United States District Court, E.D. Pennsylvania
MEMORANDUM AND ORDER
ELIZABETH T. HEY, U.S.M.J.
Joyce Sheppard (“Plaintiff”) seeks review of the
Commissioner's decision denying her claim for disability
insurance benefits (“DIB”). I conclude that the
decision of the Administrative Law Judge (“ALJ”)
denying benefits is supported by substantial evidence and
will affirm the Commissioner's decision.
protectively filed for DIB on July 13, 2015, claiming that
she became disabled on April 1, 2013, due to migraine
headaches, chronic obstructive pulmonary disease
(“COPD”), dizziness, and leg and knee pain and
swelling. Tr. at 61, 119, 150.The application
was denied initially, id. 64-68, and Plaintiff
requested an administrative hearing before an ALJ,
id. at 70, which took place on May 10, 2017.
Id. at 27-51. On September 19, 2017, the ALJ found
that Plaintiff was not disabled. Id. at 11-21. The
Appeals Council denied Plaintiff's request for review on
September 25, 2018, id. at 1-3, making the ALJ's
September 19, 2017 decision the final decision of the
Commissioner. 20 C.F.R. § 404.981.
commenced this action in federal court on October 19, 2018.
Doc. 1. The matter is now fully briefed and ripe for review.
prove disability, a claimant must demonstrate an
“inability to engage in any substantial gainful
activity by reason of any medically determinable physical or
mental impairment . . . which has lasted or can be expected
to last for . . . not less than twelve months.” 42
U.S.C. § 423(d)(1). The Commissioner employs a five-step
1. Whether the claimant is currently engaged in substantially
2. If not, whether the claimant has a “severe
impairment” that significantly limits her physical or
mental ability to perform basic work activities;
3. If so, whether based on the medical evidence, the
impairment meets or equals the criteria of an impairment
listed in the listing of impairments
(“Listings”), 20 C.F.R. pt. 404, subpt. P, app.
1, which results in a presumption of disability;
4. If the impairment does not meet or equal the criteria for
a listed impairment, whether, despite the severe impairment,
the claimant has the residual functional capacity
(“RFC”) to perform her past work; and
5. If the claimant cannot perform his past work, then the
final step is to determine whether there is other work in the
national economy that the claimant can perform.
See Zirnsak v. Colvin, 777 F.3d 607, 610 (3d Cir.
2014); see also 20 C.F.R. § 404.1520(a)(4).
Plaintiff bears the burden of proof at steps one through
four, while the burden shifts to the Commissioner at the
fifth step to establish that the claimant is capable of
performing other jobs in the local and national economies, in
light of her age, education, work experience, and RFC.
See Poulos v. Comm'r of Soc. Sec., 474 F.3d 88,
92 (3d Cir. 2007).
court's role on judicial review is to determine whether
the Commissioner's decision is supported by substantial
evidence. 42 U.S.C. § 405(g); Schaudeck v.
Comm'r of Soc. Sec., 181 F.3d 429, 431 (3d
Cir. 1999). Therefore, the issue in this case is whether
there is substantial evidence to support the
Commissioner's conclusions that Plaintiff is not disabled
and is capable of performing jobs that exist in significant
numbers in the national economy. Substantial evidence is
“such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion, ” and must
be “more than a mere scintilla.”
Zirnsak, 777 F.2d at 610 (quoting Rutherford v.
Barnhart, 399 F.3d 546, 552 (3d Cir. 2005)). The court
has plenary review of legal issues. Schaudeck, 181
F.3d at 431.
ALJ's Findings and Plaintiff's
found that Plaintiff suffered from three severe impairments
at the second step of the sequential evaluation; migraines,
degenerative joint disease of the right knee, and obesity.
Tr. at 13. The ALJ found that Plaintiff did not have
an impairment or combination of impairments that met the
Listings, id. at 15, and that Plaintiff retained the
RFC to perform light work except she is limited to no
climbing of ladders, ropes, or scaffolds; no kneeling or
crawling; no more than occasionally performing all other
postural maneuvers; no exposure to hazards such as
unprotected heights or moving mechanical parts; no outdoor
work; no bright or flickering lights such as those found in
metal-cutting or welding; and no more than moderate noise.
Id. at 16. At the fourth step of the evaluation, the
ALJ found that Plaintiff could perform her past relevant work
as a medical assistant. Id. at 19. In the
alternative, the ALJ found at step five that there were other
jobs that existed in significant numbers in the national
economy that Plaintiff could perform. Id. at 20.
claims that the ALJ (1) failed to properly consider the
opinions of her treating neurologists, (2) mischaracterized
the evidence of record, (3) erred in discrediting
Plaintiff's testimony, and (4) failed to properly utilize
Vocational Expert (“VE”) testimony. Doc. 15 at
5-13. Defendant responds that the ALJ properly considered the
medical opinions, Plaintiff's testimony, and the VE
testimony, and argues that substantial evidence supports the
ALJ's decision. Doc. 16 at 6-14
Summary of Medical Evidence
record references Plaintiff's treatment for various
physical ailments, and I will summarize these first before
turning to her primary complaint of migraines. Her history
includes plantar fasciitis of the left foot, chest pain,
vertigo, and back pain and spasm. Tr. at 228, 263,
264, 433442. Plaintiff began experiencing right knee
pain after a fall in August 2014. Id. at 228, 248,
377. Orthopedist George Stollsteimer, M.D., diagnosed
Plaintiff with meniscal tears, a subchondral cyst,
subchrondal edema,  and degenerative joint disease of the
right knee, for which she underwent arthroscopy with partial
meniscectomy and chondroplasty on January 2, 2015. Id.
at 308, 368, 377-78. After the surgery, Plaintiff underwent
several injections for continued pain. Id. at 358,
360 (2/24/15 - Depo-Medrol injection), 336, 338 (5/7/15 -
Orthovisc injection), 330, 333 (5/21/15 - Orthovisc
injection), 319, 324, 326 (7/9/15 - lidocaine
same fall, Plaintiff also injured her left hindfoot.
Tr. at 354. An MRI revealed posterior tibial
tendinitis and tenosynovitis,  for which Andre Pagiaro, M.D.,
performed Carbocaine and Depo-Medrol injection on March 25,
2015. Id. at 351, 355.
October 23, 2015, Dr. Stollsteimer performed a right knee
iliotibial band resection due to continued pain in the
lateral aspect of the knee. Id. at 410, 491. Two
months after the surgery, Plaintiff twisted her knee and
complained of increased pain in the knee. Id. at
490. In January 2016, Plaintiff again fell, landing on her
right knee. Id. at 488. When she saw Dr.
Stollsteimer on January 13, she was complaining of increased
pain in the right knee and pain in the right ankle and left
foot. Id. X-rays of the knee, ankle, and foot were
unremarkable. Id. The doctor prescribed a Medrol
Dosepak. Id. at 489. Dr. Stollsteimer
ordered an MR arthrogram to evaluate the meniscus for a
re-tear or worsening arthritic symptoms, id. at 487,
which revealed no evidence of a meniscal retear. Id.
February 25, 2016, Dr. Stollsteimer noted that Plaintiff
“may be . . . dealing with the lateral patellofemoral
[degenerative joint disease], ” and referred Plaintiff
for further evaluation of possible patellofemoral
replacement. Tr. at 483-84. Following an examination
on March 24, 2016, John Avallone, D.O., planned to do a
diagnostic arthroscopy. Id. at 479-80. During the
surgery on June 14, 2016, Dr. Avallone found a large tear of
the lateral meniscus and arthritic changes in the lateral
compartment and patellofemoral joint, and performed a lateral
meniscectomy and arthroscopic debridement. Id. at
August 8, 2016 follow up, Plaintiff complained of pain in her
right Achilles tendon. Tr. at 474. Dr. Avallone
ordered an MRI of her foot and prescribed Medrol Dosepak.
Id. After reviewing the MRI on September 2, 2016,
Dr. Avallone diagnosed Plaintiff with chronic tendinitis of
the Achilles, and noted bilateral peripheral lower extremity
edema for which he recommended she consult with her
cardiologist or primary care physician. Id. at 472.
primary complaint during the relevant period -- and the focus
of this appeal -- involve her migraine headaches.
Tr. at 31. In February 2014, Plaintiff complained to
Mark Liebreich, M.D., her primary care physician, of
dizziness, double vision, and headaches for the prior four
weeks. Id. at 257. Dr. Liebreich noted a history
of pituitary adenoma. Id. In September 2014, Dr.
Liebreich noted that a neurosurgical evaluation concluded
that the “pituitary microadenoma was not an issue and
needed only yearly MRI follow-up, ” yet Plaintiff
continued to suffer with vision loss, confusion, headaches,
and dizziness. Id. at 252.
James Gaul, M.D., began treating Plaintiff on March 31, 2015.
Tr. at 402. She described episodes of dizziness,
sometimes causing her to fall (including a fall causing
injury to her right knee). Id. “With and
without the vertigo she gets recurrent headaches described as
a generalized vertex pain with generalized spread, with
pulsatile components and visual blurring, at times
diplopia.” Id. At the time, Plaintiff's
medications included Lyrica, Klonopin, Lexapro, Ambien,
Dexilant, Voltaren, Percocet, and Symbicort. Id.
Dr. Gaul suspected migraines, prescribed a trial of Topamax,
and ordered cerebral electrophysiologic studies. Id.
at 403. In June, Plaintiff reported that she was intolerant
of and stopped Topamax, and Dr. Gaul noted that her cerebral
electrophysiologic studies were normal and started her on
Inderal. Id. at 399. In August 2015,
Plaintiff reported no improvement with Inderal for the
headaches, which occurred three or four times a week, and Dr.
Gaul increased the dosage of Inderal. Id. at 398.
Prior to her October 13, 2015 follow up, Dr. Gaul again
increased the dosage of Inderal, and at the appointment, he
added imipramine to her regimen. Id. at 397. In
December, with no change in Plaintiff's headaches and
dizziness, the doctor increased Plaintiff's imipramine.
Id. at 429. On March 22, 2016, with no significant
change in Plaintiff's headaches, the doctor again
increased her dosage of Inderal. Id. at 428.
October 21, 2016, Plaintiff began treating with Rene Gomez,
M.D., of Lawrenceville Neurology Center. Tr. at 500.
Plaintiff reported having headaches two or more times per
week that she rated an 8/10, with photophonophobia, visual
disturbance, significant incapacitation and nausea/vomiting.
Id. Dr. Gomez diagnosed migraines without aura,
described as high frequency with significant disability,
recommended a psychiatry consultation to assess her
medication needs such as Effexor, and directed that she taper
off imipramine, continue on Inderal, stop using oxycodone,
and take Imitrex.Id. at 501. At Plaintiff's
November 28, 2016 follow up, Dr. Gomez noted that Plaintiff
had stopped imipramine and propranolol, needed to stop
Tylenol and oxycodone completely, and had not followed ...