Teresa WEIDMAN, Plaintiff v. Carolyn W. COLVIN, Acting Commissioner of Social Security, Defendant, 164 F. Supp. 3d 650

MEMORANDUM MALACHY E. MANNION, United States District Judge Pending before the court is the report of Judge Cohn, the magistrate judge to whom the above matter was referred, (Doc. 18), which recommends that the Court enter judgment in favor of the Commissioner of the Social Security Administration and against Plaintiff Teresa Weidman. More specifically, the report recommends that the Court affirm the Commissioner’s final decision denying the plaintiffs application for benefits under the Social Security Act, as the Commissioner’s decision was supported by substantial evidence.

Based upon the court’s review of the record, the court will ADOPT Judge Cohn’s Report and Recommendation. I. STANDARD OF REVIEW When objections are timely filed to the report and recommendation of a magistrate judge, the district court must review de novo those portions of the report to which objections are made. 28 U.S.C. § 636(b)(1); Brown v. Astrue, 649 F.3d 193, 195 (3d Cir.2011). Although the standard is de novo, the extent of review is committed to the sound discretion of the district judge, and the court may rely on the recommendations of the magistrate judge to the extent it deems proper. Rieder v.

Apfel, 115 F.Supp.2d 496, 499 (M.D.Pa.2000) (citing United States v. Raddatz, 447 U.S. 667, 676, 100 S.Ct. 2406, 65 L.Ed.2d 424 (1980)). For those sections of the report and recommendation to which no objection is made, the court should, as a matter of good practice, “satisfy itself that there is no clear error on the face of the record in order to accept the recommendation.” Fed. R. Civ. P. 72(b), advisory committee notes; see also Univac Dental Co. v. Dentsply Intern., Inc., 702 F.Supp.2d 465, 469 (M.D.Pa.2010) (citing Henderson v.

Carlson, 812 F.2d 874, 878 (3d Cir.1987) (explaining judges should give some review to every report and recommendation)). Nevertheless, whether timely objections are made or not, the district court may accept, not accept, or modify, in whole or in part, the findings or recommendations made by the magistrate judge. 28 U.S.C. § 636(b)(1); Local Rule 72.31. When reviewing the denial of disability benefits, the court must determine whether the denial is supported by substantial evidence. Brown v. Bowen, 845 F.2d 1211, 1213 (3d Cir.1988); Johnson v. Commissioner of Social Sec., 529 F.3d 198, 200 (3d Cir.2008).

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, 108 S.Ct. 2541, 101 L.Ed.2d 490 (1988); Hartranft v. Apfel, 181 F.3d 358, 360 (3d Cir.1999), Johnson, 529 F.3d at 200. It is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971). If the ALJ’s decision is supported by substantial evidence, the court is “bound by those findings.” Fargnoli v.

Massanari, 247 F.3d 34, 38 (3d Cir.2001) (citation omitted). Furthermore, in determining if the ALJ’s decision is supported by substantial evidence the court may not parse the record but rather must scrutinize the record as a whole. Smith v. Califano, 637 F.2d 968, 970 (3d Cir.1981).

To receive disability benefits, the plaintiff 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. § 432(d)(1)(A).

Furthermore, • [a]n individual shall be determined to be under a disability only if [her] physical or mental impairment or impairments are of such severity that [she] is not only unable to do [her] previous work but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which [she] lives, or whether a specific job vacancy exists for [her], or whether [she] would be hired if [she] applied for work.

For purposes of the preceding sentence (with respect to any individual), ‘work which exists in the national economy’ means work which exists in significant numbers either in the region where such individual lives or in several regions of the country. 42 U.S.C. § 423(d)(2)(A). The Commissioner of Social Security must follow a five-step process to determine if an applicant is disabled under the Act.

This legal framework requires the Commissioner to sequentially determine: (1) whether the applicant is engaged in substantial gainful activity; (2) whether the applicant has a severe impairment; (3) whether the applicant’s impairment meets or equals a listed impairment; (4) whether the applicant’s impairment prevents the applicant from doing past relevant work, and; (5) whether the applicant’s impairment prevents the applicant from doing any other work. 20 C.F.R. §§ 404.1520, 416.920.

Since the five-step legal framework for addressing a disability claim was properly stated in the R & R, (Doc. 18, at 55-56), this portion of the R & R is incorporated by reference. II. RELEVANT MEDICAL BACKGROUND Judge Cohn’s report and. recommendation (“R & R”) contains a thorough review of the plaintiffs medical history. (Doc. 18, at 9-54). The plaintiff did not file any objection to Judge Cohn’s factual determinations regarding her medical history, so they will be adopted. See Butterfield v. Astrue, 2010 WL 4027768, *3 (E.D.Pa.

Oct. 14, 2010) (“To obtain de novo determination of a magistrate[ ] [Judge’s] findings by a district court, 28 U.S.C. § 636(b)(1) requires both timely and specific objections to the report.”) (quoting Goney v. Clark, 749 F.2d 5, 6 (3d Cir.1984)). The court will restrict its discussion below to the relevant medical background as it pertains to the plaintiffs objections. III.

DISCUSSION On March 24, 2014, Plaintiff Teresa Weidman filed her Complaint in the instant action, (Doc. 1), seeking judicial review of the Commissioner of the Social Security Administration’s (“Commissioner”) denial of her claim for Disability Insurance Benefits and Supplemental Security Income under Titles II and XVI of the Social Security Act. 42 U.S.C. § 405(g); 42 U.S.C. § 1383(c)(3). The Commissioner filed an answer as well as an administrative transcript of the relevant proceedings on April 30, 2014 (Doc. 7, 8). And, on August 4, 2014, the Court referred this case to Judge Cohn.

Plaintiff filed a brief in support of her appeal on August 4, 2014, (Doc. 12), and on September 5, 2014, the Commissioner filed a response brief. (Doc. 13). Finally, on September 16, 2014, the plaintiff filed a reply brief. (Doc. 14). Judge Cohn issued a comprehensive R & R on August 7, 2015 recommending that the plaintiffs appeal be denied and the action dismissed.

On August 23, 2015, the plaintiff filed objections to the report recommending dismissal of her action, on three bases: that Judge Cohn erred in finding that substantial evidence supports (1) the ALJ’s credibility assessment; (2) the ALJ’s Step Three Findings; and (3) the ALJ’s RFC Assessment. The defendant Commissioner waived its opportunity to respond to the plaintiffs objections on September 4, 2015. This court will review each of the plaintiffs objections in turn. A.

Whether Substantial Evidence Supports the ALJ’s Credibility Assessment The plaintiff argues that the ALJ’s credibility assessment, finding the plaintiff, Weidman, not credible, was not supported by substantial evidence. The plaintiff points to four specific findings by the Commissioner, and affirmed by the Magistrate Judge’s R & R, regarding her credibility and the severity of her symptoms. Upon review, the court finds that the ALJ’s credibility determination was proper and supported by substantial evidence. 1.

Somatoform Disorder Is Consistent with a Finding of Adverse Credibility The plaintiff first contends that Judge Cohn erred in affirming the ALJ’s finding that the plaintiff had “a severe impairment of undifferentiated somatoform disorder and ... that she was not entirely credible and feigned or exaggerated the severity of her symptoms.” (Doc. 18, at 61-62); (Doc. 19, at 2). The plaintiffs argument is based upon the ALJ’s failure to conduct the “legally correct analysis” in light of the plaintiffs diagnosis of a somatoform disorder.

The issue of credibility in this case, as Judge Cohn accurately noted in the R & R, presents an issue of first impression in the Third Circuit, namely, “whether it is error for an ALJ to make an adverse credibility finding when a claimant has been diagnosed with a somatoform disorder (a diagnosis which requires a determination regarding malingering) and when the ALJ determines that the somatoform disorder was a severe impairment under step two.” (Doc. 18, at 57-58).

Judge Cohn’s R & R notes the importance of credibility determinations with respect to “somatization and undifferentiated somato-form disorders where their diagnostic criteria explicitly require a finding that the reported symptoms are ‘not intentionally produced or feigned (as in Factitious Disorder or Malingering).’ ” (Doc. 18, at 58). Ultimately, Judge Cohn determined, “[w]hile the diagnostic criteria require a finding that the symptoms were not produced by malingering, it is possible [ ] for a mixed diagnosis of both undifferentiated somatoform disorder symptoms and malingering to coexist.” Id. at 59.

Thus, this court adopts in full Judge Cohn’s rigorously examined and reasoned conclusion that “where a claimant has been diagnosed with undifferentiated somatoform disorder and an ALJ concludes that the disorder was a severe impairment, it is legally possible for an ALJ to make an adverse credibility finding.” Id. at 67, 58-67; see also Carradine v. Barnhart, 360 F.3d 751, 756-81 (7th Cir.2004) (J. Coffey, dissenting); Minner v. Am. Mortgage & Guar. Co., 791 A.2d 826, 871-72 (Del.Super.2000). Credibility may be analyzed despite a diagnosis of undifferentiated somatoform disorder.

Therefore, plaintiffs objection that the ALJ analyzed the plaintiffs credibility “without doing legally correct analysis” must fail. In addition, the plaintiff, in her objections, contends that no medical opinion in the record supports a finding of malingering or factitious disorder, and that the Magistrate Judge erred in basing its entire credibility assessment on “baseless malingering and factitious disorder allegations.” (Doc. 19, at 2-3). “Allegations of pain and other subjective symptoms must be supported by objective medical evidence.” Hartranft v.

Apfel, 181 F.3d 358, 362 (3d Cir.1999) (citing 20 C.F.R. § 404.1529); see also 20 C.F.R. § 404.1508. If objective medical evidence fails to substantiate the severity of the claimant’s pain or symptoms, then the ALJ must make a credibility finding regarding the claimant’s subjective statements. Social Security Ruling (SSR) 96-7p. An ALJ’s credibility finding with respect to the severity of a claimant’s symptoms requires consideration of the entire record. Id.

More specifically, the ALJ must consider the following seven factors, in totality: 1) claimant’s daily activities; (2) the location, duration, frequency, and intensity of claimant’s pain or other symptoms; (3) precipitating and aggravating factors; (4) the type, dosage, effectiveness, and side effects of any medication claimant takes or has taken to alleviate pain or other symptoms; (5) treatment, other than medication, claimant receives or has received for relief of pain or other symptoms; (6) any measures claimant uses or has used to relieve pain or other symptoms; and (7) other factors concerning claimant’s functional limitations and restrictions due to pain or other symptoms.

SSR 96-7p; 20 C.F.R. § 404.1529; Seney v. Comm’r Soc. Sec., 585 Fed.Appx. 805, 808-09 (3d Cir.2014) (unpublished decision). In the instant case, the ALJ examined the record and, while she did not explicitly enumerate her findings according to the seven categories mentioned above, she addressed the entire record and concluded that the plaintiffs “allegations regarding her symptoms and limitations [are] not fully credible” (Tr. 840, 333-344).

Judge Cohn, in his R & R examined the ALJ’s decision and correctly found that each of the seven factors was assessed by the ALJ, and that the totality of the evidence supported the ALJ’s finding that the plaintiff was not fully credible. (Doc. 18, at 69-79).

More specifically, the ALJ identified “several occasions where the claimant gave poor effort, malingered and alleged excessive symptoms, which tends to question the extent to which her allegations are believable.” (Doc. 15, at 334-35).The objective record supports the ALJ’s observations, and provides substantial evidence that the plaintiff may have feigned or exaggerated her symptoms, thus calling into question her credibility. These instances of possible malingering in conjunction with the totality of the evidence provides ample support for the ALJ’s adverse credibility finding. 2.

The ALJ Properly Assessed Plaintiffs Syncopal Episodes The plaintiff next contends that the ALJ’s assessment of the plaintiffs synco-pal episodes, which formed part of the seven factor analysis to determine credibility, was incorrect and unsupported by substantial evidence. The ALJ noted that the plaintiff “has never hurt herself’ during one of her syncopal episodes. (Doc.-15, at 333).

The plaintiff states that this allegation is not supported by substantial evidence; she points to one instance, documented in the record, when she suffered neck pain as a result of a syncopal episode (a fall) and was given morphine for pain relief as support that she has in fact hurt herself during an episode. (Doc. 19, at 4 (citing Doc. 15, at 860)). As Judge Cohn accurately noted in his R & R, the record indicates that the during the instance cited by the plaintiff, the plaintiff only complained of subjective neck pain. (Doc. 15, at 860).

This does not constitute a physical injury, and thus, the plaintiffs objection must fail. Furthermore, the entirety of the record supports the ALJ’s determination that there is no evidence of objective indicia of falls (e.g. contusions or bruising) arising from synco-pal episodes. See Doc. 18, at 85-86. Thus, the ALJ did not err in concluding that the syncopal episodes have never resulted in physical injury to the plaintiff and correctly noted this fact as part of its seven factor credibility analysis. 3.

The ALJ’s Inference Regarding Plaintiffs Past Drug Use Is a Harmless Error In addition, the plaintiff argues that the ALJ drew an adverse inference concerning the plaintiffs credibility due to testimony about past crack cocaine use. (Doc. 19, at 4-5). The record demonstrates that plaintiff previously used crack cocaine from 2000 to 2004. The plaintiff stated that she quit “cold turkey” without aid of any substance abuse treatment programs. (Doc. 15, at 1067, 1071, 1074, 1234).

The ALJ’s decision found the plaintiffs statement that she “quit cold turkey” to be implausible, and the ALJ further stated that the testimony contributed to her finding that the plaintiff was not credible. (Doc. 15, at 333). As Judge Cohn noted, “evidence can be used to discount credibility if such evidence demonstrates a contradiction or inconsistency.” (Doc. 18, at 89 (quoting Gleason v. Colvin, No. 3:14-CV-00021-GBC, 152 F.Supp.3d 364, 380-81, 2015 WL 4232569, at *13-14 (M.D.Pa. July 13, 2015)).

The record contains no contradictory or inconsistent evidence that would suggest the plaintiff did not quit cold turkey. Despite the absence of any contrary evidence, the ALJ found the plaintiffs testimony that she “quit cold turkey” implausible and used this determination to support a finding that the plaintiff is not credible. (Doc. 15, at 333). This court agrees with Judge Cohn’s finding that the ALJ erred in drawing an improper inference about the method in which the plaintiff stopped using crack cocaine. (Doc. 18, at 90).

The ALJ determined the plaintiffs credibility by looking to the totality of the circumstances, and as discussed previously, the record includes extensive evidence, other than the abovementioned drug use testimony, to support the ALJ’s adverse credibility finding. Therefore, like Judge Cohn, this court finds that the ALJ’s improper inference solely amounts to harmless error and does not negate a finding that the plaintiff is not credible. (Doc. 18, at 91). 4.

ALJ’s Mischaracterization of the Findings of Different Doctors Is a Harmless Error Finally, the plaintiff objects to the ALJ’s mischaracterization of the findings of different doctors. The plaintiff alleges that the ALJ erroneously stated that doctors used words “such,as feigning, malingerer, factitious and exaggerated” in then-diagnosis of the plaintiff. (Doc. 19, at 5). Judge Cohn agreed that the plaintiff “correctly pointed out that the ALJ erroneously stated that doctors explicitly determined that Plaintiff was a malingerer.” (Doc. 18, at 86-87; Doc. 19, at 5).

However, Judge Cohn correctly determined that the mischaracterization resulted in a harmless error. The plaintiff objects that this mischaracterization “clouded the entire decision” and amounts to a harmful error. However, this court agrees with the standard identified in Judge Cohn’s analysis: The Court in Williams v. Barnhart, upheld an ALJ decision where although “[s]ome of the discrepancies pointed out in the ALJ’s opinion are not great and might not alone support an adverse credibility determination,” other record evidence, supported the ALJ’s finding of incredibility. Williams v.

Barnhart, 87 Fed.Appx. 240, 243-44 (3d Cir.2004). (Doc. 18, at 88). See also Napoli v. Colvin, No. 3:13-CV-01815, 2014 WL 2808603, at *11 at n. 23 (M.D.Pa. June 20, 2014) (finding harmless error under the totality of the evidence); Bivins ex rel. N.B. v. Astrue, No. 5:11-CV-51 MSH, 2011 WL 5859954, at *5 (M.D.Ga. Nov. 22, 2011) (“Considering the totality of the medical evidence, the ALJ’s erroneous reference to a statement ... is harmless....

A remand to have the ALJ perfect the record as to this statement would serve no practical purpose, would not alter the ALJ’s findings, and would be a waste of judicial and administrative resources”). In the instant action, the medical records by six different doctors contain statements relating to or identifying the possibility that the plaintiffs description of her symptoms was exaggerated or intentional. See supra Footnote 2.

In addition, other evidence found in the record contributes to and support the ALJ’s credibility finding, including the plaintiffs history of writing bad checks and initial lying about past drug use. (Doc. 15, at Therefore, looking at the totality of the evidence, substantial evidence supports the adverse credibility finding despite the ALJ’s mischaracterization error, which this court concludes is harmless. B.

Substantial Evidence Does Not Support the ALJ’s Step Three Findings At step three of the disability benefits evaluation process, the ALJ must determine whether a claimant’s alleged impairment matches a number of listed impairments that are acknowledged as so severe as to preclude substantial gainful activity. 20 C.F.R. § 416.920(a)(4)(iii); 20 C.F.R. pt. 404, subpt. P, App. 1; Sullivan v. Zebley, 493 U.S. 521, 529, 110 S.Ct. 885, 107 L.Ed.2d 967 (1990); Burnett v. Comm. of SSA, 220 F.3d 112, 119 (3d Cir.2000).

A claimant bears the burden of establishing each element of a Listing, or “all of the criteria in the listing.” 20 C.F.R. § 404.1525(d). If even one element is not satisfied, then the ALJ has substantial evidence to conclude that the claimant’s impairment is not equivalent and does not meet a Listing. Williams v. Sullivan, 970 F.2d 1178, 1186 (3d Cir.1992). Plaintiff objects to Judge Cohn’s determination that the ALJ was correct in finding that the plaintiff does not meet the requirements of Listing 12.07B. (Doc. 19, at 6-9).

Listing 12.07B requires that the claimant demonstrate that his medical symptoms (from the 12.07A finding) result in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration. 20 C.F.R. pt. 404, subpt. P, app. 1, § 12.07.

The ALJ found that the plaintiff did not suffered from marked restriction of activities of daily life; did not suffer marked difficulties in maintaining social functioning or concentration, persistence, or pace; and did not undergo repeated episodes of decompensation of extended duration. (Doc. 15, at 329-31). The plaintiff objects to the ALJ’s determination as to 12.07B(2)-(4), and also to Judge Cohn’s “summarized and unfounded reasoning” that affirms the determination. (Doc. 19, at 6)'.

This court agrees that the ALJ’s determination was supported by substantial evidence, but for slightly different reasons, which will be discussed below. First, plaintiff states that she has marked impairment in maintaining social functioning, and presents several facts from the consultative examination performed by Dr. Laguna to support the assertion. These facts indicate that the plaintiff sometimes feels frustrated by her family and others, and suffers from “emotional numbing and dissociative disorders.” (Doc. 19, at 7; Doc. 15, at 957-59).

However, the ALJ looked at the entire record, not simply the examination of Dr. Laguna. The ALJ noted the plaintiffs testimony at the hearing, where the plaintiff stated she talks on the phone with others, she lives with her husband and children, and a friend takes her to appointments. (Doc. 15, at 330). The plaintiffs behavior clearly demonstrates an ability to get along with others and interact effectively. In addition, Dr.

Fretz’ report, which reviewed the plaintiffs medical record and history, stated that the plaintiff suffered solely from moderate impairment in maintaining social functioning, (Doc. 15, at 438), and as will be discussed below, the ALJ properly placed great weight on Dr. Fretz’ opinion. (Doc. 15, at 343). The ALJ’s determination, which relied on objective record evidence, medical opinions, and hearing testimony, clearly amounts to substantial evidence and must be upheld.

Next, the plaintiff objects on the basis that the plaintiff suffers from a marked impairment in maintaining concentration, persistence, or pace, and that the ALJ incorrectly found otherwise. (Doc. 19, at 7). This 12.07B criterion refers to the ability of the claimant to “sustain focused attention and concentration sufficiently long to permit the timely and appropriate completion of tasks.” 20 C.F.R. pt. 404, subpt.

P, app. 1. “Marked” impairment here refers to the “nature and overall degree of interference” with work functioning, and is generally assessed through mental status examinations (e.g. serial sevens or threes) or simulated work tasks that require short term memory and completion of the task. Id. The plaintiff claims that she has marked difficulties, and supports her assertion by identifying Dr. La-guna’s assessment that she had “a poor capacity for calculating serial threes,” and that treatment records that assign low GAF scores. (Doc. 19, at 7).

The ALJ, on the other hand, focused on objective evidence from the record showing that the plaintiffs condition improves with treatment and that she left her last job due to a physical hand problem, not a problem sustaining the job mentally. (Doc. 15, at 330). Later in the ALJ’s opinion, she places only partial weight on Dr. Laguna’s reports, but great weight on Dr. Fretz’ report which concludes that the plaintiff has only “mild” difficulties with concentration, persistence, or pace. (Doc. 15, at 343, 438).

The ALJ also addresses the low GAF scores by noting the range of scores the plaintiff received through years of treatment (25 to 55). The ALJ further explains that GAF scores are subjective and attach only to a particular moment in time, but fail to take into account “a longitudinal view of the claimant’s functioning.” (Doc. 15, at 342). Thus, because the plaintiffs functioning and GAF scores improved with treatment, the lower scores do not reflect the plaintiffs functional ability today.

While the ALJ did give some weight to the plaintiffs poor capacity calculating threes and following instructions, the remainder of the objective evidence, particularly the medical treatment reports and Dr. Fretz’s report, supports the conclusion that the plaintiff has greater than mild, but less than marked impairment. Thus, the ALJ’s determination that the plaintiff has moderate restrictions in this area of functioning is supported by substantial evidence and will be upheld.

Finally, the plaintiff contends that she has experienced multiple ■ episodes of de-compensation, each of which was of extended duration, which satisfy the fourth criterion under 12.07B. (Doc. 19, at 6-8). The plaintiff states that Judge Cohn incorrectly found that substantial evidence supported the ALJ’s determination that this criterion was not satisfied. (Doc. 19, at 9). Episodes of decompensation are defined by 20 C.F.R.

Part 404, Subpart P, Appendix I as “exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning, as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace.” 20 C.F.R. pt. 404, subpt. P, app. 1. These episodes must be repeated and of extended duration, which means there must be three episodes in one year (or an average of once every four months), and each must last for “at least 2 weeks.” Id.

Judge Cohn’s analysis in the R & R arrived at the correct conclusion, namely that substantial evidence supported the ALJ’s determination that the plaintiff did not experience multiple episodes of decom-pensation of extended duration, but we will affirm for a different reason. Judge Cohn stated that the ALJ’s finding that the plaintiff is not credible effectively prevents the plaintiffs emergency room visits from counting as episodes of decompensation because her symptoms during those visits were likely feigned. (Doc. 18, at 92).

However, this issue can be decided without consideration of the plaintiffs credibility. Credible or not, the alleged episodes of decompensation are not of extended duration. Extended duration, as stated previously, requires that each episode last for at least two weeks. All alleged episodes, except for the plaintiffs attendance at Phil-haven Acute Partial Program from July 15, 2011 to August 12, 2011, do not meet the two week requirement. (Doc. 19, at 8).

The ALJ accurately noted these facts and properly concluded that “[w]hile there is evidence of multiple exacerbations in symptoms or signs associated with the claimant’s mental impairments, the lack of extended duration and evidence of improvement with treatment ... do[ ] not meet the requisite adaptive functioning deficits to meet this listing.” (Doc. 15, at 331). Therefore, substantial evidence supports the ALJ’s finding that this criterion is not met.

And, furthermore, because the plaintiff cannot satisfy any of the four 12.07B criteria, substantial evidence supports the ALJ’s finding that the plaintiff does not meet the criteria required for a 12.07 Listing. C. Whether Substantial Evidence Supports the ALJ’s Residual Functional Capacity (RFC) Assessment The plaintiff lastly objects on the grounds that the residual functional capacity (RFC) assessment was not supported by substantial evidence because the ALJ incorrectly weighed medical opinion testimony and thus failed to include limitations related to the plaintiffs somatoform disorder in her RFC assessment.

Specifically, the plaintiff points to the ALJ’s reliance upon Dr. Fretz, a non-treating, non-examining medical source and the ALJ’s failure to give any weight to Ms. Yevtukh, a non-acceptable medical source. An RFC assessment, or residual functional capacity assessment, is required after Step 3 but before moving on to Step 4 of the Commissioner’s sequential evaluation process. 20 C.F.R. §§ 404.1520(e), 416.920(e). Residual functional capacity is defined as the most a claimant can do in a work setting despite the physical and mental limitations resulting from all of her impairments. Id. at § 404.1545(a)(1).

The Commissioner must use all relevant evidence in the record to make the RFC assessment. Id. In reviewing the record to make the RFC assessment, the ALJ must take into account all the medical opinion evidence along with all other relevant evidence in the record, 20 C.F.R. § 404.1527(b), and must allocate weight to each medical opinion upon which it relies.

In the R & R, Judge Cohn accurately described what qualifies as medical opinion evidence and the process by which it is then analyzed and weighed: “Medical opinions are statements from ... acceptable medical sources that reflect judgments about the nature and severity of [a claimant’s] impair- ■ ment(s), including ... symptoms, diagnosis and prognosis, what [a claimant] can still do despite impairment(s), and [a claimants] physical or mental restrictions.” 20 C.F.R. §§ 404.1527(a)(2), 416.927(a)(2) (emphasis added).

Only licensed physicians (medical or osteopathic doctors), licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language pathologists are considered “acceptable medical sources.” See 20 C.F.R. §§ 404.1513(a) & 416.913(a). Evidence from “other sources” that are not “acceptable medical sources” ... are not entitled controlling weight. See 20 C.F.R. §§ 404.1513(

a) and (d)(1), 404.1527(a)(2), 416.913(

a) and (d)(1), 416.927(a)(2); Social Security Ruling (SSR) 96-2p (rule for according controlling weight to “treating source medical opinions”); SSR 06-03p; Hartranft v. Apfel, 181 F.3d 358, 361 (3d Cir.1999); cf. Gomez v. Chater, 74 F.3d 967, 970-71 (9th Cir.1996) (Opinions from “other sources” can be accorded “less weight than opinions from acceptable medical sources”). (Doc. 18, p. 94) (emphasis added).

Any medical opinion from an. acceptable medical source, unless it is designated a controlling treating medical opinion, must be analyzed according to factors set forth in the Code of Federal Regulations. 20 C.F.R. § 404.1527(c). These factors include: the examining and treating relationship; the length and frequency of the relationship; the extent and nature of the relationship; the amount of objective medical evidence supporting the opinion; consistency with the entire record; specialization of the medical professional; and other factors that tend to support or contradict an opinion. Id. 1.

The ALJ Did Not Err in Giving “Great Weight” to Dr. Fretz’ Opinion The plaintiff specifically objects to the R & R because it affirms the ALJ’s allocation of “great weight” to the opinion of Dr. Fretz, a non-treating, non-examining medical source. The plaintiff argues that a non-treating, non-examining acceptable medical opinion can only be given “little, if any, weight.” (Doc. 19, p. 9).

However, a non-treating, non-examining medical opinion must be analyzed according to the factors set forth above to determine its weight, and may ultimately be entitled to more than “little, if any, weight.” In fact, a non-treating, non-examining medical opinion may be allocated greater weight than other acceptable and non-acceptable medical sources, provided the ALJ gives adequate explanation for its determination. SSR 96-6p; 20 C.F.R. § 404.1527(c); Morales v. Apfel, 225 F.3d 310, 317 (3d Cir.2000); Hartranft v. Apfel, 181 F.3d 358, 361 (3d Cir.1999).

In the instant action, the ALJ clearly explained why it afforded Dr. Fretz’ opinion great weight: Dr. Fretz, opined the [plaintiff] can understand, remember and carry out simple tasks. (Exhibit 2A). This is consistent with the medical records from Dr. Laguna, Philhaven Hospital, Hershey Medical Center and Good Samaritan Hospital, which all reveal the [plaintiff] having depression and anxiety, and related symptoms, that would reasonably limit the [plaintifffs ability to carry out more detailed tasks and instructions. (See generally Exhibits 2F; 3F; 4F; 6F; 8F-12F; 13F; 16F; 17F). Moreover, Dr.

Fretz’s opinion is based on his specialty in mental health and his familiarity with the Social Security Administration disability program. His opinion reasonably comports with the evidence contained in the record at the time of the assessment, and evidence received at the hearing level did not demonstrated a worsening or deterioration in [Plaintifffs condition requiring more restrictive limitations. (Doc. 15, p. 343). This explanation includes consideration of numerous factors, as required by

section 404.1527(

c) of the regulations, namely the specialty and knowledge of Dr. Fretz, objective medical evidentiary support, consistency with other evidence at the hearing, and other factors. Thus, the ALJ’s decision to place great weight on Dr. Fretz’ opinion is proper, and the plaintiffs objection must be denied. 2. The ALJ Did Not Err in Giving “No Weight” to Ms. Yevtukh’s Opinion The plaintiff also raises an objection regarding the ALJ’s decision to give “no weight” to treating Nurse Practitioner, Ms. Yevtukh’s opinion. Ms.

Yev-tukh is a Nurse Practitioner who treated the patient every 6 months for two years, from 2010 to 2012. (Doc. 15, p. 1245). As stated above, “[o]nly licensed physicians (medical or osteopathic doctors), licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language pathologists are considered ‘acceptable medical sources.’ ” (Doc. 18, p. 94). A nurse practitioner is not an acceptable medical source under the regulations; therefore, a nurse practitioner’s opinion cannot be given controlling weight.

However, an ALJ may consider a non-acceptable medical opinion to assess severity of impairments and functional effect, and may reject or accept the opinion after explaining the reasons for doing so. (Doc. 18, p. 95); SSR 06-03p; Burnett v. Comm’r of Soc. Sec. Admin., 220 F.3d 112, 122 (3d Cir.2000) (explaining that an ALJ must consider all nonmedical evidence and explain why it rejects or accepts such testimony). The plaintiff, in her objections, admits that Ms. Yevtukh is not an acceptable medical source, but states that the ALJ failed by not giving her opinion any weight in the RFC assessment. (Doc. 19, p. 11).

The plaintiff states, more specifically, that the ALJ incorrectly found Ms.-.Yevtukh’s opinion to be inconsistent with objective evidence in the record, thus requiring that it be given “no weight.” To support her objection, the plaintiff points to consistencies between the RFC questionnaire completed by Ms. Yevtukh and Ms. Yevtukh’s own previous treatment notes. However, the plaintiff fails to address the contradictory and inconsistent evidence found throughout the voluminous record for this case. The ALJ found inconsistencies between Ms.

Yevtukh’s RFC questionnaire and both her own findings regarding the plaintiff as well as objective evidence in the record. Judge Cohn thoroughly reviewed the medical evidence presented in this case and identified numerous pieces of evidence that are inconsistent with or contradict Ms. Yevtukh’s opinion. See Doc. 18, p. 97-98. Furthermore, Ms. Yevtukh herself states that she is not a neurologist and she does not treat the plaintiffs depression; these statements further weaken her conclusions with regard to the plaintiffs physical limitations. (Doc. 15, p. 342, 1245).

Therefore, Judge Cohn properly found that the ALJ adequately explained her allocation of weight to Ms. Yevtukh’s opinion, and that the record supported such determination. This objection will, thus, be denied. IV. CONCLUSION For the foregoing reasons, the ALJ’s decision to deny the plaintiffs Social Security claim is supported by substantial evidence. Accordingly, the R & R issued by Judge Cohn, (Doc. 18), is ADOPTED. The final decision of the Commissioner is AFFIRMED, and the plaintiffs appeal, (Doc. 1), is DENIED. An appropriate order shall issue.

ORDER In accordance with the accompanying memorandum, IT IS HEREBY ORDERED THAT: 1. The plaintiffs objections to the report and recommendation, (Doc. 19), are DENIED. 2. The report .and recommendation, (Doc. 18), is ADOPTED. 3. The plaintiffs appeal, (Doc. 1), of the defendant Commissioner’s decision, is DENIED. 4. The Clerk of Court shall close this case. REPORT AND RECOMMENDATION TO DENY PLAINTIFF’S APPEAL GERALD B. COHN, UNITED STATES MAGISTRATE JUDGE REPORT AND RECOMMENDATION I. Introduction

Summary The administrative law judge (“ALJ”) thoroughly reviewed and accurately characterized the record. Substantial evidence supports the ALJ conclusion that Plaintiffs claims were not credible and that a number of her symptoms were the result of malingering. Plaintiff contends that the ALJ erred in rejecting her credibility on these grounds because she was diagnosed with a somatoform disorder, not malingering. A somatoform disorder may produce impairments severe enough to warrant an award of social security benefits.

A soma-toform disorder is characterized by symptoms that cannot be fully explained by a known medical reason, another mental disorder, or the direct effects of a substance. Although the diagnostic criteria require ruling out whether symptoms are the result of malingering, a somatoform diagnosis may coexist with malingering. In other words, it is possible for an individual to have a “mixed” diagnosis where some symptoms are due to a somatoform disorder, while other symptoms are intentionally feigned or exaggerated. Hence, soma-toform disorders and malingering are not mutually exclusive.

A somatoform diagnosis does not automatically preclude an ALJ from making an adverse credibility determination. Plaintiff reported to have been raped at the age of five-years-old and reported head trauma from a domestic violence incident in 2007. The records received prior to the June 2012 ALJ decision, reveal that Plaintiff has been seen by at least forty different doctors and other healthcare professionals over a span of roughly four years.

Plaintiff has underwent a number of outpatient medical visits, clinical tests, consultations, outpatient psychiatric treatment, therapy, has underwent inpatient psychiatric treatment twice (July 2011 and April 2012), and has visited the emergency department approximately one time in 2008, two times in 2009, three times in 2010, eight times in 2011, and once in 2012. During these many instances of seeking treatment, Plaintiff reported symptoms of dizziness, chest-pounding, and syncopal episodes where she would pass out and not remember what happened.

Examination and testing throughout this four year span generally revealed benign findings. Six different physicians whose reports were reviewed and approved by six additional attending physicians (on January 26, 2011, February 6, 2011, February 15, 2011, February 16, 2011, April 9, 2011, and April 13, 2011), observed indicia of Plaintiff intentionally feigning symptoms. Plaintiff has a criminal conviction for writing bad checks and initially lied in testimony about prior illegal drug use.

Plaintiffs inconsistent reporting of her symptoms and repeated indicia of feigned symptoms support the ALJ’s determination that Plaintiff did not actually experience a number of the symptoms and that she exaggerated other symptoms. Agency mental health experts concluded that Plaintiff exaggerated her level of dysfunction and did not diagnose Plaintiff with any type of somatoform disorder.

Rather, agency mental health experts found that Plaintiff met the diagnostic criteria for major depressive disorder; posttraumatic stress disorder (“PTSD”); and personality disorder, not otherwise specified, Cluster B traits. “Cluster B traits,” encompasses traits of antisocial, borderline, narcissistic and histrionic disorders, and histrionic disorder is characterized by “pervasive and excessive emotionality and attention-seeking behavior.” The ALJ based her credibility determination on the totality of the evidence and the ALJ did not rely solely on the lack of objective medical evidence to support Plaintiffs subjective symptoms, which may be explained by a somatoform disorder.

The ALJ also relied on Plaintiffs inconsistent statements, doctors’ observations of indicia of intentionally feigning symptoms, a conviction for writing bad checks, and initially lying diming testimony regarding prior illegal drug use. The ALJ properly relied on a state agency psychiatrist who reviewed the record, acknowledged Plaintiffs somatoform diagnosis, yet still concluded she could work, based, in part, on an examination by another state agency psychiatrist who observed that Plaintiff was overstating her level of dysfunction.

Under the deferential substantial evidence standard, the Court is bound by the reasonable conclusions of the ALJ. Even if Plaintiff offers an alternative, reasonable

interpretation of the evidence, the Court must uphold the decision of the ALJ if any reasonable person could find the relevant evidence as adequate to reach the decision. All of the opinions relied upon by the ALJ support her assessment. In addition to the inconsistencies between objective and subjective evidence, the ALJ pointed to multiple other legitimate reasons to find Plaintiff less than credible. Plaintiffs so-matoform diagnosis does not preclude this determination or automatically entitle her to benefits.

Consequently, the Court concludes that the ALJ’s decision was reasonable and recommends the appeal be denied. II. Procedural Background On January 27, 2011, Teresa Weidman (“Plaintiff’) filed as a claimant for disability insurance benefits under Title II and XVI of the Social Security Act, 42 U.S.C. §§ 401-34, 1181 — 1183f, with a last insured date of September 30, 2012, and claimed a disability onset date of November 30, 2010. (Administrative Transcript (hereinafter, “Tr.”), 326, 526-547).

After the claim was denied at the initial level of administrative review on June 21, 2011 (Tr. 426-445), the administrative law judge (“ALJ”) held a hearing on May 15, 2012. (Tr. 354-425). On June 8, 2012, the ALJ found that Plaintiff was not disabled within the meaning of the Act. (Tr. 323-350). On August 7, 2012, Plaintiff filed a request for review with the Appeals Council (Tr. 315-320), which the Appeals Council denied on January 28, 2014, thereby affirming the decision of the ALJ as the “final decision” of the Commissioner. (Tr. 1-7).

On March 24, 2014, Plaintiff filed the above-captioned action pursuant to 42 U.S.C. § 405(

g) and pursuant to 42 U.S.C. § 1383(c)(3), to appeal a decision of the Commissioner of the Social Security Administration denying social security benefits. (Doc. 1). On May 22, 2014, the Commissioner (“Defendant”) filed an answer, and an administrative transcript of proceedings. (Doc. 7, 8). On April 30, 2014, the Court referred this case to the undersigned Magistrate Judge. On August 4, 2014, Plaintiff filed a brief in support of the appeal. (Doc. 12 (“PI. Brief’)). On September 5, 2014, Defendant filed a brief in response. (Doc. 13 (“Def. Brief’)).

On September 16, 2014, Plaintiff filed a reply brief. (Doc. 14). III. Relevant Facts in the Record Plaintiff was born in July 1971 and thus was classified by the regulations as a younger person through the date of the ALJ decision rendered on June 8, 2012. (Tr. 344, 364-65); 20 C.F.R. § 404.1563(c). Plaintiff initially alleged the following impairments: 1) seizures; 2) double vision; 3) brain problems; 4) depression; and 5) dizziness. (Tr. 571) (application for benefits).

In a letter dated May 14, 2012, through counsel, Plaintiff additionally alleged to have: 1) undifferentiated somato-form disorder; 2) anxiety disorder; 3) PTSD; 4) major depressive disorder; and, 5) personality disorder. (Tr. 351). Plaintiff completed the twelfth grade. (Tr. 366, 572). Although Plaintiff testified that she was in the special education program at her high school, the records department from her former high school indicated that no records existed indicating that she took special education classes. (Tr. 366, 572, 951).

Plaintiff reported that she cared for her mentally and emotionally impaired children (who receive social security disability benefits), pets, and was able to meet personal needs unassisted and without reminders. (Tr. 366, 578-79). Plaintiff reported that she had never obtained a drivers’ license because a former abusive boyfriend of eleven years forbade her from driving and so she depends on her husband or a friend to drive her to appointments. (Tr. 367, 415).

Earnings reports demonstrate that Plaintiff has worked off and on since the age of eighteen with the following annual earnings from the most recent eight years: 1) 2004: met earning threshold for four quarters of coverage, totaling $16818.66; 2) 2005: met earning threshold for four quarters of coverage, totaling $4192.64; 3) 2006: met earning threshold for first three quarters of coverage, totaling $3481.25; 4) 2007: did not meet earning threshold for any quarter of coverage, totaling $32.83; 5) 2008: no earnings; 6) 2009: met earning threshold for four quarters of coverage as self-employed, totaling $15,863; 7) from 2010 through 2012, no earnings. (Tr. 558-563).

Her past relevant work includes working as a packer and cashier/stock-er/storekeeper. (Tr. 344, 593). Plaintiff had not engaged in substantial gainful activity since her alleged onset date of November 30, 2010. (Tr. 328.558-563). A. Relevant Treatment History and Medical Opinions 1. Good Samaritan Hospital In a treatment record dated September 24, 2009, in preparation for a tarsal tunnel procedure, it was noted that her medical history included depression and syncopal episodes for two years and although testing was inconclusive, the syncopal episodes may have been due to panic attacks. (Tr. 734).

On January 31, 2010, Plaintiff was brought by an ambulance to the emergency room. (Tr. 716-17). The treatment record noted “panic attack” and that Plaintiff was experiencing gastrointestinal symptoms, dizziness, and hand numbing. (Tr. 716-724). Dr. Michael Rusli diagnosed Plaintiff with viral gastroenteritis and with a panic attack, as evidenced through the hyperventilation. (Tr. 716-726). On July 6, 2010, Plaintiff arrived by ambulance to the ER due to chest pain radiating into the left arm with the left arm feeling numb and tingly. (Tr. 697-99).

Plaintiff reported that she had similar pain three days prior, the pain waxed and waned, and that she also experienced left lower quadrant pain. (Tr. 699-670). Plaintiff also reported that two weeks pri- or, she had a syncopal episode and hit her sternum on a banister. (Tr. 699, 701). On November 30, 2010, Plaintiff was hospitalized after she “passed out” after going to the bathroom. (Tr. 682, 686). Her children called 9-1-1 and Plaintiff complained of chest pain when she got into the ambulance and was pain free later at the hospital. (Tr. 682, 686).

On examination, Plaintiff was alert and coherent, and she exhibited a normal gait. (Tr. 688). An MRI of her chest revealed no evidence of cardiopulmonary disease. (Tr. 695). In a treatment record dated April 26, 2012, Plaintiff went to the ER seeking medical attention for suicidal ideation. (Tr. 1253). Once she was at the hospital, Plaintiff reported that her symptoms had improved. (Tr. 1250-55). 2. Hershey Medical Center: Michelle A. Fischer, M.D.; Krishnamoorthy Thamburaj; Steven M. Stuic, D.O.; Dr. Fauzia Mahr; Krista M. Todoric, M.D.; Aiesha Ahmed, M.D.; Diu-preet Kaur, M.D.; Sandra J.

Williams, D.O.; Kimberly R. Schol-field, M.D., F.A.C.E.P.; Nina Rig-gins, M.D.; Matthew P. Wicklund, M.D.; Nancy S. Graves, M.D.; Todd M. Felix, M.D.; Olympia P. Robert, M.D.; Brandon Bryce, M.D.; Thya-garajan Subramanian, M.D.; Divpreet Kaur, M.D.; Michelle Fischer, M.D., MPH, Fernando L. Cortes, MD; David Ermak, D.O.; David J. Gill, M.D.; Matthew L. Sil-vis, M.D.; Dr. Keith C. Kaplan, M.D.; Thomas Dykes, M.D.; El Centro Coffey, M.D.; Mark J. Ki-mak, M.D.; Alexandria N. Nickless, D.O.; Rory M. O’Neill, D.O.; Barbara A. Bentz, C.R.N.P.; Sveltana M. Yevtukh C.R.N.P.; Suzanne Frazier, C.R.N.P.

On January 2, 2008, Plaintiff reported that over the past few days she had experienced dizziness, nausea, headaches, and twenty-four hours of diarrhea. (Tr. 674). According to Plaintiff, a week prior, she passed out onto the floor from similar symptoms. (Tr. 674). Her daughter called EMS and Plaintiff was transported to Good Samaritan Hospital (“GSH”) emergency department around December 26th or December 27th. (Tr. 674).

Plaintiff reported that she had been having episodes like this periodically, and that with these episodes she often experienced right neck pain radiating sometimes down to her chest and felt as if her heart was pounding. (Tr. 674). Ms. Frazier noted that Plaintiff had been seen over the last few months for varying symptoms and had “encountered a domestic violence incident” a number of months ago and had developed chronic headaches and neck pain. (Tr. 674). Ms.

Frazier noted that Plaintiff had a “myriad of complaints [after the domestic encounter] of fatigue and facial numbness along with just feeling very weak.” (Tr. 674). Plaintiff had been evaluated by neurology and there were no neurological deficits noted and she received physical therapy for what was believed to be cervical strain and paresthesias from the “domestic incident.” (Tr. 674). Ms. Frazier noted that: [Plaintiffs] fatigue has been ongoing. She has had numerous blood tests done most recently being December 17th.

At that time she had normal thyroid function, normal Iron profile and CBC and her monospot was negative. Her electrolytes and fasting glucose have been normal.... When questioned further about the syncopal episode, she tells me that recently these episodes are different than the past times we have discussed. [During the previous syncopal episodes], she had felt very panicked and that was the explanation for her weakness and chest pounding. She has been treated for her depression and panic in the past.

The most two recent episodes, she feels that she blacked out and had not felt panicked before the event. (Tr. 674). Regarding the recent change in symptoms, Plaintiff stated that she had been experiencing headaches, not feeling well, not drinking as much fluids and her appetite had been waxing and waning over the last six months. (Tr. 674). At the time of the January 2008 visit, Plaintiff was not experiencing any chest pain, heart pounding, or paresthesias, and reported only feeling extremely weak. (Tr. 674). The examination was unremarkable and Ms.

Frazier noted no focal neurological deficits, no neurovascular deficits, and that Plaintiffs cranial nerves II though XIII were intact. (Tr. 675). Ms. Frazier noted that tests including the EKG were normal and assessed Plaintiff with dizziness, chest pain, gastroenteritis, and a history of depression. (Tr. 675). On March 11, 2008, Plaintiff sought follow-up treatment for depression. (Tr. 670). Ms. Frazier noted that Plaintiff: has had many chronic complaints over the last year including physical aches, dizziness, low mood, and chronic headaches; she also has been treated for depression/anxiety.

She has in the past been on Celexa and Lexapro with minimal results. She had recurring episodes of fatigue and dizziness. She wondered if that might have been related to the Lexapro. She had been checked for orthostasis and had a negative cardiology evaluation. Since she has been on the Cymbalta, the symptoms have resolved. It is possible that the Lexapro may have been a piece of the problem, although I don’t believe that we can blame all her symptoms on the medication. Nonetheless, the medication did not seem to be benefiting her. She has been on Cymbalta for 2 months and tells me that her mood is much improved.

She is sleeping without medication and overall her physical aches are much less. (Tr. 670). On May 12, 2008, Plaintiff complained of left wrist pain after trying to move some furniture. (Tr. 668). According to a treatment record dated June 23, 2008, Plaintiff complained of a sore throat and came after a visit with the ER and stated that prior to starting the medication from the ER she was experiencing fevers of 99 to 101. (Tr. 666). July 2, 2008, Plaintiff complained of a sore throat and reported that she was seen at the ER of GSH on June 22, 2008 and treated for pharyngitis. (Tr. 664).

After completing a five-day treatment of another medication, she reported that her overall achiness and other body symptoms were improved but, her ears hurt and her throat still itched and burned. (Tr. 664). She tested positive for Strep and diagnosed with Strep pharyngitis. (Tr. 664). On August 5, 2008, Plaintiff complained of foot pain which she had experienced for three to four weeks but had increased four days prior. (Tr. 660). On August 14, 2008, in response to foot pain, Plaintiff had X-rays which were normal and upon examination, a small plantar spur was noted. (Tr. 652-59).

On August 26, 2008, Plaintiff reported pain and swelling in the right leg with nothing alleviating or aggravating the pain. (Tr. 648). Ms. Frazier noted that “[Plaintiff] complains of 10/10 pain, although this seems excessive based on the fact that I am able to push and pull on her leg without her having an extreme reaction. She is able to weight bare, flex, and extend the leg without difficulty.” (Tr. 648). Plaintiff voiced concern that her symptoms may be due to a blood clot (Tr. 649), tests were normal (Tr. 650).

In a treatment record dated September 16, 2008, Plaintiff reported of ear pain and dizziness which had persisted for a few weeks. (Tr. 645). Plaintiff had no fever or ear-related symptoms. (Tr. 645). Plaintiff reported a history of having severe dizziness in January of 2008 followed by extensive testing which included cardiac factors, but there were no findings to explain the January 2008 symptoms. (Tr. 645). Ms. Frazier concluded that there were no clinical findings for Plaintiffs dizziness. On January 5, 2009, Plaintiff went to the ER with complaints of feeling dizzy and sleepy all of the time. (Tr. 641). Ms.

Yevtukh noted that three days prior, on January 2, 2009, Plaintiff visited the ER at the GSH due to a syncopal episode with shortness of breath. (Tr. 641). Ms. Yev-tukh noted that blood work, CAT scan of her head, and EKG results were within normal limits and Plaintiff was discharged from GSH without any medications. (Tr. 641). Plaintiff reported pain of six out of ten, with Tylenol relieving a dull headache and Ms. Yevtukh assessed her with dizziness. (Tr. 641). On December 2, 2010, Plaintiff was evaluated by Ms. Yevtukh. (Tr. 888).

Plaintiff reported of pre-syncopal episodes two to four times a day over the preceding three weeks. (Tr. 888). Plaintiff reported that the episodes would cause dizziness, fatigue, occasional paresthesias in her hands, blurred vision, decreased hearing, chest pain, and palpitations. (Tr. 888). After initial treatment at GSH, Plaintiff sought follow-up treatment and tests at Hershey Medical Center on December 2, 2010; December 4, 2010; December 6, 2010, and; December 13, 2010. (Tr. 881-919).

Physical examination findings were within normal limits with exception of an EKG which revealed evidence of sinus bra-dycardia. (Tr. 881-83, 888-89). Plaintiff experienced fatigue and lightheadedness during an exercise echocardiogram, however, an MRI of her brain revealed normal results. (Tr. 883, 885-86). On January 1, 2011, Plaintiff sought treatment from the ER (Tr. 863-66), due to reported recurrent and persistent dizziness and syncope since November 2010. (Tr. 856). Plaintiff was taken to the hospital after having a “blackout spell” along with daily symptoms of dizziness. (Tr. 856).

Plaintiff described these episodes as starting out with dizziness, followed by double vision, and then she would pass out. (Tr. 851). These episodes would happen once or twice a day and she would experience confusion upon waking up. (Tr. 851). During the latest episode just before her “blackout spell,” she felt dizzy and remembers waking up after the paramedics arrived. (Tr. 856). Neurological and physical examinations conducted on January 1, 2011, revealed unremarkable results, and a series of CT scans of Plaintiffs head, abdomen, pelvis, and spine all revealed normal results. (Tr. 864, 869-80, 867-80). Drs.

Coffey and Ki-mak noted that physical examination and diagnostic testing revealed no evidence of acute injury. (Tr. 865-66). In an examination conducted on January 1, 2011, while under the supervision of Dr. Dykes, Dr. Kaplan noted no evidence of mediastinal injury and no local contusions (bruising). (Tr. 859, 879, 880). Examination revealed no abnormalities, and Dr. Felix diagnosed Plaintiff with vertigo, recurrent; diplopia; a syncopal episode possibly related to or-thostasis; and, depression. (Tr. 857-59). On January 20, 2011, Plaintiff reported that she became dizzy and developed double vision. (Tr. 854).

During her evaluation, she described repeated episodes of loss of consciousness. (Tr. 854). When asked about other factors in her life, Plaintiff reported that she was having problems with her daughter, but did not go into details. (Tr. 855). Dr. Graves noted that the laboratory work was unremarkable and Plaintiff was referred to further testing with other departments. (Tr. 855). On January 21, 2011, Ms. Bentz, of the Hershey Cardiology Clinic wrote an outpatient letter to Ms. Yevtukh. (Tr. 851-852). The letter stated that Plaintiff had been evaluated for her syncope episodes. (Tr. 851).

Plaintiff had a CT of the head which showed no abnormalities, she also had a stress echocardiogram using the treadmill, but she was unable to complete the test due to dizziness and fatigue. (Tr. 851). However, a dobutamine stress echo determined that her heart was in good condition. (Tr. 851). The

summary of other tests and physical examination revealed no abnormal results. (Tr. 851-52). On January 26, 2011, Plaintiff stated to neurologist Dr. Riggins that she ran out of the medications that helped her symptoms. (Tr. 847). Plaintiff reported a history of having experiencing double vision and dizziness followed by a loss consciousness which started about a month prior and subsequently experienced four to six similar episodes since that time. (Tr. 847). Dr. Riggins noted that Plaintiffs medical history included daily persistent headaches reported after head trauma in 2007 due to domestic violence. (Tr. 847).

Plaintiff reported that she stopped using rock cocaine approximately four years ago and reported no other substance abuse. (Tr. 847). Upon examination, Plaintiff reported being unable to see all of Dr. Riggins’ fingers and those she saw were blurry. (Tr. 848). Dr. Riggins observed no neurological abnormalities. (Tr. 848). With regard to motor skills and strength, Dr. Riggins stated that such was “difficult to assess completely as [Plaintiff] create[d] very poor effort,” however, assessed Plaintiffs gross motor abilities as 5/5 bilaterally. (Tr. 848). Upon evaluation of Plaintiffs sensation, Dr.

Riggins observed, intact reflexes for all of the extremities, except Plaintiff reported “inconsistantly [sic] mild questionable decrease in sensation to the touch, pinprick from the different areas on her left arm.” (Tr. 848). From February 2, 2011, to February 5, 2011, Plaintiff underwent an EEG study wherein Plaintiff pressed a button to indicate symptoms of dizziness and blacking out. (Tr. 825-26, 843).

However, “[n]o electrographic abnormalities were seen with the events/symptoms” that Plaintiff indicated and the ambulatory EEG was deemed normal with no epileptiform features indicated from Plaintiff reported “spells/events.” (Tr. 826). On February 6, 2011, Plaintiff sought treatment at the ER. (Tr. 833-35). Plaintiff had three “loss of consciousness episodes” that day and underwent a consultation with Dr. Kaur under the supervision of Dr. Subramanian, Director of Division of Movement Disorders and professor of Neurology. (Tr. 833). Dr.

Kaur noted that all of these episodes have been reported by her husband as Plaintiff did not remember any of these episodes. (Tr. 833). The day of the consultation, Plaintiff reported that she had two episodes in the morning and one in the afternoon while she was sitting on the couch watching television. (Tr. 833). After the last episode, Plaintiffs husband attempted to wake her with a sternal rub, however, she remained unresponsive. (Tr. 833). Treatment notes indicated that paramedics found her unresponsive when they arrived and gave her 2mg of Narcan and she became responsive. (Tr. 837).

Plaintiff denied taking any medications to induce unresponsiveness. (Tr. 837). The differential diagnosis for Plaintiffs symptoms included: urinary tract infection, alcohol intoxication, drug abuse, dehydration, electrolyte imbalance, depression, anxiety, medication reaction, pseudoseizures, and psychiatric causes. (Tr. 838). Urine drug screen and alcohol screen tests were ordered. (Tr. 839). In another treatment record dated February 6, 2011, Dr. Williams examined Plaintiff and was supervised by Dr. Schol-field. (Tr. 840). Dr.

Williams observed: At one point, [Plaintiff] rang for nurse, then when nurse went into room, [Plaintiff] was unresponsive to voice with fluttering eyelids. I was called in, tried sternal rub with no change, then put tongue blade in to check for gag reflex. [Plaintiff] had intact gag and immediately after, woke up and said “What happened?” [Plaintiff] had 2 more self-limited episodes while [I] was here. (Tr. 840). On February 8, 2011, Plaintiff underwent a MRI of her brain, an angiogram of her head, an MRI angiography of her cervical spine. (Tr. 829-30). Dr.

Thamburaj interpreted the tests and found them unremarkable. (Tr. 830). On February 15, 2011, Plaintiff went to the emergency room due to sudden vision loss. (Tr. 811). Plaintiff reported that over the prior two months, she would have episodes where she would develop double vision followed by complete left eye visual field obscuration, which would last for a few minutes and then would resolve completely on its own. (Tr. 811).

Plaintiff reported that recently, she also had continued episodes involving her right eye, where symptoms begin with double vision followed by vision in both eyes going completely black and lasting for a couple of minutes. (Tr. 811).

It was also noted that Plaintiffs MRI/MRA was recently taken with the findings reported as “hypointense T2 signals in the bilateral globus pallidus substanyia nigra retina nucleus and den-tate nucleus of the cerebellum uncommon for the age” and “a normal variant in the absence of extrapyramidal symptoms such as tremors, rigidity, or akinesia, otherwise was negative.” (Tr. 811, 821, 823-24, 829-30). During examination, Plaintiff reported decreased sensation over all three left branches of the trigeminal nerve, ten percent of the right, and a reported “seemingly bilateral cranial nerve XI weakness.” (Tr. 812).

However, Dr. Todoric observed that the results “seem[ed] somewhat effort related.” (Tr. 812). Dr. Todoric noted that Plaintiff was able to do finger-to-nose without difficulty even though Plaintiff claimed to continue to experience bilateral loss of vision. (Tr. 812). Dr. Todoric observed that Plaintiff also correctly copied when Dr. Todoric said “do this” while raising her arms parallel or spreading her fingers, although Plaintiff claimed that she was unable to see a pen or name its color. (Tr. 812). According to Dr.

Todoric, Plaintiff stated that she was unable to complete other visual tests saying “no ifs, ands, or buts.” (Tr. 812). Dr. Todoric determined that Plaintiff should: be admitted for neurology observation due to questionable lesions shown on a prior MRI and deficit/proprioception on the left; undergo a head CT to rule out other causes for symptoms; undergo a psychiatry consultation to rule out “either malingering, facticious, [sic] or conversion.” (Tr. 813). Plaintiff then underwent a psychiatric evaluation with Dr. Stuic under the supervision of Dr.

Mahr, to “rule out conversion versus malingering” as a reason for blindness. (Tr. 808). Dr. Stuic noted that Plaintiff reported that she had a “substantial abuse history” in a previous relationship for eleven and half years with the father of her two children. (Tr. 808). The former relationship included physical, mental, and occasional sexual abuse. (Tr. 808). She reported that this man went to jail for six months as a result of threats of violence towards her and she still had contact with him due to a weekend custody arrangement with her children. (Tr. 809).

At the time of the examination she was not in current danger, stating that the last year has been the best of her life. (Tr. 809). List of medications included: 1) Flu-oxetine 40 mg daily; 2) Protonix 40 mg b.i.d.; 3) Meclizine 25 mg t.i.d.; 4) Clona-zepam 0.5 mg b.i.d.; 5) Midodrine 5 mg t.i.d.; 6) Topamax 25 mg q.a.m., 50 mg q.p.m.; and, 7) Diclofenac 50 mg b.i.d. (Tr. 809). Plaintiff reported not currently drinking or using illicit drugs. (Tr. 809). Dr.

Stuic noted that Plaintiff was cooperative, tracked his movements on walking into the room, maintained good eye contact throughout the exam, and maintained normal speech. (Tr. 809). Dr. Stuic noted that: Plaintiff maintained an alert state of consciousness; she was oriented to time, place and, person; her attention and concentration was normal, and; insight and judgment was fair. (Tr. 809). For the neurological exam, Dr. Stuic observed that initially when testing, extrao-cular motor function, Plaintiff would not track his finger. (Tr. 809).

However, upon repeated tries Plaintiff was able to track his finger without any deficits. (Tr. 809). Dr. Stuic found that Plaintiffs ex-traocular motor function was intact. (Tr. 809). Dr. Stuic noted that testing of Plaintiffs proprioception with finger-to-nose with the eyes closed as well as finger-nose-to-finger test for any dysmetria revealed that although Plaintiff was able to do the test with her right finger, when she tried with her left finger, she repeatedly pointed the left finger to the right chin. (Tr. 809). Dr. Stuic determined that the rest of the neurologic examination unremarkable. (Tr. 809). Drs.

Stuic and Mahr concluded that in the absence of any organic neurologic disorder identified by their colleagues in neurology, they diagnosed Plaintiff with “[u]n-differentiated somatoform disorder not otherwise specified,” anxiety disorder not otherwise specified, chronic posttraumatic stress disorder, and “major depression disorder, recurrent, mild, resolving.” (Tr. 810). Plaintiff was assigned a Global Assessment of Functioning (“GAF”) score of 45. (Tr. 810). As a plan for treatment, Drs.

Stuic and Mahr proposed increasing Plaintiffs prescription of Prozac starting the next morning, for Plaintiff to have outpatient psychotherapy, and to continue treatment with her outpatient psychiatrist at Philhaven. (Tr. 810). On February 16, 2011, Plaintiff was examined by Dr. Robert under the supervision of Dr. Bryce. (Tr. 818-820). Examination demonstrated normal results except Dr. Robert noted that for the neurological part of the examination, Plaintiffs “[g]ri-mace does not appear normal,” however, questioned Plaintiffs effort. (Tr. 819).

On February 17, 2011, Plaintiff was discharged with a diagnosis of undifferentiated somatoform disorder, presenting with symptoms of bilateral vision loss, likely secondary to major depression disorder (MDD), anxiety, and PTSD. (Tr. 814). In a record dated March 7, 2011, Dr. Thamburaj interpreted an MR spectroscopy and concluded normal findings for the right basal ganglia and noted: Decreased [N-acetyl-aspartate (NAA) ] and increased choline in left basal gang-ha. Findings could support a diagnosis of idiopathic neurodegenerative disease with brain iron accumulation in the appropriate clinical background.

Followup [sic] basal ganglia MRS after 6 months to one year may be obtained to validate the findings and exclude technical factors providing [these] conflicting findings between the .right and left side. (Tr. 804-05). In an ER treatment record dated March 13, 2011, Plaintiff complained of a headache radiating down her neck and lasting four days. (Tr. 785). Dr. Fischer noted that Plaintiff visited on March 10, 2011, due to syncope and visited March 12, 2011, due to weakness. (Tr. 785).

Examination revealed unremarkable results, including a normal neurological examination, and Plaintiff received a prescription for medication. (Tr. 785-87). Dr. Riggins examined Plaintiff on March 29, 2011, and recorded normal results. (Tr. 990). She reviewed the results of an EEG study, which were normal, as well as an MRI of Plaintiffs brain, which revealed decreased N-acetyl-aspartate (NAA) and increased choline in the left basal ganglia. (Tr. 989, 993-98). On April 3, 2011, Plaintiff sought emergency treatment after she reportedly lost consciousness for approximately two minutes. (Tr. 984).

She also reported an inability to see out of both eyes, with repeated, intermittent loss of vision in her right eye. (Tr. 984). Examination revealed normal pupils, intact extraocular movements, and normal neurological and physical findings. (Tr. 986). Drs. Nick-less and O’Neill also noted no associated injuries with the recent syncopal episode. (Tr. 984). On April 9, 2011, Plaintiff alleged that she fell to the floor and her whole body began to shake. (Tr. 974). She was fully conscious but did not respond during the episode, which lasted approximately five minutes. (Tr. 974).

Later that evening, her feet, arms, and head began shaking, and Plaintiff sought emergency treatment. (Tr. 974). Her husband reported that, on the way to the hospital, Plaintiff continued to shake and struck herself in the face. (Tr. 974). Dr. Ermak observed that “[d]uring the examination, [Plaintiff] multiple times shakes her head side to side and says ‘see here, it’s staring again.’ These movements last for seconds and then go away as I distract the patient.” (Tr. 975). Dr. Ermak assessed Plaintiff with “nonspecific nonepileptic intermittent movements of her head, extremities, and trunk.” (Tr. 975). Dr.

Ermak further stated that “[a]t this time, [Plaintiffs] movements do not appear to be generated from a seizure focus of any kind based on the events witnessed by myself in the emergency department. These appear to be consciously driven.” (Tr. 975). Dr. Ermak’s observations and conclusions were approved by Dr. Gill. (Tr. 976). On April 13, 2011, Plaintiff sought emergency treatment for “shakiness” after she fell at home. (Tr. 971). Dr. Cortes, under the supervision of Dr.

Fischer, observed that her head moved from side to side, but all examination findings were normal and the movement ceased when Plaintiff was distracted. (Tr. 971-72). Drs. Cortes and Fischer gave a presumptive diagnosis of “movement disorder versus factitious disorder.” (Tr. 972). On April 14, 2011, Drs. Riggins and Wicklund referred Plaintiff to Dr. Subra-manian who examined Plaintiff for a possible movement disorder. (Tr. 969). Dr.

Subramanian noted that: There are extensive records provided to me by the way of the electronic records here at the Hershey Medical Center, which documents multiple episodes of admission to the Hershey Medical Center ED and evaluation by numerous physicians here at Hershey Medical Center ... on multiple admissions.... Rest of the history is well summarized in the previous records available here at the Hershey Medical Center including extensive workup,' laboratory studies, which have all been essentially negative. (Tr. 969). Dr.

Subramanian also noted that Plaintiff: has had chronic depression and panic attacks from 1990 onwards and she has changed her medication via other psychiatrist at least 5 times every year on satisfactory resolution of symptoms. More recently, in the last 6 months or so, due to continued stress from her daughter’s illness, patient also has de-compensated. (Tr. 969). Dr. Subramanian noted that despite Plaintiffs allegation that she fell several times a week, prior examination findings were unremarkable. (Tr. 969).

He recorded completely normal neurological findings, including normal sensation, normal gait, negative Romberg sign, and negative finger-to-nose and heel-to-shin tests. (Tr. 969). He opined: I do not believe this is any form of neurodegenerativo disorder. The patient has clear-cut evidence of untreated or poorly treated depression, and she now has considerable stressors in her life that would easily explain the ongoing neuropsychiatric illness. I think her best bet is to gét aggressive psychiatric treatment in eluding psychotherapy and perhaps involvement of posttraumatic stress disorder counseling.

This requires concerted effort to improve. I don’t think there is any evidence that the patient has any neurological illness at the present time. I am not even certain that she needs further neurological workup of any kind or even followup of any kind. The overt clinical manifestations of her symptoms, which include falling and trashing around, pounding the ground with her hand, head shaking side-to-side do not represent an organic illness in my opinion. She clearly doesn’t have it while I was examining and there is no clear stigmata of any neurological illness.

She has had numerous admissions, numerous workups, and I think at this point, no further workup is indicated as the yield is highly unlikely to be of any use. This was discussed with the husband and the patient. Patient has agreed with me. She thought that her symptoms could not be due to depression and that she sought another diagnosis. I advised her that she is welcome to seek another opinion from another doctor and if she needs any referral, I would be more than happy to provide her.

But in my opinion, she does not have an organic illness and she does not need any further workup for her presumed illness at the present time. I have not scheduled a followup with her. I do not intend to follow her in my clinic. No further communication on this patient’s neurological or what is considered neurological illness is warranted with my office. (Tr. 969-70). On May 29, 2011, Plaintiff went to the walk-in clinic for treatment of a leg wound as a result of wrestling a knife away from her sleepwalking daughter. (Tr. 1028). On June 6, 2011, Dr.

Riggins noted that Plaintiff failed to appear for a follow-up examination. (Tr. 1026). July 25, 2011, Plaintiff sought treatment for a “cyst-like mass above her vaginal hood.” (Tr. 1024). Upon examination, Dr. Silvis observed that Plaintiff appeared to have a soft tissue mass superior to her vaginal hood, determined that it was possibly an early infectious process and prescribed antibiotics. (Tr. 1024). On December 21, 2011, Plaintiff sought treatment for an upper respiratory infection. (Tr. 1018). On January 11, Plaintiff returned because her cough was not improving and Ms.

Yevtukh observed normal findings and assessed Plaintiff to have a cough. (Tr. 1018). January 16, 2012, and January 25, 2012, Plaintiff sought outpatient treatment for breast discharge. (Tr. 1014-1017). On April 24, 2012, Ms. Yevtukh recorded benign findings after examining Plaintiff for dizziness. (Tr. 287-88, 1315-18). Without any previous examinations or medical observations noting the existence of any bruising, Ms. Yevtukh indicated that Plaintiff had a “bruising tendency” (Tr. 288,1316), (a remark which appears to be quoted later by Dr. Truong in a letter dated July 16, 2012 (Tr. 321)).

On April 24, 2012, Plaintiff went to Hershey Medical Center because of dizziness. (Tr. 1315). Plaintiff complained that the dizziness was constant and was exacerbated by emotional stress, exertion, and sleep deprivation. (Tr. 1315). Plaintiff reported neck pain, joint pain, muscle pain, and decreased range of motion. (Tr. 1316). Plaintiff reported suffering from moderate radiating pain in her back, had an unsteady gait, was not coordinated, and was not able to balance on her left leg or right leg. (Tr. 1316). Plaintiff also exhibited confusion. (Tr. 1318). On April 24, 2012, Ms.

Yevtukh completed a physical Residual Functional Capacity (RFC) questionnaire. (Tr. 1245). Ms. Yevtukh indicated that she has seen Plaintiff every six months for the last two years. (Tr. 1245). Ms. Yevtukh wrote that Plaintiffs diagnoses included dizziness and visual disturbance, which she also included as Plaintiffs symptoms along with unstable gait, and fatigue. (Tr. 1245). She gave no opinion regarding her prognosis, noting, “I am not a neurologist,” and further noted that Plaintiff was examined by a neurologist who found no cause for her symptoms. (Tr. 1245). Ms.

Yevtukh wrote that Plaintiff reported constant left eye pain of nine out of ten with ten indicating the most severe pain. (Tr. 1245). In response to the question of whether Plaintiffs impairments’ have lasted or could be expected to last at least twelve months, Ms. Yevtukh replied that she did not know, and later stated that the earliest that Plaintiffs symptoms and limitations developed was ten months ago. (Tr. 1245, 1248). Ms.

Yevtukh checked sections of the form indicating that Plaintiff was not a malingerer and that depression, anxiety, and somatoform disorder affects Plaintiffs physical condition. (Tr. 1245). In response to the question of whether Plaintiffs impairments are reasonably consistent with the symptoms and functional limitations described in the evaluation, Ms. Yevtukh indicated “no” and explained, “I do not manage her depression.” (Tr. 1246). Without further explanation, Ms. Yevtukh indicated that Plaintiff was incapable of “low stress” jobs. (Tr. 1246).

She indicated that Plaintiff: 1) could walk two to three city blocks without rest or severe pain; 2) could sit for up to an hour and ten minutes at one time and less than two hours in an 8-hour day; 3) could stand for up to an hour and forty-five minutes at a time or up to two hours in an 8-hour day; 4) needs to walk around every forty-five minutes for at least fifteen minutes at a time; 5) needs change positions throughout the day; 6) take unscheduled breaks; 7) requires the occasional use of a cane; 8) could lift up to ten pounds; 9) and she had various postural and upper extremity limitations. (Tr. 1246-48).

Finally, Ms. Yevtukh opined that Plaintiffs impairments or treatment would cause her to be absent from work more than four days a month. (Tr. 1248). On May 25, 2012, Plaintiff sought medical treatment for vision loss and loss of consciousness. (Tr. 1286, 1293). She also reported that she heard several voices, one of which told her to jump out the window after a particularly difficult day with her daughter. (Tr. 1286). Examination revealed normal neurologic and mental status findings. (Tr. 1287). A CT scan of Plaintiffs brain revealed no acute intracra-nial abnormality. (Tr. 1300). 3.

Wal-Mart Vision Center In April 2012, Plaintiff sought treatment for blurry vision and was diagnosed with cortical blindness and cortical abrasion. (Tr. 1244). 4. PA Eye Surgery Center In a treatment record dated May 4, 2012, Plaintiff reported that her left ear started hurting in 2011, and then vision gradually decreased for a year and went totally black since January 2012. (Tr. 1270). Plaintiff reported that she would experience double vision and have episodes of vision going black; all day dizziness for a year; balance issues, walking into things, and tripping

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