United States District Court, M.D. Pennsylvania
YVETTE KANE UNITED STATES DISTRICT JUDGE
Plaintiff Jeffrey Anthony has filed this action seeking review of a decision of the Commissioner of Social Security ("Commissioner") denying Anthony’s claim for social security disability insurance benefits and supplemental security income benefits. (Doc. 1).
Disability insurance benefits are paid to an individual if that individual is disabled and “insured.” Anthony met the insured status requirements of the Social Security Act through December 31, 2014. Tr. 15. In order to establish entitlement to disability insurance benefits Anthony was required to establish that he suffered from a disability on or before that date. 42 U.S.C. § 423(a)(1)(A).
Anthony protectively filed his applications for supplemental security income benefits and disability insurance benefits on November 12, 2010 and November 22, 2010 respectively, claiming that he became disabled on March 22, 2010. Tr. 13, 134. Anthony has been diagnosed with several impairments, including: Hypokalemia, Duodenitis, Esophagitis, Hyperlipidemia, Major Depressive Disorder, Anxiety Disorder, Attention Deficit-Hyperactivity Disorder (“ADHD”), Dyslexia, Auditory Processing Disorder, and Borderline Normal/Mild Intellectual Deficiencies. Tr. 15-16. On January 26, 2011, Anthony’s applications were initially denied by the Bureau of Disability Determination. Tr. 90.
On January 31, 2011, Anthony requested a hearing before an administrative law judge (“ALJ”). Tr. 76. The ALJ conducted a hearing on January 10, 2012, where Anthony was represented by counsel. Tr. 30-60. On March 9, 2012, the ALJ issued a decision denying Anthony’s applications. Tr. 13-23. On June 3, 2013, the Appeals Council declined to grant review. Tr. 1. Anthony filed a complaint before this Court on August 5, 2013, and this case became ripe for disposition on February 20, 2014, when Anthony declined to file a reply brief. (Docs. 1, 16, 17).
Anthony appeals the ALJ’s determination on three grounds: (1) the ALJ erred in failing to explain how Anthony’s hypokalemia was accounted for in the residual functional capacity determination, (2) the ALJ failed to give appropriate weight to the opinion of Anthony’s treating physician, and (3) the ALJ improperly discounted Anthony’s credibility. (Doc. 16). For the reasons set forth below, the decision of the Commissioner is affirmed.
II. STATEMENT OF RELEVANT FACTS
Anthony was thirty-seven years of age at the time of the ALJ’s decision, has obtained a GED, and is able to read, write, speak, and understand the English language. Tr. 31-32, 153. Anthony’s past relevant work included work as a stores laborer, which is classified as medium, unskilled work, as a landscape laborer, which is medium, unskilled work, and as a forklift operator, which is medium, semi-skilled work. Tr. 55.
A. Anthony’s Hypokalemia
Prior to the relevant period, on July 22, 2009, Anthony presented to the Carlisle Regional Medical Center with complaints of severe muscle weakness and diarrhea. Tr. 304. Anthony was found to have severe hypokalemia (low potassium levels) with a potassium level of 1.8; he was treated with potassium supplements. Tr. 304, 306. With correction of the hypokalemia, Anthony’s “muscular weakness improved dramatically.” Tr. 304. Within twenty-four hours Anthony’s potassium levels had risen to 3.3, his muscle strength was normal, and he was able to ambulate under his own power. Id. The etiology of Anthony’s hypokalemia remained unknown, and Gregory Lewis, M.D. opined that the diarrhea likely was not severe enough or frequent enough to cause Anthony’s condition. Tr. 217. Furthermore, Dr. Lewis noted that Anthony’s “pattern of stooling [remained] unchanged since childhood” and Anthony had never sought treatment for that condition. Tr. 216.
On August 25, 2009, Anthony was examined by Kevin Scott, M.D. Tr. 362. Dr. Scott noted that there had been no repeat episodes of muscle strength loss in the previous month, though Anthony reported several episodes of mild muscle weakness. Id. Anthony had a normal gait, normal reflexes, and a normal physical and neurological examination. Tr. 363. Dr. Scott diagnosed Anthony with “[e]pisodic muscle weakness secondary to hypokalemia” but opined that the “presentation is suggestive of hypokalemic periodic paralysis.” Tr. 364.
On June 23, 2010, Anthony was referred to Navin Verma, M.D. for an evaluation. Tr. 370-72. Dr. Verma noted that Anthony had been on potassium supplements since July 2009, and his “more recent [potassium] levels [were] in normal range.” Tr. 370. Anthony reported occasional visual changes, diarrhea, and muscle cramps. Tr. 371. A physical examination was normal, and Anthony was grossly intact neurologically. Id. Dr. Verma’s impression was of one episode of hypokalemia, possibly due to dehydration or gastrointestinal losses. Id. Urine collection had not revealed any potassium wasting; Dr. Verma was unable to uncover any significant etiology, and recommended a high potassium diet. Id.
On August 22, 2011, Anthony presented to the Sadler Health Corporation with complaints of muscles aches, as well as leg and hip pain. Tr. 433. His potassium level was slightly low at 3.2,  and he was encouraged to eat grapes and bananas. Id. On September 28, 2011 and October 6, 2011, Anthony’s potassium levels remained normal. Tr. 430. Anthony reported some pain in his lower extremities, but took twenty-four potassium pills which “helped.” Id.
On December 4, 2011, Anthony presented to the emergency room with complaints of leg weakness and an inability to walk. Tr. 474. Anthony was able to lift his legs, although he was unable to stand or ambulate at the time of admittance. Tr. 476. His potassium level was 1.9 and he was diagnosed with hypokalemia. Tr. 474, 476. Gabriel Gabason, M.D. opined that further observation was needed to determine the etiology of the hypokalemia. Tr. 477. By December 5, Anthony’s potassium levels had increased to 3.1, and upon discharge on December 6, his potassium levels were normal at 4.1. Tr. 480, 496.
B. Anthony’s Mental Impairments
On April 2, 2010, Anthony presented to William Thomas, M.S. for a psychological evaluation. Tr. 218. Dr. Thomas administered a Wechsler Adult Intelligence Scale – III test; Anthony scored seventy-eight on the verbal IQ portion, ninety-two on the performance IQ portion, and had a full scale IQ of eighty-four. Id. Dr. Thomas noted that Anthony “presented as a friendly [and] amicable individual with whom rapport was readily established.” Tr. 219. He answered questions directly in a frank and sincere manner, and “cooperated to the best of his abilities with all expectations.” Id.
Dr. Thomas opined that Anthony’s IQ scores were indicative of “[b]orderline normal/mildly retarded everyday adjustment and/or functioning[.]” Tr. 220. Anthony had average innate cognitive endowment with a likely presence of ADHD and a likely learning disability. Id. He was diagnosed with ADHD, Borderline Normal/Mild Intellectual Difficulties, Dyslexia, and Auditory Processing Disorder. Tr. 221. Dr. Thomas recommended dyslexic intervention, cognitive/behavioral intervention, and psychostimulants to treat ADHD. Id.
Between April and June 2010, Anthony sought treatment from Kelly Caruso, M.D. Tr. 250-53, 262-64. Anthony consistently had a normal mood and affect, was alert and oriented, and had intact immediate and remote memory. Id. His judgment was realistic and his insight was appropriate. Id.
On June 23, 2010, Anthony presented to the Northwestern Human Services Stevens Center (“Stevens Center”). Tr. 234. Anthony had normal speech, an appropriate appearance, clear and coherent thought processes, and appropriate thought content. Id. His mood and affect were depressed, but he was oriented and had adequate memory. Id. Anthony was cooperative, had a positive attitude, and good daily functions. Tr. 235. He was diagnosed with Adjustment Disorder with anxiety and a depressed mood, and was assigned a GAF score of fifty. Id.
On September 1, 2010, Anthony was examined by Mohammad Ikram, M.D. in relation to his mental impairments. Tr. 376. Anthony reported being depressed for most of his life, and reported chronic sadness, occasional crying, isolation, irritability, and an inability to relax. Tr. 377. Dr. Ikram noted that Anthony was somewhat unkempt and disheveled, restless, and became distracted from time to time. Tr. 378. He made good eye contact, had no abnormal movements, and had mostly coherent speech. Id. Anthony had a depressed mood and a sad and anxious affect, but a goal-directed thought process with some circumstantiality. Id. He was alert and oriented, had adequate insight and judgment, reported no suicidal or homicidal thoughts, and no hallucinations or delusions. Tr. 378-79. Dr. Ikram started Anthony on Zoloft and trazodone, continued Concerta at the current dose for ADHD, and recommended that Anthony continue with therapy. Tr. 379.
On September 15, 2010, Anthony continued to have a disheveled appearance and poor hygiene. Tr. 374. He was irritable with an anxious mood and appropriate affect, though he had improved attention and concentration. Id. His memory was intact, his thought processes were coherent, and he had no suicidal or homicidal thoughts. Id. Anthony reported that he had not ...