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Myers v. Berryhill

United States District Court, D. Massachusetts

August 21, 2019

ROBERT MYERS, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security Administration, Defendant.



         I. Introduction

         Robert Myers ("Plaintiff") brings this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3) seeking review of a final decision of the Acting Commissioner of Social Security ("Commissioner") denying his application for Supplemental Security Income ("SSI"). Plaintiff applied for SSI on March 18, 2014, alleging an October 1, 2013 onset of disability due to degenerative disc disease ("DDD") and learning difficulties (A.R. at 87, 153).[1] On April 14, 2017, the Administrative Law Judge ("ALJ") found that Plaintiff was not disabled and denied his application for SSI (A.R. at 70-86). The Appeals Council denied review (A.R. at 6-9) and, thus, Plaintiff is entitled to judicial review. See Smith v. Berryhill, 139 S.Ct. 1765, 1772 (2019).

         Plaintiff appeals the Commissioner's denial of his claim on the ground that the decision is not supported by "substantial evidence" under 42 U.S.C. § 405(g). Pending before this court are Plaintiff's motion requesting that the Commissioner's decision be reversed or remanded for further proceedings (Dkt. No. 22), and the Commissioner's motion for an order affirming the decision of the ALJ (Dkt. No. 29). The parties have consented to this court's jurisdiction (Dkt. No. 10). See 28 U.S.C. § 636(c); Fed.R.Civ.P. 73. For the reasons stated below, the court will grant the Commissioner's motion for an order affirming the decision and deny Plaintiff's motion.

         II. Factual Background

         Plaintiff presents multiple grounds supporting his contention that the Commissioner's decision should be reversed or remanded (Dkt. No. 22-1). Because Plaintiff's arguments mostly concern Plaintiff's back condition and mental health, the background information will be limited to the facts that are relevant to those issues.

         A. Plaintiff's Educational Background and Work History

         Plaintiff was forty-seven years old on the date of the July 14, 2016 hearing (A.R. at 626, 633). He was married and lived with his wife and five of his seven children whose ages ranged from nineteen to ten (A.R. at 154, 633, 666). Plaintiff left school in the tenth grade and had worked delivering newspapers, driving a taxi, and washing dishes (A.R. at 186). In July 2013, he began stocking shelves, doing maintenance work, and operating the cash register at an Ocean State Job Lot store where he frequently lifted fifteen to twenty pounds and occasionally lifted fifty pounds while performing his duties (A.R. at 186, 634, 635, 636-37, 639). Plaintiff stopped working at Ocean State Job Lot in March or April 2014 because he failed to adhere to his work schedule and had too many "infractions" (A.R. at 634, 642-43, 644).

         B. Plaintiff's Physical Condition

         On October 20, 2013, about two months after Plaintiff started the new job that involved lifting heavy objects, he presented at the emergency department of the North Adams Regional Hospital complaining of left flank pain associated with "lifting, motion or positioning" (A.R. at 325). The condition was diagnosed as "likely musculoskeletal in nature" (A.R. at 326). Plaintiff was advised to take ibuprofen and to rest and avoid heavy lifting (A.R. at 326).

         Plaintiff was seen in the North Adams Regional Hospital emergency department seven days later for anxiety (A.R. at 319, 320). Plaintiff reported that ibuprofen had relieved his back pain and he was attempting to change the way he lifted heavy objects (A.R. at 319). A physician's palpation of Plaintiff's paralumbar muscles produced minimal discomfort (A.R. at 320). Plaintiff was discharged after receiving Ativan (A.R. at 320).

         Two days later, on October 29, 2013, Plaintiff visited his PCP, Shaohua Tang, M.D. of Integrative Medicine in North Adams, complaining of low back pain and discomfort in his left groin area (A.R. at 394). He reported that his job entailed "a lot of lifting" (A.R. at 394). There was mild tenderness in his lumbar area and his lumbar flexion was "slightly limited" by pain (A.R. at 395). There was no muscle atrophy or costovertebral angle ("CVA") tenderness (A.R. at 395). Dr. Tang advised Plaintiff to avoid lifting or carrying heavy objects and doing "strenuous physical work" (A.R. at 395).

         Plaintiff visited the emergency department the next day, October 30, 2013, again complaining of pain in his left flank, hip, and back (A.R. at 309). Plaintiff's sensory and motor functions were intact (A.R. at 309). An x-ray of Plaintiff's lumbar spine revealed disc space narrowing at ¶ 5-S1 with degenerative changes (A.R. at 311). Minor spondylolisthesis and spondylolysis were also observed (A.R. at 311, 392). The diagnosis was back pain with left lumbar radiculopathy (A.R. at 310).

         The record of Plaintiff's visit to Dr. Tang on November 5, 2013 indicates that Plaintiff's low back pain was mainly on the left side and moved down his left leg (A.R. at 392). The physical examination of his back revealed mild tenderness in the lumbar area (A.R. at 393). Lumbar flexion was "slightly limited" due to pain (A.R. at 393). The straight leg elevation test showed "65 degrees [on the] left side" and "80 degrees [on the] right side" (A.R. at 393). There was no muscle atrophy or CVA tenderness (A.R. at 393). Dr. Tang discussed treatments for DDD and repeated his instructions to avoid lifting or carrying heavy objects and performing "strenuous physical work" (A.R. at 393). Plaintiff indicated that he wanted to try an injection treatment (A.R. at 393).

         During Plaintiff's January 15, 2014 visit to Dr. Tang, he reported low back pain and leg numbness "from time to time" (A.R. at 390). Plaintiff stated that he was performing "physical work with lots of bending and lifting" (A.R. at 390). Dr. Tang's examination of Plaintiff's lumbar area revealed mild tenderness, normal range of motion, no muscle atrophy, no CVA tenderness, and no peripheral edema (A.R. at 391). Dr. Tang advised Plaintiff to avoid "prolonged" walking and standing, heavy lifting or carrying, and "strenuous physical work" (A.R. at 391). Dr. Tang reviewed Plaintiff's October 2013 x-ray and characterized Plaintiff's DDD as "mild" (A.R. at 39). He ordered an MRI study (A.R. at 391).

         Plaintiff returned to the emergency department on January 17, 2014 with complaints of left lower quadrant discomfort and back pain without radicular symptoms down either leg (A.R. at 301). The physical examination revealed that Plaintiff's gait and motor and sensory reflexes were within normal limits (A.R. at 301). He was instructed to take ibuprofen (A.R. at 303).

         Plaintiff underwent an MRI of his lumbar spine on January 27, 2014 (A.R. at 299). The impression was that Plaintiff had mild, grade 1 anterolisthesis of L5 on S1 due to bilateral pars defects (A.R. at 299). "This [was] associated with a diffuse annular bulge and vertebral body spurring, all of which combine[d] to result in severe left and moderate right foraminal narrowing. The left L5 nerve root appear[ed] compressed" (A.R. at 299-300).

         Plaintiff returned to Dr. Tang on January 31, 2014 and reported that he had reduced his physical activities and his back pain was "somewhat better" (A.R. at 388). However, he had mild numbness in his left leg and "some pain" in his right leg (A.R. at 388). Dr. Tang's physical examination of Plaintiff's back revealed mild tenderness in the lumbar area (A.R. at 389). The lumbar range of motion and straight leg elevation on both sides were normal (A.R. at 389). There was no muscle atrophy, CVA tenderness, or peripheral edema (A.R. at 389). Dr. Tang instructed Plaintiff to "avoid heavy lifting and carrying," perform lumbar stretching exercises and local massage, and use a heating pad (A.R. at 389).

         When Plaintiff saw Dr. Tang on March 20, 2014 with complaints of neck pain, he indicated that his back pain was "not so bad lately" (A.R. at 385). Dr. Tang examined Plaintiff's lower back (A.R. at 386). His observations were consistent with those of the prior visit; that is, mild tenderness, normal range of motion of the cervical spine, and no muscle atrophy, CVA tenderness, or peripheral edema (A.R. at 386). Dr. Tang indicated that Plaintiff's low back pain appeared "relatively stable" and was "not . . . bothering [him] now" (A.R. at 386). The physician "encouraged [Plaintiff] to do suitable physical work, but [to] avoid heavy physical work" (A.R. at 386).

         Plaintiff completed a Social Security Administration ("SSA") Work Activity Report on March 26, 2014 indicating that he could lift twenty pounds (A.R. at 192, 198). On Plaintiff's March 30, 2014 Questionnaire on Pain, he indicated that medication relieved his pain for about six hours, although he could still feel it (A.R. at 202-03).

         The notes of Plaintiff's May 1, 2014 visit to Dr. Tang indicated that Plaintiff was generally "feeling fine" (A.R. at 383). Again, Dr. Tang observed mild tenderness in Plaintiff's lower cervical spine, normal cervical spine range of motion, no muscle atrophy, and no peripheral edema (A.R. at 384).

         On June 6, 2014, Plaintiff reported that his back pain was five on a ten point scale and was "relatively stable" (A.R. at 381). Dr. Tang noted that Plaintiff's back condition was the same as the previous month (A.R. at 382). Plaintiff received lidocaine injections into eight trigger points in his low back (A.R. at 382).

         During Plaintiff's September 10, 2014 visit to Dr. Tang, he reported that he still experienced low back pain, but the trigger point injections enabled him to function (A.R. at 378). The results of Dr. Tang's physical examination of Plaintiff's lumbar area remained the same: mild tenderness; normal range of motion; no muscle atrophy; no CVA tenderness; and no peripheral edema (A.R. at 378). Dr. Tang administered trigger point injections (A.R. at 378).

         The record of Plaintiff's October 10, 2014 visit to Dr. Tang indicates that Plaintiff experienced intermittent low back pain (A.R. at 375, 376). Upon examination, the condition of Plaintiff's back remained the same (A.R. at 376). Dr. Tang administered trigger point injections and referred Plaintiff for physical therapy ("PT") (A.R. at 376, 377).

         On October 13, 2014, Plaintiff visited the Berkshire Medical Center Satellite Emergency Facility because he was experiencing chest pain (A.R. at 274). He did not have back pain (A.R. at 275). The examination of Plaintiff's back showed there was no CVA or midline point tenderness and his range of motion was normal (A.R. at 276).

         Plaintiff's October 28, 2014 evaluation at Williamstown Physical Therapy indicated that his lumbar flexion range of motion was 25% limited and his lumbar extension range of motion was 50% limited (A.R. at 462). His symptoms were consistent with thoracic and lower back pain that was exacerbated by "poor lifting mechanics, poor postural control, decreased muscle tissue extensibility, and poor strength" (A.R. at 462). The therapist recommended that Plaintiff attend PT twice a week for four weeks (A.R. at 463). Plaintiff attended a therapy session on October 28 (A.R. at 450).

         On October 31, 2014, Plaintiff saw Dr. Tang with complaints of chest pain (A.R. at 373). The results of the physical examination of his lumbar area were consistent with the results of Dr. Tang's prior examinations (A.R. at 374). Plaintiff reported that PT relieved his back pain, but he wished to continue the trigger point injections, which Dr. Tang administered (A.R. at 373, 374).

         Plaintiff attended PT sessions on November 5, 12, 14, 21, and 25, 2014, but missed sessions on November 7 and 19 (A.R. at 448, 449, 450). On November 12, 2014, Plaintiff indicated that he felt better after the previous PT appointment (A.R. at 448). At the November 25, 2014 appointment, he reported that his back was feeling better "lately" (A.R. at 449).

         Plaintiff visited Dr. Tang on December 3, 2014 to receive a trigger point injection treatment for his lower back (A.R. at 372). Plaintiff reported that the injections "really help[ed]" for "some days" (A.R. at 372). Dr. Tang indicated that Plaintiff's lumbar range of motion was normal and his low back pain was "stable" (A.R. at 372).

         The January 13, 2015 letter from Williamstown Physical Therapy to Dr. Tang indicated that Plaintiff had attended six PT sessions, but had not received PT between November 25, 2014 and January 13, 2015 (A.R. at 444). Consequently, "there was a setback in his progress" (A.R. at 444). The therapist recommended continuing PT twice a week for six weeks (A.R. at 444). Plaintiff indicated that he was "feeling okay" due to the injections that Dr. Tang administered on that date (A.R. at 445).

         During Plaintiff's preventive physical examination on February 4, 2015, he told Dr. Tang that the trigger point injections relieved his lower back pain (A.R. at 368). Again, Dr. Tang observed minimal tenderness in Plaintiff's lumbar area and no muscle atrophy or CVA tenderness (A.R. at 370). He assessed Plaintiff's low back pain and DDD as "stable" (A.R. at 370).

         Plaintiff received trigger point injections on February 10 and March 5, 2015 (A.R. at 367, 458). On those dates, Plaintiff's condition was "relatively stable," his lumbar area was mildly tender, and his lumbar range of motion was normal (A.R. at 367, 458).

         Plaintiff attended PT sessions on February 4, 11, and 13, 2015 (A.R. at 442, 445). Plaintiff indicated that he felt better for "about two days" after receiving PT (A.R. at 442). By a February 13, 2015 letter, Williamstown Physical Therapy notified Dr. Tang that Plaintiff "has attended PT for 9 visits since 10/28/14 and shows poor compliance [with a] home exercise program" (A.R. at 441). The letter further indicated that Plaintiff reported "some improvement in his pain to a 4/10" (A.R. at 441). According to the letter, Plaintiff could stand and walk for five to ten minutes (A.R. at 441). The therapist recommended continuing PT once or twice a week for two weeks (A.R. at 441). Plaintiff was discharged from PT on March 3, 2015 because he was "non-compliant [with] appointments" (A.R. at 440).

         On October 30, 2015, Plaintiff presented at the Berkshire Medical Center emergency department with dental pain (A.R. at 490). He had full range of motion in his back and no CVA tenderness (A.R. at 492).

         On November 19, 2015, an ambulance transported Plaintiff to the Berkshire Medical Center emergency department with complaints of pain on his right side (A.R. at 499). He had no CVA tenderness in his back, had normal range of motion, and had no tenderness or edema in his extremities (A.R. at 500).

         Plaintiff returned to the Berkshire Medical Center emergency department on February 11, 2016 after he experienced dizziness, especially when he stood up quickly (A.R. at 514, 517). Plaintiff reported that his chronic low back pain with paresthesia in the left leg had improved with exercise (A.R. at 514). The physical examination of his back revealed no CVA, midline vertebra, or paraspinal tenderness (A.R. at 515). Plaintiff's range of motion was normal and his gait was steady (A.R. at 512, 515).

         Plaintiff visited CHP North Adams Family Medicine on March 31, 2016 complaining of pain on his right side and in his lower back, which radiated to his right thigh and left foot, but without numbness in his legs and feet (A.R. at 557). He indicated that the pain was aggravated by "movement/positioning, flexing [his] back, [and] lifting more than [twenty] pounds" (A.R. at 557). Plaintiff reported that rest, heat, and over-the-counter medication (Aleve) relieved the pain (A.R. at 557). Plaintiff ambulated normally (A.R. at 559). The examination by Marguerite Vardman, N.P., revealed tenderness of Plaintiff's left spine, positive standing and sitting flexion tests on the right side, unequal leg lengths, and normal movement of all his extremities (A.R. at 560). N.P. Vardman observed abnormal lordosis of Plaintiff's back (A.R. at 560).

         Dr. Bruce Navom of Living Well Chiropractic, LLC evaluated Plaintiff on April 2, 2016 and noted "[s]egmental and somatic dysfunction of [the] sacral region" and "low back pain" (A.R. at 585). Dr. Navom performed spinal adjustments (A.R. at 585).

         The April 7, 2016 x-rays of Plaintiff's lumbar spine revealed the previously viewed pars defect at ¶ 5 with spondylolisthesis of L5 over S1 (A.R. at 524). "Vertebral body height [was] maintained. Flexion-extension views demonstrate marked movement of 9 mm indicating presence of instability" (A.R. at 524).

         The treatment record of Plaintiff's visit to N.P. Vardman on April 18, 2016 states that he was walking for exercise and his lumbar radiculopathy was "improving" (A.R. at 570, 573). Plaintiff reported that his back felt "much better" after Dr. Novom's chiropractic treatment (A.R. at 570). His gait was normal on that date (A.R. at 573).

         On April 19, 2016, Plaintiff presented at the emergency department complaining of pain in his lower abdomen (A.R. at 536). He stated "that he had been golfing the past couple days" and indicated that "he probably strained his abdominal muscles" (A.R. at 530, 532, 536). His ability to walk was not impaired (A.R. at 536). He had full range of motion and no CVA tenderness in his back (A.R. at 537). He was diagnosed with diverticulitis (A.R. at 533, 539, 542).

         Plaintiff was ambulating normally during his May 4, 2016 visit to Anping Han, M.D. at CHP (A.R. at 576, 578). Based on Plaintiff's chronic back pain, Dr. Han referred Plaintiff to Joshua Yurfest, M.D. (A.R. at 33).

         Plaintiff visited Dr. Yurfest on July 5, 2016 with complaints of lower back pain that radiated into both of his legs and sometimes produced numbness and weakness (A.R. at 586). Plaintiff reported that his pain was five on ten point scale (A.R. at 586). Plaintiff told Dr. Yurfest that physical therapy and chiropractic manipulation did not relieve the pain, but trigger point injections provided relief (A.R. at 586). Upon examination, Dr. Yurfest noted that trigger points were present in the piriformis muscle, gluteus maximus, gluteus medius, and lumbar paraspinals (A.R. at 587). Assessment of Plaintiff's back revealed that straight leg raises ("SLR") were negative, the PSIS level was equal, and kyphosis and scoliosis were absent (A.R. at 587). Dr. Yurfest reviewed the April 4, 2016 x-rays of Plaintiff's lumbar spine and indicated that Plaintiff's "pain syndrome [was] secondary" to the increased movement at the L5-S1 level (A.R. at 587). Dr. Yurfest further indicated that the electrodiagnostic studies were normal thereby excluding a lumbar radiculopathy (A.R. at 587). Plaintiff rejected surgical intervention (A.R. at 587). The physician recommended PT and core strengthening exercises (A.R. at 587).

         Plaintiff was evaluated by Adams Physical Therapy, LLC on July 18, 2016 (A.R. at 595-98, 600-01). Plaintiff reported that he experienced pain when lifting and bending (A.R. at 595). He could walk about 100 yards, sit for about thirty minutes, and stand for about ten minutes without pain (A.R. at 595, 600, 601). Plaintiff indicated that he was unable to carry anything (A.R. at 600). Upon examination, Plaintiff's lumbar flexion range of motion/strength were 4/5 and his hip range of motion/strength ranged from 4/5 to 5/5 (A.R. at 596). Plaintiff attended a PT session on July 20, 2016 (A.R. at 593). The therapist told Plaintiff that PT would not "fix" his condition and that surgery usually was indicated (A.R. at 593).

         C. Plaintiff's Mental Condition

         Plaintiff presented records of The Brien Center spanning the period from September 11, 2014 to November 20, 2014 (A.R. at 410-29).[2] During the initial evaluation on September 11, 2014, Plaintiff reported that family and friends supported him and his activities of daily living were not limited (A.R. at 417). The mental status exam revealed that Plaintiff's appearance, eye contact, speech, mood, affect, facial expression, perception, thought content, thought process, intellectual functioning, orientation, memory, insight, and judgment were within normal limits (A.R. at 420). His behavior was relaxed (A.R. at 420). He was diagnosed with anxiety disorder NOS (A.R. at 425). On September 30, 2014, Plaintiff reported that he had increased his activities and was spending more time with his family (A.R. at 410-11). The counselor and Plaintiff discussed anxiety management on October 14, 2014 (A.R. at 412-13). On November 20, 2014, the counselor did not observe or report any significant changes in Plaintiff's condition (A.R. at 414).

         The records of Plaintiff's emergency department visits on January 17, 2014, April 2, October 31, and November 19, 2015, and February 11 and April 19, 2016 indicated that Plaintiff's mood and affect were normal (A.R. at 301, 479, 480, 490, 492, 499, 500, 514, 515, 536, 537, 570, 573). The records indicated no depression on April 2, 2015 and no anxiety, depression, or suicidal thoughts on October 31, 2015 and April 19, 2016 (A.R. at 479, 490, 536). Treatment records of October 29, 2013, January 15 and 31, March 20, May 1, June 6, October 10 and 31, 2014, February 4 and March 23, 2015, and March 31 and July 5, 2016 indicated no sleep disturbances or insomnia (A.R. at 368, 373, 375, 381, 383, 385, 388, 390, 394, 456, 557-58, 586).

         On March 31, 2016, N.P. Vardman noted Plaintiff's report that his depression and anxiety had improved after he stopped drinking alcohol and started taking vitamins (A.R. at 558). N.P. Vardman observed that Plaintiff was active and alert and his mood and affect were normal (A.R. at 559). Dr. Han made the same notation on April 14, 2016 (A.R. at 573).

         D. Consultative Examiner's Evaluation

         Teena Guenther, Ph.D., conducted a consultative examination of Plaintiff on August 13, 2014 (A.R. at 401). Plaintiff reported "a long history of learning difficulties" and participation in special education, including remedial classes at school (A.R. at 401). He expressed difficulty with reading comprehension, spelling, concentration, and memory (A.R. at 401, 409). His wife assisted him with paperwork because his math skills were subpar (A.R. At 401, 404, 406). Plaintiff described symptoms of depression and anxiety, including "what may be panic attacks" (A.R. at 403-04). His hobbies and interests were limited to playing video games with his children (A.R. at 406). He reported having "limited" social contacts and difficulty sleeping (A.R. at 403).

         On the mental status examination, Plaintiff's gait and motor behavior were normal, his eye contact was appropriate, his thought processes were concrete, and his insight and judgment were fair (A.R. at 404). "His speech [was] fluent and intelligible but there . . . [were] some expressive language difficulties, as he ha[d] trouble organizing or articulating his thoughts" (A.R. at 404). He "often" asked Dr. Guenther to repeat or clarify her questions (A.R. at 404, 406-07).

         Dr. Guenther administered intellectual and achievement tests (A.R. at 404-06). On the WRAT-4 subtests, Plaintiff's grade equivalents were as follows: reading was 11.2; spelling was 3.9; and mathematics was 2.9 (A.R. at 405, 406). Plaintiff's full-scale IQ, as measured by the WAIS-IV, was 77 (A.R. at 405). His verbal comprehension score of 85 was in the 16th percentile, his perceptual reasoning score of 81 was in the 10th percentile, his working memory score of 77 was in the 6th percentile, and his processing speed score of 79 was in the 8th percentile (A.R. at 405). His verbal comprehension index and perceptual reasoning scores "placed him in the low average range of intellectual functioning" and his working memory and processing speed scores were deemed to be "borderline" (A.R. at 405).

         Dr. Guenther determined that Plaintiff's test scores reflected "a learning disability/border intellectual functioning" (A.R. at 406). She opined that Plaintiff was capable of "following and understanding simple directions and instructions" (A.R. at 407). He might have difficulty, however, executing more complicated requests and completing tasks efficiently or on time (A.R. at 407). Based on Plaintiff's description of being "a bit socially withdrawn," the examiner indicated that he might have difficulty relating to co-workers (A.R. at 407). Dr. Guenther diagnosed Plaintiff with anxiety disorder NOS, depressive disorder NOS, "borderline intellectual functioning (versus learning disorder NOS)," and a learning disability (A.R. at 407). She assigned a GAF score of 55 (A.R. at 407).[3] The examiner concluded that "considering the presence of the learning difficulties and psychiatric symptoms, the results of the present evaluation are consistent with the [Plaintiff's] allegations" (A.R. at 407). She recommended formal psychiatric intervention and vocational rehabilitation and training and listed the prognosis as "fair" (A.R. at 407-08).

         E. State Agency Consultants' Opinions

         1. 2014

         On July 8, 2014, S. Ram Upadhyay, M.D., assessed Plaintiff's physical residual functional capacity ("RFC") based on a review of his records (A.R. at 92-94). Dr. Upadhyay opined that Plaintiff could: lift twenty pounds occasionally and ten pounds frequently; stand and/or walk and sit for about six hours in an eight hour workday with normal breaks; occasionally climb ramps, stairs, ladders, ropes, or scaffolds, stoop, and crawl (A.R. at 93). Dr. Upadhyay opined that Plaintiff was capable of performing light work and was not disabled (A.R. at 96-97).

         Jon Perlman, Ed.D., assessed Plaintiff's mental RFC on August 26, 2014 (A.R. at 94-95). Dr. Perlman determined that Plaintiff had mild restrictions in activities of daily living, moderate difficulties in maintaining social functioning and concentration, persistence, or pace, and no repeated episodes of decompensation (A.R. at 91). Specifically, Dr. Perlman opined that Plaintiff's ability to understand, remember, and carry out detailed instructions was moderately limited, but Plaintiff could understand and remember simple instructions (A.R. at 94). Plaintiff's ability to maintain attention and concentration for extended periods, complete a normal workday and workweek without interruption from psychologically based symptoms, and perform at a consistent pace were moderately limited (A.R. at 94-95). According to Dr. Perlman, Plaintiff could complete simple, routine tasks and maintain concentration for at least two hours when performing simple one and two step tasks (A.R. at 95). Finally, Dr. Perlman opined that Plaintiff's ability to get along with coworkers was moderately limited, although he could relate to others in a socially appropriate manner (A.R. at 95).

         2. 2015

         K. Malin Weeratne, M.D., conducted a reconsideration evaluation of Plaintiff's physical RFC on March 26, 2015 (A.R. at 454). Dr. Weeratne agreed with Dr. Upadhyay's opinion (A.R. at 454-55).

         Kenneth Higgins, Ph.D., reconsidered Plaintiff's mental RFC on February 17, 2015 (A.R. at 453). Dr. Higgins adopted Dr. Perlman's assessment except Dr. Higgins opined that Plaintiff was markedly limited in his ability to carry out detailed tasks and moderately limited in his ability to interact with the general public (A.R. at 453).

         F. Fun ...

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