
down, increased anxiety from financial problems, and multiple panic
attacks per week. 22 	Dr. Grady noted concern with Ruggiero’s elevated
lipid panel, blood pressure, and A1C readings. 23
18 Tr. 366.
19
Id.
20 Tr. 366-67.
21 Tr. 399-402.
22 Tr. 399.
23 Tr. 400.
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In June of 2023, Ruggiero reported to Dr. Partheeban that she was
continuing to suffer from anxiety, as well as insomnia, and that her
anxiety sometimes made her unable to drive.24 	At a follow-up in July of
2023, Ruggiero continued to report insomnia, and Dr. Warren Lam noted
that Xanax and melatonin had helped with, but failed to cure, Ruggiero’s
insomnia. 25 	In August of 2023, Ruggiero reported her anxiety was
leading to binge eating. 26
It is against this factual backdrop that the ALJ conducted a hearing
in Ruggiero’s case on March 6, 2024. 27 	Ruggiero and a vocational expert
(“VE”) both testified at this hearing. 	Ruggiero waived her right to a
representative at the hearing, and then testified about,
inter alia, her
treatments, her difficulties sitting and standing for long periods, her
panic attacks while driving, the recent death of her service dog, and her
activities 	of 	daily 	living. 28 	The 	VE 	in 	his 	testimony 	answered
24 Tr. 613.
25 Tr. 607.
26 Tr. 602.
27 Tr. 41.
28 Tr. 43-63.
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hypothetical questions about an individual with Ruggiero’s background
and specific types of limitations.29
Following this hearing, on May 14, 2024, the ALJ issued a decision
denying Ruggiero’s application for benefits. 30 	In that decision, the ALJ
first concluded that Ruggiero had not engaged in substantial gainful
activity since April 25, 2022. 31 	At Step 2 of the sequential analysis that
governs Social Security cases, the ALJ found Ruggiero suffered from the
following severe impairments: major depressive disorder and generalized
anxiety disorder with panic attack. 32 At Step 3 the ALJ determined that
Ruggiero did not have an impairment or combination of impairments that
met or medically equaled the severity of one of the listed impairments. 33
Between Steps 3 and 4 the ALJ concluded that Ruggiero retained
the following residual functional capacity to:
[P]erform a full range of work at all exertional levels but with
the following nonexertional limitations: she would be limited
29 Tr. 64-70.
30 Tr. 18-35.
31 Tr. 20.
32
Id.
33 Tr. 21.
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to 	occupations 	that 	require 	the 	claimant 	to 	understand,
remember and carry out simple instructions, and make simple
work-related decisions; she would be limited to occupations
that require the claimant to deal with occasional changes in a
routine work setting: she would be limited to occupations
which 	require 	no 	more 	than 	occasional 	interaction 	with
members 	of 	the 	general 	public; 	further, 	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. 34
In reaching this RFC determination, the ALJ made the following
findings: the ALJ considered Ruggiero’s reported, subjective symptoms,
and found that “claimant’s medically determinable impairments could
reasonably be expected to cause the alleged symptoms; however, the
claimant’s statements concerning the intensity, persistence and limiting
effects of these symptoms are not entirely consistent with the medical
evidence and other evidence in the record [.]”35 	The ALJ also found that
Ruggiero’s “statements about the intensity, persistence, and limiting
effects of her symptoms, they are inconsistent with the medical evidence
because the objective evidence does not support the severity of the
34 Tr. 24.
35 Tr. 26.
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claimant’s alleged symptoms related to her impairments.” 36 	The ALJ
then embarked on a lengthy review of the medical record evidence she
found supported those findings. 37
The ALJ next considered the medical opinions on record. 	She was
persuaded by the opinions of the state agency medical consultants, Drs.
Wadicar Nugent and Dilip Kar, who opined that Ruggiero had no severe
physical impairments requiring limitations or restrictions. 38 	The ALJ
found that opinion to be consistent with the overall medical evidence of
record and supported by physical examinations and diagnostic imaging. 39
The ALJ was partially persuaded by the state agency mental health
consultants, Drs. John Bigna and Shelly Ross.40 Both doctors opined that
Ruggiero had “moderate limitations in understanding, remembering, or
applying 	information, 	moderate 	limitations 	interacting 	with 	others,
moderate limitations in concentrating, persisting, and maintain pace,
36 Tr. 26.
37 Tr. 26-31.
38 Tr. 31.
39
Id.
40 Tr. 31.
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and moderate limitations in adapting or managing oneself [.]”41 The ALJ
was persuaded by this opinion to the extent that it supported Ruggiero’s
ability to do simple work, which the ALJ found to be supported by and
consistent with the medical evidence of record. 42 	But the ALJ was not
persuaded by the portions of the opinion finding moderate limitations in
Ruggiero’s abilities to: work in coordination or in proximity to others
without being distracted; sustain an ordinary routine without special
supervision; 	complete 	a 	normal 	workday 	and 	workweek 	without
interruptions 	from 	psychologically 	based 	symptoms; 	perform 	at 	a
consistent pace without an unreasonable number and length of rest
periods; and set realistic goals or make plans independently of others. 43
The 	ALJ 	explained 	that 	those 	conclusions 	were 	unpersuasive 	both
because they lacked support and because they were “vague and/or ill-
defined 	in 	vocational 	terms.” 44 	The 	ALJ 	did 	incorporate 	certain
supported and consistent limitations into Ruggiero’s RFC, related to
41
Id.
42 Tr. 31-32.
43 Tr. 32.
44
Id.
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understanding, remembering, or applying information, interacting with
others, concentrating, persisting, and maintaining pace, and in adapting
or managing oneself.45
Finally, the ALJ considered evidence of Ruggiero’s activities of daily
living, and found that, taken together, they “suggest the claimant can
perform work” as described in the RFC. 46
The ALJ then found at Step 4 that Ruggiero could not perform her
past work but, at Step 5, found that she could perform other occupations
with jobs that existed in significant numbers in the national economy,
such as hand packager, produce packer, and retail marker. 47 	Having
reached these conclusions, the ALJ determined that Ruggiero had not
met the demanding showing necessary to sustain this claim for benefits
and denied this claim.
45
Id.
46 Tr. 33.
47 Tr. 34-35.
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This 	appeal 	followed. 48 	On 	appeal, 	Ruggiero 	challenges 	the
adequacy of the ALJ’s decision arguing it is not supported by substantial
evidence. 49
As 	discussed 	in 	greater 	detail 	below, 	having 	considered 	the
arguments of counsel and carefully reviewed the record, we conclude that
the ALJ’s decision should be affirmed, and this appeal denied.
III. 	Discussion
A. Substantial Evidence Review – the Role of this Court
This Court’s review of the Commissioner’s decision to deny benefits
is limited to the question of whether the findings of the final decision-
maker are supported by substantial evidence in the record.50 	Substantial
evidence “does not mean a large or considerable amount of evidence, but
rather such relevant evidence as a reasonable mind might accept as
48 Doc. 1.
49 Doc. 11.
50
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).
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adequate to support a conclusion.” 51 	Substantial evidence means less
than a preponderance of the evidence but more than a mere scintilla.52
A single piece of evidence is not substantial evidence if the ALJ
“ignores, 	or 	fails 	to 	resolve, 	a 	conflict 	created 	by 	countervailing
evidence.”53 	However, where there has been 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] from
being supported by substantial evidence.” 54 	The court must “scrutinize
the record as a whole” to determine if the decision is supported by
substantial evidence. 55
The Supreme Court has explained the limited scope of our review,
noting 	that 	“[substantial 	evidence] 	means—and 	means 	only—’such
51
Pierce v. Underwood, 487 U.S. 552, 565 (1988).
52
Richardson v. Perales, 402 U.S. 389, 401 (1971).
53
Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993) (quoting
Kent v.
Schweiker, 	710 	F.2d 	110, 	114 	(3d 	Cir. 	1983)) 	(internal 	quotations
omitted).
54
Consolo v. Fed. Maritime Comm’n, 383 U.S. 607, 620 (1966).
55
Leslie v. Barnhart, 304 F. Supp.2d 623, 627 (M.D. Pa. 2003).
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relevant evidence as a reasonable mind might accept as adequate to
support a conclusion.’”56 	Under this standard, we must look to the
existing 	administrative 	record 	to 	determine 	if 	there 	is 	“‘sufficient
evidence’ to support the agency’s factual determinations.”57 	Thus, the
question before us is not whether the claimant is disabled, but rather
whether the Commissioner’s finding that she is not disabled is supported
by substantial evidence and was based upon a correct application of the
law. 58
When conducting this review, we must remain mindful that “we
must not substitute our own judgment for that of the fact finder.” 59 Thus,
56
Biestek, 139 S. Ct. at 1154 (quoting
Consolidated Edison Co. v. NLRB,
305 U.S. 197, 229 (1938)).
57
Id.
58
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 . . . .”).
59
Zirnsak v. Colvin, 777 F.3d 607, 611 (3d Cir. 2014) (citing
Rutherford
v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005)).
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we cannot re-weigh the evidence. 	Instead, we must determine whether
there is substantial evidence to support the ALJ’s findings. 	In doing so,
we must also determine whether the ALJ’s decision meets the burden of
articulation necessary to enable judicial review; that is, the ALJ must
articulate the reasons for their decision.60 	This does not require the ALJ
to use “magic” words, but rather the ALJ must discuss the evidence and
explain the reasoning behind his or her decision with more than just
conclusory 	statements. 61 	Ultimately, 	the 	ALJ’s 	decision 	must 	be
accompanied by “a clear and satisfactory explication of the basis on which
it rests.” 62
B. Initial Burdens of Proof, Persuasion, and Articulation for the
ALJ
To receive disability benefits under the Social Security Act, a
claimant must show that he or she is unable to “engage in any substantial
gainful activity by reason of any medically determinable physical or
60
Burnett v. Comm’r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000).
61
See Diaz v. Comm’r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009)
(citations omitted).
62
Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981).
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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.” 63 This requires a claimant to show a severe physical or
mental impairment that precludes him or her from engaging in previous
work or “any other substantial gainful work which exists in the national
economy.” 64 	To receive benefits under Title II of the Social Security Act,
a claimant must show that he or she is under retirement age, contributed
to the insurance program, and became disabled prior to the date on which
he or she was last insured. 65
In 	making 	this 	determination, 	the 	ALJ 	follows 	a 	five-step
evaluation. 66 	The 	ALJ 	must 	sequentially 	determine 	whether 	the
claimant: (1) is engaged in substantial gainful activity; (2) has a severe
impairment; (3) has a severe impairment that meets or equals a listed
impairment; (4) is able to do his or her past relevant work; and (5) is able
63 42 U.S.C. §423(d)(1)(A); 42 U.S.C. §1382c(a)(3)(A);
see also 20 C.F.R.
§§404.1505(a), 416.905(a).
64 	42 	U.S.C. 	§423(d)(2)(A); 	42 	U.S.C. 	§1382c(a)(3)(B); 	20 	C.F.R.
§§404.1505(a), 416.905(a).
65 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
66 20 C.F.R. §§404.1520(a), 416.920(a).
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to do any other work, considering 	his or her age, education, work
experience and residual functional capacity (“RFC”).67
Between Steps 3 and 4, the ALJ must also determine the 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).”68 	In making this assessment, the ALJ must consider all
the claimant’s medically determinable impairments, including any non-
severe impairments identified by the ALJ at step two of his or her
analysis. 69 	Our review of the ALJ’s determination of the plaintiff’s RFC
is deferential, and that determination will not be set aside if it is
supported by substantial evidence. 70
The claimant bears the burden at Steps 1 through 4 to show a
medically 	determinable 	impairment 	that 	prevents 	him 	or 	her 	from
6720 C.F.R. §§404.1520(a)(4), 416.920(a)(4).
68
	Burnett, 220 F.3d at 121 (citations omitted);
	see also 20 C.F.R. §
404.1545(a)(1).
69 20 C.F.R. §§404.1545(a)(2), 416.945(a)(2).
70
Burns v. Barnhart, 312 F.3d 113, 129 (3d Cir. 2002).
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engaging in any past relevant work. 71 	If met, the burden then shifts to
the Commissioner to show at Step 5 that there are jobs in significant
numbers 	in 	the 	national 	economy 	that 	the 	claimant 	can 	perform
consistent 	with 	the 	claimant’s 	RFC, 	age, 	education, 	and 	work
experience. 72
With 	respect 	to 	the 	RFC 	determination, 	courts 	have 	followed
different paths when considering the impact of medical opinion evidence
on this determination. 	While some courts emphasize the necessity of
medical opinion evidence to craft a claimant’s RFC, other courts have
taken the approach that “[t]here is no legal requirement that a physician
have made the particular findings that an ALJ adopts in the course of
determining an RFC.” 73 	Additionally, in cases that involve no credible
medical opinion evidence, courts have held that “the proposition that an
71
Mason, 994 F.2d at 1064.
72 20 C.F.R. §§404.1512(f), 416.912(f);
Mason, 994 F.2d at 1064.
73
Titterington v. Barnhart, 174 F. App’x 6, 11 (3d Cir. 2006);
see also
Biller v. Acting Comm’r of Soc. Sec., 962 F. Supp. 2d 761, 778–79 (W.D.
Pa. 2013).
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ALJ must always base [the] RFC on a medical opinion from a physician
is misguided.”74
Given these differing approaches, we must evaluate the factual
context 	underlying 	an 	ALJ’s 	decision. 	Cases 	that 	emphasize 	the
importance of medical opinion support for an RFC assessment typically
arise in the factual setting where well-supported medical sources have
found limitations to support a disability claim, but an ALJ has rejected
the medical opinion based upon an assessment of other evidence. 75 These
cases simply restate the notion that medical opinions are entitled to
careful consideration when making a disability determination. 	On the
other hand, when no medical opinion supports a disability finding or
when an ALJ relies upon other evidence to fashion an RFC, courts have
routinely sustained the ALJ’s exercise of independent judgment based
upon all the facts and evidence. 76 Ultimately, it is our task to determine,
74
Cummings v. Colvin, 129 F. Supp. 3d 209, 214–15 (W.D. Pa. 2015).
75
Biller, 962 F. Supp. 2d at 778–79.
76
See Titterington, 174 F. App’x 6;
Cummings, 129 F. Supp. 3d at 214–
15.
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considering 	the 	entire 	record, 	whether 	the 	RFC 	determination 	is
supported by substantial evidence. 77
C. Legal 	Benchmarks 	for 	the 	ALJ’s 	Assessment 	of 	Medical
Opinions
The plaintiff filed this disability application in April of 2022 after
Social 	Security 	Regulations 	regarding 	the 	consideration 	of 	medical
opinion evidence were amended. Prior to March of 2017, the regulations
established a hierarchy of medical opinions, deeming treating sources to
be the gold standard. 	However, in March of 2017, the regulations
governing the treatment of medical opinions were amended. 	Under the
amended regulations, ALJs are to consider several factors to determine
the persuasiveness of a medical opinion: supportability, consistency,
relationship with the claimant, specialization, and other factors tending
to support or contradict a medical opinion. 78
Supportability and consistency are the two most important factors,
and an ALJ must explain how these factors were considered in his or her
written decision. Supportability means “[t]he more relevant the objective
77
Burns, 312 F.3d 113.
78 20 C.F.R. § 404.1520c(c).
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medical evidence and supporting explanations . . . are to support his or
her medical opinion(s) . . . . the more persuasive the medical opinions . . .
will be.” 79 	The consistency factor focuses on how consistent the opinion
is 	“with 	the 	evidence 	from 	other 	medical 	sources 	and 	nonmedical
sources.” 80
While there is an undeniable medical aspect to the evaluation of
medical opinions, it is well settled that “[t]he ALJ – not treating or
examining physicians or State agency consultants – must make the
ultimate disability and RFC determinations.” 81 	When confronted with
several medical opinions, the ALJ can choose to credit certain opinions
over others but “cannot reject evidence for no reason or for the wrong
reason.” 82 Further, the ALJ can credit parts of an opinion without giving
credit to the whole opinion and may formulate a claimant’s RFC based
on different parts of different medical opinions, so long as the rationale
79 20 C.F.R. §§ 404.1520c(c)(1), 416.920c(c)(1).
80 20 C.F.R. §§ 404.1520c(c)(2), 416.920c(c)(2).
81
Chandler v. Comm’r of Soc. Sec., 667 F.3d 356, 361 (3d Cir. 2011).
82
Mason, 994 F.2d at 1066
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behind the decision is adequately articulated.83 	On the other hand, in
cases 	where 	no 	medical 	opinion 	credibly 	supports 	the 	claimant’s
allegations, “the proposition that an ALJ must always base [their] RFC
on a medical opinion from a physician is misguided.” 84
D. Legal Benchmarks for Assessing a Claimant’s Obesity
The plaintiff also challenges the ALJ’s assessment of her obesity.
Under the agency’s regulations, the ALJ must analyze the effects of a
claimant’s obesity on his or her ability to function. 85 	This is particularly
so when the ALJ identifies the claimant’s obesity as a severe impairment
at Step 2. 86 	The Third Circuit has explained that the ALJ need not “use
particular language or adhere to a particular format in conducting his
analysis” 	of 	a 	claimant’s 	obesity.87 	Rather, 	so 	long 	as 	the 	ALJ
“meaningfully consider[s] the effect of a claimant’s obesity, individually
83
See Durden v. Colvin, 191 F. Supp. 3d 429, 455 (M.D. Pa. 2016).
84
Cummings, 129 F. Supp. 3d at 214–15.
85
See SSR 02-01p, SSR 00-3p.
86
Diaz v. Comm’r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009).
87
Diaz, 577 F.3d at 504 (citations omitted).
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and in combination with her impairments, on her workplace function at
step three and at every subsequent step[,]”88 a remand is not required.89
E. Simple Tasks RFC Analysis
The claimant challenges the ALJ’s decision to limit her to a simple
tasks RFC in light of a finding that she suffers from a moderate limitation
in concentration, persistence, and pace. The Third Circuit rejected a
per
se rule that a simple tasks RFC was inadequate to account for such
limitations in this area.90 Rather, the Court of Appeals held that “as long
as the ALJ offers a ‘valid explanation,’ a ‘simple tasks’ limitation is
permitted after a finding that a claimant has ‘moderate’ difficulties in
‘concentration, persistence, or pace.’”91 	For such an explanation to be
valid, the ALJ may highlight “mental status examinations and reports
that revealed that [the claimant] could function effectively; opinion
evidence showing that [the claimant] could do simple work; and [the
88
Id. at 504.
89
See Woodson v. Comm’r Soc. Sec., 661 F. App’x 762, 765 (3d Cir. 2016);
Cooper v. Comm’r of Soc. Sec., 563 F. App’x 904, 911 (3d Cir. 2014).
90
See Hess v. Comm’r Soc. Sec., 931 F.3d 198, 212 (3d Cir. 2019).
91
Id. at 211.
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claimant]’s activities of daily living, which demonstrated that [s]he is
capable of engaging in a diverse array of ‘simple tasks[.]’”92
F. This Case Will Be Affirmed.
Our review of the ALJ’s decision denying an application for benefits
is significantly deferential. Our task is simply to determine whether the
ALJ’s decision is supported by substantial evidence in the record; that is,
“only— ‘such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.’” 93 	Judged against this deferential
standard of review, we conclude that substantial evidence supported the
ALJ’s decision in this case.
Ruggiero argues there are four errors in the ALJ’s decision. 	First,
she alleges the ALJ failed to properly evaluate her morbid obesity.
Ruggerio argues that the ALJ failed to include analysis of the cumulative
impact of obesity and other impairments, and failed to consider SSR 19-
2p, 	which 	discusses 	postural 	limitations 	in 	the 	context 	of 	obesity.
Specifically, she alleges that the ALJ should have concluded that the
92
Id. at 214.
93
Biestek, 139 S. Ct. at 1154.
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cumulative 	effect 	of 	obesity 	and 	plantar 	fasciitis 	make 	light 	work
impossible. 	After 	consideration, 	we 	conclude 	the 	ALJ 	sufficiently
considered obesity in conjunction with other impairments.
The ALJ acknowledged obesity as a non-severe impairment.94 	She
explained that in determining Ruggiero’s RFC, she considered all non-
severe impairments, 95 which is supported by the decision’s references to
Ruggiero’s BMI. 96 The ALJ also explained that she was persuaded by the
medical opinions of Drs. Nugent and Vigna, who each concluded Ruggiero
had no severe physical impairments, including obesity. 97 	The ALJ also
explained that Ruggiero’s activities of daily living belied the need for
postural limitations in her RFC. 98 	These references are sufficient to
evince consideration of obesity in combination with other impairments,
and 	of 	obesity’s 	relationship 	to 	possible 	postural 	limitations. 	We
therefore conclude there was no error in the ALJ’s treatment of obesity.
94 Tr. 21.
95
Id.
96 Tr. 26-27.
97 Tr. 31, 75, 78, 87, 90.
98 Tr. 25-26.
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26
Ruggiero’s second alleged error is that the ALJ failed to properly
consider one of the medical opinions on record, that of Ms. Lombardi.
Ruggerio does not dispute that the ALJ discussed both essential factors
(supportability 	and 	consistency) 	in 	relation 	to 	Lombardi’s 	opinion.
Instead, she argues that the facts do not support the ALJ’s conclusions
on those factors. 	Ruggiero’s briefs99 attack many of the ALJ’s specific
conclusions, arguing she should have reached different conclusions from
certain facts. But we may not re-weigh the evidence, and so these factual
attacks are unavailing. Ruggiero cites caselaw for the principles that an
ALJ cannot reject evidence for no reason and ought to explain specific
reasons 	for 	departing 	from 	the 	medical 	opinion 	of 	a 	consultative
examiner. 	We conclude the ALJ satisfied those obligations: The ALJ’s
99 We note that substantial portions of Ruggiero’s reply brief repeat her
brief in support word for word. (
Compare doc. 11
with doc. 17). 	As we
have recently twice-reminded Ruggiero’s counsel, there is no obligation
to file a reply brief.
	Geibe v. Bisignano, No. 1:24-CV-1400, 2025 WL
1570000, at *6 n.2 (M.D. Pa. June 3, 2025);
Hoppes v. Bisignano, No. 24-
1503, 2025 WL 1919491 at *8 n.3 (M.D. Pa. July 11, 2025);
see also, CSX
Transp. Co. v.
Novolog Bucks Cnty., 2006 WL 1451280, at *17 n.17 (E.D.
Pa. May 24, 2006) (“Response, reply, and surreply briefs are intended to
shed greater light on the substantive issues and address new arguments
or nuances raised by opposing counsel; they are not fora for reiterating
word for word one’s prior argument.”).
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decision devotes nearly a full single-spaced page to analysis of Lombardi’s
opinion, and that page is a fulsome and detailed explanation of the ALJ’s
reasons for finding Lombardi’s opinion only partially persuasive. 	We
conclude the ALJ’s treatment of this opinion is supported by substantial
evidence.
Third, Ruggiero alleges that the ALJ erred in crafting an RFC that
limits her to simple instructions and simple work-related decisions,
rather than limiting her to one-and two-step tasks. Ruggiero argues that
the ALJ should have relied on the medical opinion evidence, and that the
RFC “is in contradiction with all opinion evidence in the record.” 100 	But
we do not agree that the state agency psychological consultants limited
Ruggiero to one-and two-step tasks—that record is ambiguous at best.
Dr. Vigna stated that “due to the ability to understand and remember
one and two-step instructions, the claimant is able to perform simple,
routine tasks [,]”101 and Dr. Ross said Ruggiero “can understand, retain
and follow simple instructions (i.e., perform/follow one and two-step
100 Doc. 11 at 12.
101 Tr. 80.
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tasks/instructions.)”102 The intermixing of terminology makes the precise
limitations opined here difficult to divine, as the ALJ recognized:
[A]s it pertains to the doctors’ indication that the claimant is
capable of performing one to two step tasks, if it is an example,
and not a limitation, it is consistent with, and supported by
the 	longitudinal 	record. 	However, 	if 	it 	is 	meant 	to 	be 	a
limitation, it is not consistent with, or supported by the
longitudinal record or the claimant’s reported activities of
daily living[.] 103
As for Ms. Lombardi’s opinion that Ruggiero has “mild” limitations to
understanding and remembering simple instructions, but “moderate”
limitations 	to 	carrying 	out 	the 	same, 	those 	limitations 	are 	not
inconsistent with an RFC limiting Ruggiero to “understand, remember
and 	carry 	out 	simple 	instructions, 	and 	make 	simple 	work-related
decisions.” 104 	Firstly, as we have explained, the Third Circuit rejected
the idea that a moderate limitation in this area prohibits a claimant from
completing simple tasks.105 Secondly, it is not a requirement that an RFC
102 Tr. 92
103 Tr. 32.
104 Tr. 366.
105
Hess, 931 F.3d at 212.
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29
be consistent with a medical opinion. 106 	What is required is for the ALJ
to explain what evidence leads them to a different conclusion than all
medical opinions. 107 	The ALJ here did that, explaining that she was:
[N]ot 	persuaded 	by 	the 	portions 	of 	the 	opinion 	that 	the
claimant 	would 	have 	a 	moderate 	limitation 	carrying 	out
simple instructions and making simple decisions . . . [because]
this 	assessment 	is 	based 	on 	a 	one-time 	snapshot 	of 	the
claimant’s function by a nontreating provider who was not
familiar with the whole record. The undersigned finds that
opinions 	appear 	to 	be 	based 	heavily 	on 	the 	claimant’s
subjective complaints, particularly at that time and are not
consistent with the clinical findings on exam that showed
some 	mild 	memory 	impairment 	but 	intact 	concentration,
coherent 	thought 	processes, 	cooperative 	behavior, 	normal
speech, 	normal 	motor 	behavior, 	and 	fair 	insight 	and
judgement and are not supported by the evidence reflecting
no more than medication prescribed by her primary care
provider 	and 	reported 	therapy, 	without 	evidence 	of
recommendation for a more intensive level of care, such as
inpatient psychiatric hospitalization, partial hospitalization
programming, 	or 	structure[d] 	living, 	as 	previously
discussed. 108
We 	conclude 	the 	ALJ’s 	decision 	properly 	explained 	her 	reasons 	for
departing from this opinion. 	The specific references to record evidence
106
Cummings, 129 F. Supp. 3d at 214–15.
107
Durden, 191 F. Supp. 3d at 455.
108 Tr. 32.
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30
assure us that this portion of the decision is supported by substantial
evidence.
Finally, Ruggiero argues that the ALJ made errors in evaluating
Ruggiero’s reported symptoms. 	She alleges the ALJ inappropriately
made her own inferences as to the meaning of the phrase “no acute
distress” 	and 	improperly 	weighed 	certain 	facts, 	specifically: 	that
Ruggiero got treatment not from a psychologist or similar specialist but
from her PCP, that she did not get inpatient or similar treatment, that
she was not compliant with medication regimes, that the ALJ should
have credited Ruggiero’s self-reported symptoms over treatment notes
indicating normal mental health, that she was capable of caring for her
service dog, and that she traveled to New Jersey.109
Ruggiero overreaches in arguing “the ALJ improperly relied on his
[sic] own inferences from medical record notations of ‘no acute distress’
to determine Ms. Ruggiero’s RFC.” 110 	True, the ALJ did report several
instances 	in 	which 	the 	medical 	record 	noted 	“no 	signs 	of 	acute
109 Doc. 11 at 16-20.
110 Doc. 11 at 16.
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31
distress,” 111 but there is nothing in the decision suggesting the ALJ
improperly interpreted that evidence. The notes in the medical record of
“no acute distress” are merely listed in the ALJ’s decision as being
contained 	in 	the 	medical 	record, 	and 	that 	fact 	is 	indisputable. 112
Ruggiero 	apparently 	believes 	the 	ALJ’s 	references 	to 	these 	notes
somehow show that the ALJ improperly made further inferences, but she
does not explain what inference the ALJ made, where such inference is
shown in the text of the decision, nor why such inference is inappropriate,
and so this argument fails.
As to the facts which Ruggiero argues the ALJ misinterpreted, we
discern no error in the ALJ’s treatment of these facts. The mental health
care issued through a PCP and the lack of inpatient hospitalizations were
not improper to discuss, as they are on the subject of “[t]reatment[s],
other than medication, an individual receives or has received for relief of
pain or other symptoms” which the regulations explicitly direct an ALJ
111 Tr. 23, 26, 27, 28.
112 Tr. 672, 740, 781.
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32
to 	consider. 113 	As 	for 	Ruggiero’s 	non-compliance 	with 	medication
regimes, same as “no acute distress,” it is not error to simply report that
objective fact, which is established by the record, and to which neither
the ALJ nor any medical source pinned any specific conclusion. 	The
evaluation of Ruggiero’s self-reported symptoms is also not error: the ALJ
was within her discretion to credit other portions of the record over those
informed by Ruggiero’s self-reports.
As to the argument concerning Ruggiero’s late service dog: 	The
court is sympathetic to the general principles that: (1) certain pets are
akin to family members, and (2) it may be unfair to ‘punish’ a claimant
for caring for a family member, as that task may be personally significant
in a way that makes it a poor analogue for work capabilities. 	However,
that does not mean it is reversible error for the ALJ to reference or
consider such care. 	Were this fact the sole, or even a prominent, reason
for denial of disability benefits, we might have doubt that such a decision
113 [20 C.F.R. § 404.1529(c)(3)(v);
see also SSR 16-3p, 2017 WL 5180304,
at *8 (ALJ may consider if “the frequency or extent of the treatment
sought 	by 	an 	individual 	is 	not 	comparable 	with 	the 	degree 	of 	the
individual’s subjective complaints”).]
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33
was 	supported 	by 	substantial 	evidence. 	But 	where, 	as 	here, 	the
caregiving in question is one of at least a dozen activities of daily living
that 	supported 	the 	ALJ’s 	conclusion, 	we 	cannot 	conclude 	the 	mere
presence of this consideration means the resulting RFC is not based in
substantial evidence.
Lastly, Ruggiero argues that the ALJ failed to explain why her trips
to New Jersey belied her reported symptoms. The ALJ did mention these
trips, but, like the service dog, discussed it as one item in a list comprising
at least a dozen distinct activities of Ruggiero’s daily living. 114 	The ALJ
followed 	that 	list 	with 	the 	explanation 	that 	“taken 	together 	and
considered in conjunction with the above medical evidence of record,
[these activities] suggest that the claimant can perform work within the
above parameters.” 115 	That passage clearly refers back to the ALJ’s
discussion of the medical evidence, which includes the observation that
“[Ruggiero] testified she could not leave her home for more than one
114 Tr. 33.
115
Id.
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hour[.]”116 	Ruggiero’s address is in Vandling, Pennsylvania, 117 and so it
would clearly take in excess of an hour to reach, much less visit in and
return from, New Jersey. 	We cannot say it was error for the ALJ to
consider 	this 	apparent 	contradiction 	as 	one 	of 	many 	reasons 	that
Ruggiero’s activities of daily living undermined her statements about her
symptoms.
In sum, we find no error in the ALJ’s treatment of Ruggiero’s
activities 	of 	daily 	living, 	nor 	of 	symptom 	evidence 	generally, 	nor
anywhere else in her well-reasoned opinion. 	Accordingly, under the
deferential standard of review that applies to appeals of Social Security
disability 	determinations, 	we 	conclude 	that 	substantial 	evidence
supported the ALJ’s evaluation of this case, and that this decision should
be affirmed.
IV. 	Recommendation
For 	the 	foregoing 	reasons, 	IT 	IS 	RECOMMENDED 	that 	the
decision of the Commissioner in this case be AFFIRMED.
116 Tr. 22.
117 Tr. 15
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35
The parties are further placed on notice that pursuant to Local Rule
72.3:
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 18th day of December 2025.
s/ Daryl F. Bloom
Daryl F. Bloom
Chief United States Magistrate Judge
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