Vest v. SSA

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF KENTUCKY

CENTRAL DIVISION

LEXINGTON

) SCOTTY LEE VEST, )

) Plaintiff, )

) NO. 5:19-CV-00486-MAS

v. )

) ANDREW SAUL, ) Commissioner of Social Security, )

) )

Defendant. )

OPINION & ORDER Plaintiff Scotty Lee Vest (“Vest”) appeals the denial of the Commissioner’s denial of his application for Supplemental Security Income (“SSI”) benefits under Title XVI of the Social Security Act (“SSA”).1 Before the Court are the parties’ cross-motions for summary judgment. [DE 16, 18]. For the reasons here discussed, the Court finds that the Administrative Law Judge (“ALJ”) applied the proper legal framework and supported her non-disability finding with substantial evidence in the record. The Court grants the Commissioner’s motion and denies Vest’s competing motion.

I. FACTUAL AND PROCEDURAL BACKGROUND Vest, then 42 years old, protectively filed an SSI application on January 14, 2016, alleging disability beginning February 2, 2007.2 [R. at 50, 220, 231]. Vest attended school through completion of the seventh grade and has prior work experience as a dishwasher, dye mixer, drive- through cashier, and fry cook. [R. at 110, 401–02]. ALJ Karen Jackson conducted an administrative hearing (at which Vest was present) on May 5, 2017, and she denied Vest’s SSI claim initially on June 22, 2017. [R. at 102, 232]. On October 16, 2017, the Appeals Council vacated ALJ Jackson’s June 22 decision and remanded the case for consideration of certain specified issues. [R at 240–41]. Specifically, the ALJ was directed to obtain additional evidence regarding Vest’s impairments to complete the administrative record, further evaluate third-party statements, provide additional rationale, and further evaluate Plaintiff’s residual functional capacity (“RFC”) during the at-issue period and explain the weight assigned to treating and non- treating sources. [R. at 19–20].

ALJ Jackson conducted a second hearing on October 24, 2018. [R. at 50]. Non-attorney representative Patsy Hughes represented Vest at the October 2018 administrative hearing, and impartial Vocational Expert (“VE”) Laura Lykins was also present and testified. [R. at 50–99]. On December 21, 2018, in a thorough and lengthy written opinion, ALJ Jackson again found that Vest was not disabled during the relevant period3 and denied Vest’s SSI application. [R. at 19–

ALJ Jackson ultimately concluded that Vest had the RFC to perform light work as defined in 20 C.F.R. § 416.967(b), with certain outlined exertional and non-exertional limitations. [R. at 24–25]. For instance, the ALJ found that Vest could lift, carry, push, or pull twenty pounds occasionally and ten pounds frequently, could walk/stand or sit for six hours out of an eight-hour workday, could frequently climb stairs, could occasionally climb ladders or ropes, could frequently stoop and kneel, and should avoid concentrated exposure to extremely cold temperatures, humidity, and fumes/gases, among other things. [Id.]. Additionally, the ALJ determined that Vest was limited to performing simple routine work tasks, could maintain attention and concentration for such tasks in two-hour segments, could adapt to gradual workplace changes, could frequently definition of disability while her SSI application was pending” and clarifying that the relevant period was between application filing and the decision date); see id. (explaining that, though “disability evidence completely unrelated to the relevant period is irrelevant to adjudication of the claim[,] . . . pre-application medical records may be relevant to the existence of a disability during the relevant period” in some instances).

Though ALJ Jackson held that Vest could not perform past relevant work (see 20 C.F.R. § 416.965), she found—informed by VE testimony and based on Vest’s age, education, work experience, and RFC—that jobs existed in significant numbers in the national economy that Plaintiff could perform. [R. at 38–39]. See 20 C.F.R. §§ 416.969, 416.969a. These representative areas of work, as described in the Dictionary of Occupational Titles (“DOT”), included: packaging and sorting, weighing, measuring, checking, and inspecting, and bench assembly work. [R. at 39]. ALJ Jackson thus found that Vest was not disabled under the SSA during the pendency of his benefits application. [R. at 40]. See 20 C.F.R. § 416.920(g).

On October 15, 2019, the Appeals Council denied Vest’s request for review of the ALJ’s December 2018 decision. [R. at 1]. Vest subsequently filed this action in December 2019 [DE 1], and the parties filed cross-motions for summary judgment in July and August 2020 [DE 16, 18]. This matter is now ripe for review and resolution.

II. LEGAL FRAMEWORK Judicial review of the ALJ’s decision is deferential and strictly limited. The Court’s sole task is to determine whether the ALJ applied the correct legal standards and whether the ALJ’s factual findings are supported by substantial evidence in the record. See Blakley v. Comm’r of Soc. Sec., 581 F.3d 399, 405 (6th Cir. 2009); Jordan v. Comm’r of Soc. Sec., 548 F.3d 417, 422 (6th Cir. 2008); see also 42 U.S.C. § 405(g) (“The findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive[.]”). Substantial evidence is “more than a scintilla of evidence, but less than a preponderance; it is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Cutlip v. Sec’y of Health & Human Servs., 25 F.3d 284, 286 (6th Cir. 1994). “The substantial-evidence standard allows considerable latitude to administrative decision makers” and “presupposes that there is a zone of choice within which the decisionmakers can go either way, without interference by the courts.” Mullen v. Bowen, 800 F.2d 535, 545 (6th Cir. 1986) (quoting Baker v. Heckler, 730 F.2d 1147, 1150 (8th Cir. 1984)).

The Court must make its substantial evidence determination based on the record as a whole. Cutlip, 25 F.3d at 286. However, the Court need not comb the entire (lengthy) record in search for facts supporting under-developed arguments. [See DE 16 (General Order No. 13-7) (citing Hollon ex rel. Hollon v. Comm’r of Soc. Sec., 447 F.3d 477, 491 (6th Cir. 2006)) (“The parties shall provide the Court with specific page citations to the administrative record to support their arguments. The Court will not undertake an open-ended review of the entirety of the administrative record to find support for the parties’ arguments.”)]. Further, the Court may not “try the case de novo, resolve conflicts in evidence, or decide questions of credibility.” Bass v. McMahon, 499 F.3d 506, 509 (6th Cir. 2007). The Court must affirm the ALJ’s decision if there is substantial evidence in the record to support it, even if substantial evidence might also support the opposite conclusion. Warner v. Comm’r of Soc. Sec., 375 F.3d 387, 393 (6th Cir. 2004); Mullen, 800 F.2d at 545. Likewise, the Court must affirm any ALJ decision supported by substantial evidence, even if the Court itself might have reached a different original result. See Longworth v. Comm’r of Soc. Sec., 402 F.3d 591, 595 (6th Cir. 2005); Her v. Comm’r of Soc. Sec., 203 F.3d 388, 389–90 (6th Cir. 1999).

For context, the Court briefly outlines the proper five-step sequential analysis as conducted by an ALJ in determining disability status. See Preslar v. Sec’y of Health & Human Servs., 14 F.3d 1107, 1110 (6th Cir. 1994); 20 C.F.R. §§ 416.920(a), 404.1520(a). In the first step, the ALJ decides whether the claimant is performing substantial gainful activity. 20 C.F.R. §§ 416.920(a)(4)(i), 404.1520(a)(4)(i). In the second step, the ALJ determines whether the claimant suffers from any severe impairments. Id. at §§ 416.920(a)(4)(ii), 404.1520(a)(4)(ii). In the third step, the ALJ decides whether such impairments, either individually or collectively, meet an entry in the Listing of Impairments. Id. at §§ 416.920(a)(4)(iii), 404.1520(a)(4)(iii). In the fourth step, the ALJ determines the claimant’s RFC and assesses whether the claimant can perform past relevant work. Id. at §§ 416.920(a)(4)(iv), 404.1520(a)(4)(iv). Finally, in the fifth step, the burden shifts to the Commissioner. The ALJ must consider and decide whether there are jobs that exist in significant numbers in the national economy that the claimant could perform based on RFC, age, education, and work experience. Id. at §§ 416.920(a)(4)(v), 404.1520(a)(4)(v). If the ALJ determines at any step that the claimant is not disabled, the analysis ends there.

III. ANALYSIS Plaintiff broadly argues that the ALJ’s non-disability determination—in particular, her RFC conclusion and reliance upon the VE testimony—is not supported by substantial evidence. Specifically, Vest argues that the ALJ improperly rejected the opinions of treating and examining sources without adequate explanation for the weight assigned to them. Vest further argues that the hypotheticals ALJ Jackson posed to the VE did not appropriately reflect the impairments and limitations indicated by the sources the ALJ relied upon. The Court addresses, and ultimately rejects, each contention in turn.

A. THE ALJ DID NOT IMPROPERLY DISCOUNT THE IDENTIFIED TREATING AND EXAMINING

SOURCES’ OPINIONS, AND HER ULTIMATE RFC CONCLUSION IS SUPPORTED BY SUBSTANTIAL EVIDENCE.5 Vest first argues that ALJ Jackson provided insufficient explanation for her decision to assign little weight to the opinions of Vest’s treating neurologist, Dr. Alexander Landfield, M.D.,

1. Dr. Landfield’s Opinions Per the record, Dr. Landfield’s neurology practice, Kentucky Neurology & Rehab, treated Vest from approximately April 2017 through the fall of 2018. [R. at 829, 845–864]. During that period, Vest saw Dr. Landfield regularly, and he also saw Advanced Practice Registered Nurse (‘APRN”) Elizabeth Northcutt.6 [Id.]. In June 2017, Dr. Landfield advised that Vest, “[d]ue to his medical condition,” could not “sit or stand for more than 20” minutes. [R. at 829]. In January 2018, APRN Northcutt opined that Vest had “been diagnosed with a chronic medical condition which does not permit him to obtain gainful employment,” and, accordingly, that Vest was “permanently disabled.” [R. at 830 (emphasis omitted)]. Finally, in September 2018, Dr. Landfield rendered a nearly identical opinion, stating that Vest suffered from a chronic medical condition that precluded work and therefore was permanently disabled. [R. at 861]. of the issues, the Court analyzes only the physical evidence and corresponding ALJ findings in this section of its discussion.

The ALJ assigned little weight to all three opinions (Dr. Landfield’s June 2017 and September 2018 opinions, and APRN Northcutt’s January 2018 statement). [R. at 37]. She found that the opinions were unhelpfully vague, failing to identify the allegedly disabling chronic conditions. Moreover, she found that the opinions did not include or reference clinical findings explaining why the chronic conditions were allegedly disabling, and she further noted that the opinions were not entirely consistent with the objective medical evidence of record. Vest challenges the ALJ’s weight assignment, arguing that ALJ Jackson violated the treating source rule as to Dr. Landfield’s opinions. Vest contends that Dr. Landfield’s opinion is well-explained when referenced in conjunction with his treating notes, and that it is consistent with Dr. Landfield’s own findings and other medical evidence (including Ms. Northcutt’s findings and opinion).

The Court first determines whether Dr. Landfield was, in fact, a treating source. Cole v. Astrue, 661 F.3d 931, 938 (6th Cir. 2011). Under the regulations, it appears that Dr. Landfield does so qualify, given his ongoing treatment relationship with Vest and his status as an acceptable medical source (i.e., a licensed physician). See id.; 20 C.F.R. § 416.927(a)(2). Next, for any treating source opinion, the Court must ensure that the ALJ complied with the applicable regulations in assigning it weight. If an ALJ does not assign controlling weight to a treating source opinion, she must evaluate it per the factors outlined in § 416.927(c)(2) and is required to “give good reasons . . . for the weight” ultimately assigned to the “treating source’s medical opinion.” 20 C.F.R. §§ 416.927(c), (c)(2). Such “reasons must be ‘supported by the evidence in the case record, and must be sufficiently specific to make clear to any subsequent reviewers the weight the adjudicator gave to the treating source’s medical opinion and the reasons for that weight.’” Cole, 661 F.3d at 937 (quoting Soc. Sec. Rul. No. 96–2p, 1996 WL 374188, at *5 (July 2, 2996)). The treating source rule is more than just a mere formality; it is critical to permit meaningful review of the ALJ’s decision and to evaluate the ALJ’s compliance with the governing regulations. Id. at 938.

Here, the ALJ elected, in her discretion, not to assign Dr. Landfield’s opinion controlling weight. Instead, upon balancing the § 416.927(c)(2) factors,7 ALJ Jackson decided to assign it little weight because she found it conclusory, non-specific, and unsupported by objective medical evidence. ALJ Jackson’s rationale in this regard is reasonable, supported by substantial evidence in the record, and—albeit brief—adequate, in context of the full decision, to permit meaningful judicial review. First, neither the June 2017 nor the September 2018 Dr. Landfield opinion specifies the underlying chronic conditions deemed disabling. Though Vest accurately notes that Dr. Landfield’s treatment notes indicate several apparently chronic conditions, neither of Dr. Landfield’s statements identifies which of these conditions is, individually or in combination, the basis for his disability opinion or his view that Vest could not sit or stand for more than 20 minutes at a time. [See R. at 843–860 (Ex. 21F) (identifying chronic impairments including lumbar disc disease, osteoarthritis, lumbar radiculopathy, muscle spasms, and Marfan Syndrome, but not tying them to any specific work- or activity-related limitations or concrete disability finding)].

Throughout the treatment notes, Dr. Landfield mentions various objective symptoms that could conceivably stem from the identified impairments and could, in theory, limit Plaintiff’s daily functioning. [See, e.g., R. at 847, 853–60 (noting gait/limp issues, to some extent)]. However, Dr. Landfield’s opinion statements do not offer any explanation for why these impairments limit Vest to 20 minutes of standing/sitting per day, or, moreover, why such a limitation alone would render

Further, Dr. Landfield’s opinions are not entirely consistent with or supported by his own clinical findings. Though Exhibit 21F indicates occasional limping/imbalance (i.e., observed ataxic and antalgic gaits), apparently worsening from January 2018 forward, other objective findings indicate normal functioning. For instance, Dr. Landfield regularly observed normal reflexes, normal and unimpaired motor strength, and intact sensation. [R. at 845, 846, 848, 851, 853, 855, 857, 859]. Given the mix of normal findings (largely related to mental status, motor strength, and sensation) and abnormal findings (largely related to gait and lumbar tenderness), it is not immediately clear how the findings interact and translate into functional limitations. There is some support in Dr. Landfield’s objective records for his disability opinions, but it is far from overwhelming or unequivocal, so as to make plain the medical foundation for such conclusory opinions. This leaves Dr. Landfield’s opinions without the necessary explanatory or clinical scaffolding, and ALJ Jackson reasonably found them internally unsupported.

Finally, neither APRN Northcutt’s limited notes, nor the other evidence in the record, is so supportive of Dr. Landfield’s treating source opinions as to cure their patent deficiencies and elevate them to controlling status. Between December 2017 and January 2018, APRN Northcutt found that Vest suffered from lower back pain and difficulty walking, identifying conditions similar to those Dr. Landfield diagnosed (such as lumbar radiculopathy and lumbar sciatica). [R. at 862, 864]. Though broadly consistent with Dr. Landfield’s findings, APRN Northcutt’s notes are exceptionally brief, devoid of detail, and lacking objective foundation. There are no test results or other diagnostic data accompanying the brief treatment notes from Ms. Northcutt. Nor, notably, is the other evidence of record so wholly supportive of Dr. Landfield’s opinions that it renders them categorically well-founded. As in most cases, the medical evidence here is somewhat mixed. Some proof referenced by the ALJ indicates potential need for more restrictive limitations. [R. at 30 (ALJ discussion); R. at 666 (opining that Vest would have “moderate-to-severe difficulty lifting, handling, or carrying objects” in April 2016); R. at 681–82 (noting in August 2016 that Vest presented with chronic pain unalleviated by prescribed medication, and that Vest’s range of motion was somewhat decreased by pain and stiffness); R. at 776 (noting similar pain findings in December 2016).

Other evidence from within the relevant period, though, suggests more normal functioning with only mild/moderate limitations. [R. at 29, 31 (ALJ discussion); R. at 630–31 (noting mild degenerative changes to the medial malleolus (inner ankle) and mild hip joint narrowing in February 2016); R. at 774–75 (observing normal musculoskeletal system without deformities and a “smooth” gait “other than slight limp” in January 2017); R. at 771–72 (reflecting normal, mild, and mild-to-moderate findings in April 2017 lumbar spine imaging); R. at 867 (July 2017 MRI results indicating mild-to-moderate spinal stenosis); R. at 666 [Dr. Owen observing a normal gait in April 2016)]. Ultimately, the ALJ is tasked with balancing the respective findings, and nothing in this record demonstrates that AJL Jackson unreasonably discounted Dr. Landfield’s opinions when considered against the full backdrop of proof.

Accordingly, the ALJ’s weighing of Dr. Landfield’s treating source opinions is reasonable in context of the complete record. Though brief, her weight assignment—when read in conjunction with the decision as a whole, in which ALJ Jackson carefully surveyed all factual evidence—is sufficient to convey the crux of her analysis and enable appropriate judicial review. See Buckhanon ex rel. J.H. v. Astrue, 368 F. App’x 674, 678–79 (7th Cir. 2010) (observing that courts must “read the ALJ's decision as a whole and with common sense”); Rice v. Barnhart, 384 F.3d 363, 370 n.5 (7th Cir. 2004) (recognizing that “it is proper to read the ALJ’s decision as a whole . . . because it would be a needless formality to have the ALJ repeat substantially similar factual analyses at” various steps in the sequential process). It is apparent that ALJ Jackson undertook a balancing of the § 416.927(c)(2) factors as required by the regulatory framework, and that she found Dr. Landfield’s opinions vague, inadequately supported internally or by his treatment notes and findings, and not entirely consistent with other evidence of record. See, e.g., Elliott v. Saul, No. 3:18-CV-00720, 2019 WL 4748311, at *4 (M.D. Tenn. Sept. 30, 2019) (observing, in relation to the parallel Chapter 404 DIB provision, that “[w]hen determining the weight to give the opinion of a treating physician, ALJs need not explicitly mention in their decisions every factor” listed in the regulation) (collecting cases). And, for the reasons discussed, ALJ Jackson’s handling of the factors and ultimate weight assignment is supported by substantial evidence. The ALJ thus did not violate the treating source rule in this case.

2. Dr. Owen’s Opinion Dr. Owen, a state agency medical consultant, examined Vest in April 2016. [R. at 664]. Though not a treating source under the regulations, Dr. Owen is an examining source typically entitled to comparatively greater weight than non-examining sources. “Generally, [the Commissioner] give[s] more weight to the medical opinion of a source who has examined [the claimant] than to the medical opinion of a medical source who has not examined [him].” 20 C.F.R. § 927(c)(1) (emphasis added). However, the regulation “fails to mandate such prioritizing and lists several other factors that the ALJ must consider.” Livingston v. Comm’r of Soc. Sec., 776 F. App'x 897, 901 (6th Cir. 2019). Such factors, as previously outlined, include the frequency of examination, the opinion’s supportability, its consistency, and the provider’s specialization, among other things. 20 C.F.R. § 927(c)(2)(i), (3)-(5).

Following his single consultative examination of Vest on April 19, 2016, Dr. Owen submitted a six-page medical report summarizing his physical examination findings, as well as Vest’s subjective statements concerning his medical history and current pain. [R. at 664–68 (Ex. 9F)]. At the conclusion of the narrative portion of the report, Dr. Owen opined, as to Vest’s “ability to do work-related activities,” that “he would have moderate-to-severe difficulty lifting, handling or carrying objects.” [R. at 666]. Dr. Owen included no further detail as to the basis for the opinion, and he did not discuss any other perceived functional limitations. ALJ Jackson’s decision reflects thorough review and consideration of Dr. Owen’s findings and medical opinion. [R. at 30]. ALJ Jackson ultimately assigned the opinion limited weight, finding the opinion “vague and not consistent with [Dr. Owen’s] examination findings or the medical evidence as a whole, including the MRI results and the clinical findings discussed at Exhibit No. 23F.” [R. at 37].

Plaintiff argues that the ALJ’s rationale in this regard failed to provide legitimate reasons for discounting Dr. Owen’s opinion. He contends that the medical evidence in the full record “is consistent with debilitating limitations[,]” and that Dr. Owen’s notes reflecting right ankle reflex issues and diminished sensation and motion range further support the functional opinion. [DE 16- 1, at Page ID # 936]. Vest ultimately maintains that ALJ Jackson insufficiently explained his limited weight assignment. [Id., at Page ID # 937].

However, as ALJ Jackson found, Dr. Owen’s proposed limitations on carrying, lifting, and handling objects are not entirely consistent with or thoroughly supported by his own examination notes and findings. Though Dr. Owen indeed found below-average grip strength numbers in both Vest’s right and his left hands,8 he also noted, somewhat inconsistently, that Vest’s “[s]trength, sensation, and coordination all appear[ed] to be within normal limits.” [R. at 665–66]. Moreover, Dr. Owen’s report notably lacks many supportive clinical findings; on the attached diagrams intended to reflect range of motion values, Dr. Owen did not record any information regarding Vest’s shoulder, elbow, wrist, finger, or thumb functioning—all seemingly relevant to assessment of an individual’s ability to lift, handle, and carry objects. [R. at 667]. Accordingly, Dr. Owen’s findings are only minimally supported by even his own clinical data. Contrary to Vest’s argument, Dr. Owen’s brief finding as to right ankle reflex issues [R. at 666] has little to do with his strictly cabined opinion, that involved only Vest’s lifting/carrying/object-handling capabilities. Dr. Owen did not connect the statement regarding Vest’s ankle reflexes to his ultimate opinion in anyway, and it is not at all clear how the ankle reflex finding specifically relates to or supports Dr. Owen’s lifting/carrying/object-handling conclusion.

Additionally, as ALJ Jackson also noted, these opined restrictions are not entirely consistent with the other objective medical evidence of record. ALJ Jackson correctly observed that the July 2017 MRI reflected normal grip strength (5/5 bilaterally) and normal shoulder

The ALJ’s decision confirms that she properly applied the regulatory standards, considering such factors as Dr. Owen’s opinion’s level of detail and explanation, its supportability, and its overall consistency with the record as a whole. Moreover, her weighing of the opinion is supported by substantial evidence, as discussed. ALJ Jackson thus did not improperly discount the limited and fairly vague opinion of Dr. Owen, based on his one-time examination of Vest.

3. ALJ Jackson’s Ultimate RFC Conclusion Lastly, as an overarching matter, Plaintiff argues that the ALJ’s RFC determination (at least, to the extent it reflects exertional capabilities and limitations) is not supported by substantial evidence in the record. Specifically, Vest argues that, without greater reliance on the evidence from Dr. Landfield and Dr. Owen, any RFC determination is left medically unsupported. He further asserts that the ALJ erred in relying in part on the 2013 opinion of consultative examiner Dr. Fahira Zaheer, M.D., criticizing it as vague and outdated. [DE 16-1, at Page ID # 937].

The ALJ found that Vest could perform light work, with several specified qualifiers.9 For instance, ALJ Jackson concluded that Vest could lift, carry, push, and pull 20 pounds occasionally10 and 10 pounds frequently, could walk, sit, and stand for roughly six hours out of an eight-hour workday, could frequently climb stairs and ramps and occasionally climb ladders, could frequently stoop, kneel, and crouch, and should avoid concentrated exposure to extreme temperatures, humidity, and fumes. [R. at 24]. In formulating Vest’s RFC, it is apparent that the ALJ thoroughly surveyed all of the medical (objective and opinion) and nonmedical proof in the record. ALJ Jackson methodically discussed and summarized the evidence, and the decision demonstrates her careful consideration of the full record. [R. at 24–38]. See also Buckhanon ex rel. J.H. v. Astrue, 368 F. App’x 674, 678–79 (7th Cir. 2010) (observing that courts “read the ALJ’s decision as a whole and with common sense”); Rice v. Barnhart, 384 F.3d 363, 370 n.5 (7th Cir. 2004) (recognizing that “it is proper to read the ALJ’s decision as a whole”).

Plaintiff challenges the RFC finding, arguing that any reliance on Dr. Zaheer’s 2013 opinion was error, and contending that the ALJ did not cite enough medical opinion or functional limitation evidence to support the RFC. As to Dr. Zaheer’s May 2013 opinion, the Court agrees

Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities.

However, despite the admitted room for improvement in the clarity and detail of the ALJ’s analysis, the ALJ’s assignment of only moderate weight, coupled with the limited purpose for which ALJ Jackson used the opinion—essentially, merely to demonstrate that Vest is not entirely prohibited from gainful activity—is reasonable in context of the ALJ’s full opinion and is ultimately supported by substantial evidence. See generally Cutlip, 25 F.3d at 286 (characterizing substantial evidence simply as “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion”). Critically, in contrast to the cases where an ALJ’s reliance on an outdated opinion has been found to be reversible error, Vest does not here argue (and the record does not indicate) any material changes in or worsening of Vest’s chronic conditions between the May 2013 opinion and the relevant period. Cf. Karns v. Astrue, No. 3:10-CV-318, 2012 WL 1185990, at *2 (S.D. Ohio Apr. 9, 2012), report and recommendation adopted, 2012 WL 1463546 (S.D. Ohio Apr. 27, 2012) (concluding that an outdated medical source opinion that did not account for an intervening heart attack could not constitute substantial evidence and that the ALJ’s reliance on it was error, as the Court could not assume that the medical opinion would not have changed based on the new and material information); Elliot v. Comm'r of Soc. Sec., No. 3:15-CV-00464, 2017 WL 489743, at *5 (S.D. Ohio Feb. 7, 2017), report and recommendation adopted, No. 3:15- CV-464, 2017 WL 749005 (S.D. Ohio Feb. 24, 2017) (finding that the ALJ erred in relying on a nurse’s opinion rendered more than five years before the SSI application date and which predated objective evidence showing worsening of the plaintiff’s condition).

Rather, the later evidence in this case generally shows only mild degenerative changes in Vest’s condition within the relevant period, and the proof within the relevant window is largely consistent with Dr. Zaheer’s functional findings. [See R. at 630–31 (mild degenerative changes to the inner ankle and mild hip joint narrowing in February 2016); R. at 774–75 (normal musculoskeletal system without deformities and a “smooth” gait “other than slight limp” in January 2017); R. at 771–72 (normal, mild, and mild-to-moderate findings in April 2017 lumbar spine imaging); R. at 867 (mild-to-moderate spinal stenosis); compare R. at 606 (Dr. Zaheer finding relatively normal musculoskeletal functioning with some hip movement limitations, unimpaired ability to rise from a sitting position and to bend/walk, and normal grip strength and motor movement in May 2013) with R. at 845, 846, 848, 851, 853, 855, 857, 859 (Dr. Landfield noting normal motor strength and musculoskeletal functioning on several occasions between April 2017 and August 2018) and R. at 666 (Dr. Owen noting normal gait and station and unimpaired ability to get on an off the examination table in April 2016).

The ALJ’s thorough discussion of all of the medical and nonmedical evidence makes clear that she considered the full record, and the proof she specifically mentions at various points in her analysis (as discussed above) demonstrates the consistency between Dr. Zaheer’s opinion and later medical information. Accordingly, given the Zaheer opinion’s relative consistency with later evidence and the absence of any material intervening medical events or diagnoses that would invalidate the earlier findings, Dr. Zaheer’s opinion is not necessarily stale or irrelevant, and the ALJ’s partial reliance on it is not categorical error in the context of this specific record. See, e.g., Cauthen, 827 F. App’x at 446 (explaining that, though “disability evidence completely unrelated to the relevant period is irrelevant to adjudication of the claim[,] . . . pre-application medical records may be relevant to the existence of a disability during the relevant period” in some instances); Matthews v. Saul, No. CV 18-1110 (RC), 2020 WL 5440573, at *12 (D.D.C. Sept. 10, 2020) (observing that older medical records are not per se stale because of later information, provided the ALJ’s decision in full permits courts to discern a logical connection between the opinion and the weight assigned). Reading ALJ Jackson’s opinion as a whole, she found Dr. Zaheer’s opinion relatively consistent with other evidence, and not rendered obsolete by later contrary information. Such a determination is not unreasonable on this record, and the ALJ’s moderate weight assignment (and limited use of the opinion) is substantially supported. The Court thus cannot disturb the finding, even if it may have weighed the opinion differently upon independent review.

Finally, the ALJ Jackson did not require additional medical source opinions in order to reach a substantially supported overall RFC conclusion. The Sixth Circuit has expressly rejected the contention that an ALJ’s failure to cite a specific medical opinion supporting the RFC conclusion categorically renders it unsupported by substantial evidence. Mokbel-Aljahmi v. Comm’r of Soc. Sec., 732 F. App’x 395, 401 (6th Cir. 2018) (“We have previously rejected the argument that a residual functional capacity determination cannot be supported by substantial evidence unless a physician offers an opinion consistent with that of the ALJ.”) (collecting supportive cases). See also Woelk v. Comm’r of Soc. Sec., No. CIV.A. 13-12411, 2014 WL 2931404, at *7 (E.D. Mich. May 15, 2014), report and recommendation adopted, No. 13-12411, 2014 WL 2931411 (E.D. Mich. June 30, 2014) (noting that an ALJ’s reliance on medical evidence rather than medical opinions in support for the RFC “is not per se grounds for error” and emphasizing that and ALJ must make the RFC determination based on the entire record, including medical and nonmedical evidence and other factors, under the SSA regulations);11 20 C.F.R. 416.945(a)(3).

In any event, ALJ Jackson indeed assigned at least some weight to the various opinions of Dr. Zaheer, Dr. Owen, and Dr. Landfield. Such weight assignments were reasonable and supported, as already discussed. The medical evidence cited and discussed in detail by the ALJ, all within the RFC section of her decision, further offers substantial support for the ultimate RFC conclusion. The record supports ALJ Jackson’s functional determinations as to Vest’s particular capacity to lift/carry [see R. at 867, 845–859 (unimpaired motor and grip strength), 665 (Vest himself representing an ability to lift 10 pounds)], walk/stand/sit [see R. at 774–75 (mostly smooth gait, no need for a cane, and no musculoskeletal abnormalities), 666 (normal gait, walk, and ability to get up and down from table), 630–31 (only mold ankle and hip joint impairment)], climb stairs and stoop/kneel [see R. at 606, 666], and tolerate exposure to humidity and fumes [see R. at 51 (hearing testimony reflected Vest’s undisputed chronic pulmonary obstructive disorder (“COPD”) diagnosis and related respiratory issues]. Based on all of the medical proof (both objective and opinion) amassed by ALJ Jackson in the RFC-specific portion of her discussion, the record

B. THE ALJ’S HYPOTHETICALS TO THE VE ACCURATELY REFLECTED THE DETERMINED

MENTAL FUNCTIONING LIMITATIONS.12 Vest next argues, briefly, that the VE testimony concerning job availability cannot constitute substantial evidence supporting the ALJ’s non-disability finding because the hypotheticals presented to the VE did not accurately reflect the mental impairments that the ALJ assessed. Specifically, Vest asserts that ALJ Jackson, despite assigning great weight to the opinion of Dr. Emily E. Skaggs, Psy. D, did not appropriately incorporate Dr. Skaggs’s findings into the VE hypotheticals.13 In June 2016, Dr. Skaggs performed a consultative examination and found, among other things, that Vest showed normal memory and concentration, appropriate and logical thought processes and content, average intellectual functioning, adequate judgment and insight, and normal decision-making skills. [R. at 35–36 (ALJ discussion); R. at 670–80 (Ex. 10F)].

In terms of functional limitations, Dr. Skaggs opined that Vest had a slightly limited ability to understand/remember and to carry out simple, repetitive tasks, a markedly limited ability to tolerate workplace stress and pressure, and a moderately limited ability to sustain attention and concentration and to deal with co-workers and supervisors. ALJ Jackson accorded these opinions significant weight, and she specifically noted that the mental RFC’s inclusion of a finding that Vest should have no requirements for fast-paced production goals or quotas reflected Dr. Skaggs’s

Nonetheless, Plaintiff insists (somewhat inexplicably, given the ALJ’s relatively straightforward analysis on this front) that it is “unclear” how ALJ Jackson accounted for the marked stress tolerance limitations. [DE 16-1, at Page ID # 939]. Vest does not, however, acknowledge the ALJ’s explicit inclusion of the no-quota requirement or the ALJ’s express intent that such a requirement targeted Vest’s stress tolerance limitation. Nor does Vest explain his view that the ALJ’s incorporation of the limitation is unclear. Accordingly, contrary to Vest’s assertion, the record is indeed clear that the ALJ’s RFC finding and assessed limitations directly accounted for Dr. Skaggs’s opined stress tolerance limitations. Vest provides no authority or developed argument suggesting otherwise.

Moreover, the hypotheticals that ALJ Jackson presented to the VE fully incorporated the assessed functional limitations based on Dr. Skaggs’s stress tolerance opinion. “In order for a vocational expert’s testimony in response to a hypothetical question to serve as substantial evidence in support of the conclusion that a claimant can perform other work, the question must accurately portray a claimant’s physical and mental impairments.” Ealy v. Comm’r of Soc. Sec., 594 F.3d 504, 516 (6th Cir. 2010). To the extent the ALJ’s determination as to Vest’s mental impairments was based on Dr. Skaggs’s opinion, the hypotheticals posed accurately portrayed the opined limitations. At the October 2018 hearing, ALJ Jackson specifically asked VE Laura Lykins about employment opportunity for an individual who could adapt only “to gradual changes in a routine work environment” and for whom there was “[n]o requirement for fast-paced production goals.” [R. at 89]. Moreover, VE Lykins expressly accounted for the no-quota circumstance in her response, noting that she was evaluating “[a]lternative light, unskilled work” and was “going to reduce [her] figures by 50% based on the no fast-paced production.” [R. at 90]. And, though the ALJ at times varied her hypothetical to gauge the job availability with different restrictions applied, she at no point removed these stress-related limitations or portrayed any greater ability to tolerate workplace pressures, specifically. [R. at 92-94].

Accordingly, the record flatly contradicts Vest’s assertion that ALJ Jackson’s hypotheticals to VE Lykins failed to incorporate the marked stress tolerance limitations included in Dr. Skaggs’s opinion. The Court thus rejects this challenge and, absent any further argument casting doubt on ALJ Jackson’s reliance on VE Lykins’s testimony, the Court perceives no grounds for disturbing the ALJ’s findings in this regard. ALJ Jackson’s mental RFC is consistent with Dr. Skaggs’s opinion and the other mental health evidence of record and reasonably received great weight (a finding Vest does not here contest), and the VE testimony was based on an accurate representation of that mental health proof. VE Lykins’s testimony thus provides substantial evidence supporting ALJ Jackson’s non-disability finding.

IV. CONCLUSION For all of the reasons discussed, the Court GRANTS the Commissioner’s motion for summary judgment (DE 18) and DENIES Vest’s competing motion (DE 16). A corresponding Judgment follows.

This the 23rd day of March, 2021.

SER Signed By: uf. 7) Matthew A. Stinnett MAS a” United States Magistrate Judge