McPherson v. Astrue (605 F. Supp. 2d 744, 2009)

MEMORANDUM OPINION

THOMAS E. JOHNSTON, District Judge.

This is an action seeking review of the final decision of the Commissioner of Social Security (Commissioner) denying Barbarah J. McPherson’s (Plaintiff) application for Disability Insurance Benefits under Titles II and XVI of the Social Security Act, 42 U.S.C. §§ 401-433, 1381-1383f. This action was referred to the Honorable R. Clarke VanDervort, United States Magistrate Judge, for submission to this Court of proposed findings of fact and a recommendation for disposition (PF & R) pursuant to 28 U.S.C. § 636(b)(1)(B). On August 29, 2008, the magistrate judge submitted proposed findings of fact and recommended that the Court deny Plaintiffs Motion for Judgment on the Pleadings or in the Mternative for Remand [Docket 15], grant Defendant’s Motion for Judgment on the Pleadings [Docket 21], affirm the final decision of the Commissioner, and dismiss this action from the Court’s docket. Objections to the PF & R were due by September 15, 2008. Plaintiff filed a Motion for Extension of Time to File Objection [Docket 23] on September 11, 2008. This motion was granted, and the time to file objections was extended to September 25, 2008. On September 25, 2008, a second Motion for Extension of Time to File Objection [Docket 25] was filed. The Court granted this motion and gave Plaintiff until October 5, 2008, to file objections. Timely objections to the PF & R were filed on October 5, 2008. The briefing is complete, and the matter is now ripe for the Court’s consideration.

Pursuant to Fed.R.Civ.P. 72(b), the Court must “make a de novo determination upon the record ... of any portion of the magistrate judge’s disposition to which specific written objection has been made.” However, the Court is not required to review, under a de novo or any other standard, the factual or legal conclusions of the magistrate judge as to those portions of the findings or recommendation to which no objections are addressed. Thomas v. Arn, 474 U.S. 140, 149-50, 106 S.Ct. 466, 88 L.Ed.2d 435 (1985). The Court has reviewed de novo those portions of the Magistrate Judge’s PF & R to which Plaintiff has properly objected and finds that the objections lack merit. For the reasons set forth below, the Court ADOPTS and incorporates herein Magistrate Judge VanDervort’s PF & R. The Court DENIES Plaintiffs Motion for Judgment on the Pleadings [Docket 15], GRANTS Defendant’s Motion for Judgment on the Pleadings [Docket 21], AFFIRMS the final decision of the Commissioner, and DISMISSES this action from the Court’s docket.

I. LEGAL STANDARD

The Court’s review in this case is limited to determining whether the factual findings of the Commissioner — as set forth in the decision of his designee, Administrative Law Judge Theodore Burock (ALJ)— are supported by substantial evidence and were reached through application of the correct legal standards. See Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir.1987). The Social Security Act states that “[t]he findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive.” 42 U.S.C. § 405(g). The Supreme Court has defined substantial evidence as “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938)). Further, substantial evidence “consists of more than a mere scintilla of evidence but may be somewhat less than a preponderance.” Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir.1966).

In reviewing the record for substantial evidence, the Court does not re-weigh conflicting evidence, make determinations as to credibility, or substitute its own judgment for that of the Commissioner. See Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir.1990). Rather, the court must adopt the Commissioner’s findings if there is evidence in support of such findings “to justify a refusal to direct a verdict were the case before a jury.” Blalock v. Richardson, 483 F.2d 773, 776 (4th Cir.1972). “Where conflicting evidence allows reasonable minds to differ as to whether a claimant is disabled, the responsibility for that decision falls on the [Commissioner] (or the [Commissioner’s] designate, the ALJ).” Walker v. Bowen, 834 F.2d 635, 640 (7th Cir.1987). Thus, even if the Court would have reached a different decision, it must nonetheless defer to the conclusions of the ALJ if such conclusions are bolstered by substantial evidence and were reached t hrough a correct application of relevant law. See Coffman, 829 F.2d at 517.

II. PLAINTIFF’S OBJECTIONS

Plaintiff raises four objections to the PF & R. Each properly raised objection will be afforded de novo review.

A. First Objection: Magistrate Judge’s Review of Evidence

Plaintiffs first objection states, in its entirety:

The plaintiff contends that the U.S. Magistrate erred in his review of the ALJ’s Decision of February 24, 2006, with regard to his identification of the claimant’s severe impairments by conducting an incomplete selective and, in part, de novo review of the medical evidence. Contrary to the Magistrate’s conclusion as to which of the claimant’s impairments are “severe” for purposes of her claims for Title II and Title XVI Benefits, the plaintiff contends that the medical evidence provides substantial evidence for a finding of severity for Ms. McPherson’s left-sided weakness, imbalance, headaches, low back pain, bilateral foot pain, obesity, bladder problems, memory, concentration problems, in addition to those severe impairments identified by the Administrative Law Judge in his Decision of February 24, 2006.

(Pl.’s Objs. Prop. Findings & Recom U.S. Magistrate R. Clarke VanDervort Filed Aug. 29, 2008 at 2 [hereinafter Objs.]). Each of the two sentences of this objection raise seemingly disparate issues and will be addressed separately.

On its face, 28 U.S.C. § 636(b)(1)(B) does not require any review, by either the district court or the court of appeals, of any issue that has not been made the subject of an objection. See Thomas, 474 U.S. at 149, 106 S.Ct. 466; Camby v. Davis, 718 F.2d 198, 200 (4th Cir.1983). When a party does make objections, but these objections are so general or conclusory that they fail to direct the district court to any specific error by the magistrate judge, de novo review is unnecessary. Orpiano v. Johnson, 687 F.2d 44, 47 (4th Cir.1982); Howard’s Yellow Cabs, Inc. v. United States, 987 F.Supp. 469, 474 (W.D.N.C.1997). A litigant who makes only vague objections to the magistrate judge’s findings prevents the district court from focusing on disputed issues and thus renders the initial referral to the magistrate judge useless. Howard’s Yellow Cabs, 987 F.Supp. at 474. A general objection does not meet the requirements of 28 U.S.C. § 636(b)(1), and failure to file a specific objection constitutes a waiver of the right to de novo review. Id. (citing Mercado v. Perez Vega, 853 F.Supp. 42, 44 (D.P.R.1993)).

Neither of the two sentences of Plaintiffs first objection calls the Court’s attention to any specific error by the magistrate judge. The first sentence purports to object to the thoroughness of the magistrate judge’s review and to the standard of review applied, stating that a de novo standard was applied. Plaintiff does not, however, identify any specific portion of the PF & R in which Magistrate Judge VanDervort reviewed the record selectively or applied a de novo standard. This is precisely the type of vague and conclusory objection contemplated by Orpiano and Howard’s Yellow Cabs, Inc. that does not merit review by this Court.

The second sentence of Plaintiffs first objection is similarly general and conclusory. It alleges that the magistrate judge failed to recognize that the ALJ’s list of severe impairments was underinclusive because there is substantial evidence to support Plaintiffs claims. Plaintiff makes this assertion baldly, without a scintilla of support or argument. In addition to the fact that the details of this allegation are properly set forth in Plaintiffs second objection, the first objection misstates the applicable standard of review. Under the deferential standard mandated by 42 U.S.C. § 405(g), the findings of the Commissioner are not be disturbed if there is substantial evidence in the record to support those findings. It is not appropriate for this Court to weigh the evidence de novo. There may be, as Plaintiff asserts, “substantial evidence for a finding of severity” with regard to Plaintiffs left-sided weakness, imbalance, and headaches. (Objs. 2.) However, the inquiry is not whether Plaintiffs position enjoys the support of substantial evidence; the question is whether the ALJ’s decision is supported by substantial evidence.

The Court FINDS that Plaintiffs first objection is general and conclusory and that de novo review of the issues raised is not warranted. Therefore, it is OVERRULED.

B. Second Objection: List of Severe Impairments

Plaintiffs second objection argues that the magistrate judge erred by concluding that the ALJ’s identification of severe impairments was supported by substantial evidence. The ALJ found the following severe impairments: cervical disc disease, carpal tunnel syndrome, depression, anxiety, visual impairment, and porphyria. (Tr. 26.) Plaintiff contends that the ALJ failed to include (i) low back pain, radiculopathy of the legs, and foot pain; (ii) obesity; (iii) urinary incontinence; and (iv) memory and concentration deficiencies.

The assessment of whether a claimant has severe impairments is the second step of the sequential five-step analysis of disability claims provided for in 20 C.F.R. §§ 404.1520, 416.920. Severe impairments are impairments which, singly or in combination, “significantly limit[ ] [a claimant’s] physical or mental ability to do basic work activities.” 20 C.F.R. §§ 404.1520(c); 404.920(c). “Basic work activities” include (1) physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling; (2) capacities for seeing, hearing and speaking; (3) understanding carrying out and remembering simple instructions; (4) use of judgment; (5) responding appropriately to supervision, co-workers and usual work situations; and (6) dealing with changes in a routine work setting. Id. § 404.1521(b). “An impairment can be considered ‘not severe’ only if it is a slight abnormality which has such a minimal effect on the individual that it would not be expected to interfere with the individual’s ability to work.” Evans v. Heckler, 734 F.2d 1012, 1015 (4th Cir.1984) (emphasis omitted).

1. Low Back Pain, Radiculopathy of the Legs, and Foot Pain

The ALJ did not find that Plaintiffs claimed low back pain, radiculopathy of the legs, and foot pain constituted severe impairments. Plaintiff objects to this finding, arguing that the objective medical evidence indicates that these symptoms impaired her ability to engage in basic work activities to the extent that they are severe impairments within the meaning of 20 C.F.R. §§ 404.1520(c), 404.1521(b)(1)-(6), 416.920(c), and 416.921(b)(l)-(6). In support of this contention, Plaintiff cites several medical reports in the record.

First, Plaintiff summarizes Dr. Robert Crow’s May 17, 2004, diagnosis that Plaintiff suffered, in Plaintiffs words, “neck and bilateral arm pain but also low back pain radiating into her legs, causing her to be unsteady and unable to heel-to-toe walk.” (Objs. 4 (emphasis in original).) Dr. Crow diagnosed Plaintiff with back pain, neck pain, dysesthesia, and cervical spondylosis. (Tr. 412.) A review of Dr. Crow’s report reveals that he notes that her “[g]ait is very unsteady, she is unable to heel-toe walk.” (Tr. 410.) It does not appear that he attributes her walking problems to pain, although he does state that “[coordination of patient shows difficulty ambulating.” (Id. 411.) In his evaluation of Plaintiffs limbs, Dr. Crow found that she had normal range of motion, muscle tone and strength, and straight leg tests. Dr. Crow also noted that Plaintiffs cervical MRI did not indicate any pathology that was responsible for her reported symptoms. (Id. 412.)

Plaintiff calls the Court’s attention to the Dr. Eugene Evans’ disability determination evaluation. (See id. 207-12.) Plaintiff asserts, “Dr. Evans found the claimant’s work-related activities to be limited to light or moderate duty because of her low back pain and bilateral leg weakness.” (Objs. 4. (emphasis in original).) Plaintiffs reading of Dr. Evans’ report is overly generous to her cause. Dr. Evans noted that Plaintiff walked with a limp, “maybe due to pain in her left heel,” and the “some pain” in her back in response to palpitations. (Tr. 208.) She had a normal range of motion, ability to squat and rise, and muscle strength. He then concluded, “It appeared that [Plaintiff] probably would be able to do certain work-related activities such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling at least on a light to moderate duty basis.” (Tr. 209.) The report does not make an express causal connection between her alleged pain and weakness and the conclusion that her work-related activities may be limited.

Plaintiff likewise states that the magistrate judge ignored the findings of Dr. Alamelu Murugappan. According to Plaintiff, Dr. Murugappan “aeknowledg[ed] the plaintiff to suffer from low back pain, foot drop, and the INABILITY [sic] to tandem walk.” (Objs. 4 (emphasis in original).) This is significant, Plaintiff asserts, because her “ability to do basic work activities ... by definition, includes the ability to walk.” (Id.) Plaintiff mischaracterizes Dr. Murugappan’s reports. Although Dr. Murugappan notes Plaintiffs inability to tandem walk (i.e. walking heel to toe in a straight line), he describes her walking gait as “normal.” (Tr. 256.) Her tone and strength in all four limbs was satisfactory. (Id. 259.) Regarding her claims of foot drop, Dr. Murugappan says, “although she says her foot will drop down her symptoms are not quite as specific as a footdrop.” (Id. 260.)

Lastly, Plaintiff refers to Dr. John Collins, who “noted the claimant’s left-sided weakness and ataxic gait.” (Obj. 4.) An ataxic gait indicates “an inability to coordinate muscle activity during a voluntary movement.” Stedman’s Medical Dictionary (28th ed. 2006). Dr. Collins ordered an MRI to ascertain the source of Plaintiffs alleged symptoms. The MRI showed no abnormalities. (Tr. 348.) Dr. Collins stated that her symptoms may be caused by her visual disturbance. (Id. 347.)

Upon reviewing the record and the ALJ’s discussion of Plaintiffs impairments (id. 26-29), the Court FINDS that there is substantial evidence to support the Commissioner’s finding that Plaintiffs alleged low back pain, radiculopathy of the legs, and foot pain are not severe impairments.

2. Obesity

Plaintiff objects to the ALJ’s omission of obesity from his finding of severe impairments. The ALJ took notice of the impairment but failed to find that it significantly interfered with her ability to engage in work activities. Plaintiff charges that neither the ALJ nor the magistrate judge gave Plaintiffs obesity claims proper consideration as set forth in Social Security Ruling (SSR) 02-lp, titled Policy Interpretation Ruling Titles II and XVI: Evaluation of Obesity.

According to SSR 02-lp, obesity is a “chronic disease characterized by excessive accumulation of body fat.” SSR 02-lp ¶ 1. It is measured by with a body mass index (BMI), which is a ratio of person’s weight to height. Id. A BMI of 30 or greater is considered obese. Although obesity alone may warrant a finding of severe impairment, it is often a “risk factor” that increases the likelihood of other impairments. Id. ¶ 2. Like any other impairment, obesity will only be considered severe if it significantly limits an individual’s ability to engage in basic work activities. Id. ¶ 6. To assess the severity of an obesity impairment, the regulations give the following guidance:

There is no specific level of weight or BMI that equates with a “severe” or a “not severe” impairment. Neither do descriptive terms for levels of obesity (e.g., “severe,” “extreme,” or “morbid” obesity) establish whether obesity is or is not a “severe” impairment for disability program purposes. Rather, [the Commissioner] will do an individualized assessment of the impact of obesity on an individual’s functioning when deciding whether the impairment is severe.

Id.

Plaintiffs height is 5'4" and her weight is approximately 200 pounds. This corresponds with a BMI that was determined at various times to be 35 or 36 (E.g., Tr. 256, 314, 323.) These BMI scores place her within the second of three levels of obesity. SSR 02-lp ¶ 1. Plaintiff calls the Court’s attention to the report of Dr. S.K Shammaa, who noted that Plaintiff was “[g]rossly obese” and had “palpable tenderness to heels of both feet.” (Tr. 319.) Dr. Shammaa also advised Plaintiff to exercise and try to lose weight. (Id. 317.)

At a hearing on November 3, 2005, the ALJ inquired into the source of Plaintiffs weight problems. Plaintiff attributed it to “[n]ot being as active as I used to be.” (Id. 444.) This short colloquy indicates that the ALJ was aware of Plaintiffs obesity. It is notable that Plaintiffs weight and alleged consequent impairment was not raised by Plaintiffs counsel at the hearing. Thus, aside from the single question from the ALJ, the issue of Plaintiffs obesity was not developed on the record.

The only evidence of Plaintiffs obesity in the objective medical evidence is the recording of her BMI by various doctors and Dr. Shammaa’s isolated statement. There is no medical evidence on the record suggesting that Plaintiffs obesity interferes with her ability to engage in work activities or that it is the cause of any of Plaintiffs alleged symptoms. Dr. Shammaa’s singular description of Plaintiff as “grossly obese,” without more, is not evidence that Plaintiffs obesity is a severe impairment. SSR 02-lp ¶ 6. Accordingly, the Court FINDS that there is substantial evidence to support the Commissioner’s omission of obesity from the list of Plaintiffs severe impairments.

3. Frequent Urination and Incontinence

Plaintiff states that the ALJ erred by not finding that Plaintiffs bladder problems constituted a severe impairment. Plaintiff was diagnosed with an overactive bladder based on her representation to her doctors. (Tr. 246, 260, 319.) She was prescribed Detrol LA (id. 246) and used incontinence products to control this problem (id. 260, 460).

In support of her argument that her bladder impairment is severe, Plaintiff primarily relies on a diagnosis by Dr. Shammaa on December 19, 2005. Dr. Shammaa noted that Plaintiff “suffers from stress incontinence, causing urinary frequency which is aggravated by lifting, bending or stooping.” (Id. 415.) Dr. Shammaa proceeded to draft a letter in which he stated,

I feel that she would not be able to work at a job secondary to the frequency/urgency of urination which would interfere with a job, regardless of sedentary or not. She states she has difficulty with lifting secondary to being able to control the leakage of her bladder. We will need further evaluation regarding her bladder.

(Id. 416.)

The ALJ misstates the record in his decision. He states that Plaintiff complained of bladder problems in 2001 and sought no further treatment until December 2005. (Id. 31.) Based on this observation, he concludes that “if in fact this was a problem of the magnitude which she alleges, the claimant would have undergone further treatment and testing by now.” (Id.) The record reflects, however, that Plaintiff sought medical treatment for bladder problems at other times between 2001 and 2005. (See, e.g., id. 246 (May 2003); 256 (November 2004).)

Notwithstanding the ALJ’s error, there is other evidence in the record to support his conclusion that Plaintiffs bladder problem was not a severe impairment. To the extent that there is evidence of Plaintiffs bladder problems in the medical record, it is the result of plaintiffs self-reporting of symptoms. Thus, the allegations of severe bladder impairment are not supported by objective medical evidence to the extent and severity alleged by Plaintiff. See Hammond v. Apfel, 5 Fed.Appx. 101, 104 (4th Cir.2001) (unpublished disposition). Furthermore, Plaintiff stated that she only wears incontinence products “occasionally,” which suggests that her problem is not so frequent or disruptive that it rises to the level of a severe impairment. (Tr. 260.) Accordingly, the Court FINDS that there is substantial evidence to support the ALJ’s finding that Plaintiffs frequent urination and incontinence problems are not severe impairments.

4. Memory and Concentration

The ALJ found that Plaintiffs depression and anxiety were severe impairments. (Id. 28.) He did not find that Plaintiffs claims of concentration and memory deficiencies amounted to severe impairments. However, the ALJ took note of Plaintiffs mental impairments— documented and claimed alike — in- concluding that Plaintiff would be limited to jobs requiring more than “simple, routine, repetitive tasks.” (Id. 31.) Notwithstanding the ALJ’s findings, Plaintiff objects to the absence of concentration and memory deficiencies from the list of severe impairments.

Like physical impairments, mental impairments are considered severe only if they “significantly limit[ ] ... physical or mental ability to do basic work activities.” 20 C.F.R. § 404.1520(c). Assessing the degree of a claimant’s limitation is a “complex and highly individualized process” which must take into account all relevant evidence bearing on the claimant’s mental condition. Id. § 404-.1520a(c)(l). In this context, relevant evidence includes “clinical signs and laboratory findings, the effects of [claimant’s] symptoms, and how [claimant’s] functioning may be affected by factors including, but not limited to, chronic mental disorders, structured settings, medication, and other treatment.” Id. Severity is determined by evaluating the evidence in light of four categories: (1) activities of daily living; (2) social functioning; (3) concentration, persistence, or pace; and (4) episodes of decompensation. Id. § 404.1520a(c)(3); see also 20 C.F.R. pt. 404, app. 1, § 12.00(C).

The record contains reports from four psychological and psychiatric experts. Plaintiff highlights portions of each expert’s report to demonstrate that Plaintiffs memory and concentration problems are severe impairments. The parts of the reports relied on by Plaintiff are highly selective, however. A review of each expert’s report reveals that there is evidence to support a finding a mild memory and concentration impairments.

Psychologist Sunny S. Bell examined Plaintiff on January 1, 2005. (Tr. 282.) Plaintiff emphasizes ' Bell’s prognosis, which was “poor.” (Id. 285.) Plaintiff also refers to her self-reported symptoms which were reflected in Bell’s report. These symptoms included decreased memory and concentration and an inability to engage housework, cooking, shopping, or past hobbies. None of these claimed symptoms was the subject of an opinion or assessment by Bell, and therefore cannot be considered objective evidence of a severe limitation on Plaintiffs daily activities. Bell’s observations of Plaintiff during the examination led Bell to conclude that Plaintiffs social functioning was only “mildly deficient.” (Id.) Regarding Plaintiffs memory, Bell noted that her immediate memory was normal, recent memory was moderately deficient, and remote memory was mildly deficient. (Id. 284.) Although Plaintiffs concentration level was “markedly deficient” based on her difficulty performing serial threes, her persistence and pace were normal. (Id. 284-86.) There is no mention of decompensation in the report.

The record reflects that Psychiatrist Rhonda L. Hamm treated Plaintiff from approximately October 2004 to October 2005. On November 11, 2005, after nearly three weeks of treatment, Dr. Hamm prepared a psychiatric evaluation of Plaintiff. Dr. Hamm reported the following:

[Plaintiff] is alert and oriented on all spheres. Her affect is slightly flattened and her mood is slightly depressed. However, this is improved from her initial visit. She has no suicidal or homicidal ideation. Her speech is fluent and goal directed. Her thoughts are clear.... She attends well to conversation. Her memory in both the long and short term appears to be intact.

(Id. 295.) Despite the apparently normal findings, Dr. Hamm assigned Plaintiff a global assessment functioning (GAF) score of 35. (Id.) This level indicates:

Some impairment in reality testing or communication (e.g., speech is at times, illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgement, thinking or mood (e.g.¡ depressed person avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

Diagnostic and Statistical Manual of Mental Disorders 34 (4th ed., text revision 2000). Based on Dr. Hamm’s report read as a whole, it is likely that the low GAF score is attributable Plaintiffs diagnoses of chronic post traumatic stress disorder and mood disorder, rather than to her claimed memory and concentration issues. Additionally, Dr. Hamm’s treatment notes indicate that Plaintiffs memory level throughout the course of treatment was usually “normal,” with only a few instances where “short term deficits” were noted. (Tr. 289-98, 366-90.) With a single exception, (id. 297), Plaintiffs insight and judgment were rated as normal at every evaluation, (id. 289-98, 366-90).

Plaintiff was evaluated by psychologist Dr. Debra L. Lilly on February 19, 2005. Dr. Lilly diagnosed Plaintiff with affective disorders which would impair Plaintiffs functioning on a short-term basis only. (Id. 299.) Dr. Lilly could find “no identified neurological disorder to account for memory or concentration issues” (id. 311) and concluded that Plaintiffs impairment was only mild, (id. 309).

Plaintiff faults Magistrate Judge VanDervort for not discussing the report of psychiatrist Dr. Khalid Hasan in his PF & R. Dr. Hasan’s report was filed after the ALJ’s decision and was made part of the record by the Social Security Administration Appeals Council. (Id. 10.) Dr. Hasan evaluated Plaintiff on four occasions in 2006: April 3, April 17, May 15, and June 12. According to Plaintiff, Dr. Hasan’s conclusions support Plaintiffs contention that there is sufficient evidence to demonstrate a severe memory or concentration impairment. At the April 3 evaluation, however, Dr. Hasan described Plaintiffs mental status as follows:

The patient was neat, tidy, and cooperative, talked clearly, audibly, and rationally. Speech was clear, lacked spontaneity. Affect was of some dysphoria.... The patient showed no evidence of psychosis or thought disorder was elicited. Cognition was intact.... No bizarre thought processes, tangential or circumstantial thinking was elicited. Abstract thinking was appropriate____No clinical evidence of organicity, psychosis or thought disorder was elicited.... Insight, judgment and problem solving fair.

(Id. 13.) Perhaps most damaging to Plaintiffs arguments about memory and concentration, Dr. Hasan notes that Plaintiff was able to do serial sevens, which is one of the Social Security Administration’s recommended tests for concentration. See 20 C.F.R. pt. 404 app. 1 § 12.00(C)(3). Dr. Hasan diagnosed Plaintiff with major depression and adjustment disorder. (Tr. 13.) He assessed her GAF at 45-50 — a significant improvement from Dr. Hamm’s earlier assessment. Although Dr. Hasan rated Plaintiffs occupational abilities to follow work rules, use judgment, maintain attention/concentration as “poor,” he found her abilities in a great many other areas to be “fair.” (Id. 17-18.) Furthermore, Dr. Hasan found that Plaintiffs ability to understand, remember, and carry out simple job instructions was “good.” (Id. 18.)

After reviewing the record, the Court FINDS that there is substantial evidence to support the ALJ’s finding that Plaintiffs concentration and memory problems are not severe impairments.

Because the ALJ’s list of substantial impairments is supported by substantial evidence, Plaintiffs second objection is OVERRULED.

C. Third Objection: Residual Functional Capacity

Plaintiff objects to the ALJ’s determination of her residual functional capacity (RFC). The ALJ found that Plaintiff

has the residual functional capacity to perform simple routine, repetitive tasks at the limited light exertional level. Specifically, she can lift and carry 20 pounds occasionally and 10 pounds frequently, can stand/walk for 6 hours in an 8 hour day and can sit for 6 hours in an 8 hour day. She can further perform jobs as long as they do not require working outdoors, concentrated and extensive exposure to sunlight, concentrated exposure to extreme cold and dampness, operating a motor vehicle or dangerous machinery and exposure to dangerous situations.

(Tr. 29.) Plaintiff contends that the ALJ erred in three respects: (1) the ALJ improperly weighed the objective medical evidence in concluding that Plaintiff could perform light duty work; (2) the ALJ failed to account for Plaintiffs mental impairments; and (3) the ALJ did not properly evaluate Plaintiffs pain.

RFC is a determination of a claimant’s capabilities notwithstanding her impairments, which occurs at step four of the five-step sequential evaluation of disability claims. See 20 C.F.R. § 416.945(a)(1); see also SSR 96-8p (“RFC represents the most that an individual can do despite his or her limitations or restrictions.”). RFC takes into account both physical and mental impairments that may limit the claimant’s work-related abilities. See id. § 416.945(b)-(c). All relevant evidence, medical, observational, and subjective, will be considered. See id. § 416.945(a)(3).

Though the ALJ considers each of the medical opinions, the determination of a claimant’s RFC is ultimately the province of the ALJ as the representative of the Commissioner. 20 C.F.R. § 404.1527(e)(2); see also Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir.1990). The reviewing court’s sole responsibility is to determine whether the ALJ’s determination of the claimant’s RFC is rational and based on substantial evidence. Oppenheim v. Finch, 495 F.2d 396, 397 (4th Cir.1974).

1. Weight of Medical Testimony

Plaintiff maintains that the ALJ improperly discredited the medical reports of Dr. S.K. Shammaa and Plaintiffs treating physician, Dr. Pamela Butcher, while improperly crediting the reports of Dr. Eugene Evans, Dr. Rogelio T. Lim, and Dr. R.L. Co. Each of these doctors’ reports will be reviewed to determine if they contain substantial evidence to support the ALJ’s RFC findings.

When deciding the weight to give each medical opinion, unless the ALJ gives a treating source’s opinion controlling weight, the ALJ takes into account the following factors: (1) whether the source has examined the claimant and the length and frequency of the examinations; (2) the nature and extent of relationship with a treating physician; (3) supportability; (4) consistency; (5) specialization; and (6) various other factors. 20 C.F.R. § 404.1527. Generally, more weight is given to examining sources than to sources who do not examine. 20 C.F.R. § 404.1527(d)(1). Similarly, more weight is given to treating sources than to examining sources. 20 C.F.R. § 404.1527(d)(2). If “the treating source’s opinion is [not] given controlling weight, the administrative law judge must explain in the decision the weight given to the opinions of a State agency medical or psychological consultant or other program physician or psychologist, as the administrative law judge must do for any opinions from treating sources, nontreating sources, and other nonexamining sources who do not work for [the Social Security Administration].” 20 C.F.R. § 404.1527(f)(2)(ii).

Plaintiff contends that the ALJ should have given more weight to a letter written by Dr. Shammaa in which he opined that Plaintiff “would not be able to work at a job secondary to the frequency/urgency of urination which would interfere with a job, regardless of sedentary or not.” (Tr. 416.) The ALJ discredited Dr. Shammaa’s conclusion because it was inconsistent with other objective evidence and appeared to be based primarily on Plaintiffs subjective complaints. (Id. 31.) See also supra Part II.B.3 (discussing Dr. Shammaa’s findings).

Dr. Shammaa’s opinions should be given due deference based on the length of time he treated Plaintiff, see 20 C.F.R. § 404.1527, but his opinions are not dispositive. Among the numerous evaluations of Plaintiff by Dr. Shammaa reflected in the record, only once did she complain about bladder problems. (Tr. 319.) This deficiency in the record is what lead the ALJ to remark that “if in fact this was a problem of the magnitude which she alleges, the [Plaintiff] would have undergone further treatment and testing by now.” (Id. 31.) Furthermore, Dr. Shammaa’s letter does not indicate that his opinion regarding Plaintiffs inability to engage in work activities is conclusive. In the letter, Dr. Shammaa states, “I am referring [Plaintiff] to Dr. Meriwether, urologist in Lewisburg in the near future for evaluation.... She states she has difficulty with lifting secondary to being unable to control the leakage of her bladder. We will need further evaluation regarding her bladder.” (Id. 416 (emphasis added).) This suggests that Dr. Shammaa’s opinion was of a preliminary nature based on Plaintiffs subjective representations. Accordingly, it is evident that the ALJ’s decision to discount Dr. Shammaa’s letter is supported by substantial evidence.

Plaintiff also faults the ALJ for not giving greater weight to Dr. Butcher’s report dated March 3, 2004. In that report, Dr. Butcher opined that Plaintiff was unable to work for at least a six-month period “until further neurological work up.” (Id. 408.) Plaintiff was specifically cautioned to avoid climbing and lifting pending the evaluation. (Id.) Plaintiff argues that this statement should be construed as evidence that Plaintiff was physically unable to work. Dr. Butcher’s statement should not, however, be given a meaning other than what it plainly says — Plaintiff was not to work until she had had further tests to determine whether she had neurological problems. The ALJ properly refused to credit Dr. Butcher’s statement as evidence that Plaintiff suffered documented impairment. The ALJ’s finding is buttressed by the fact that “further neurological work up” mentioned in the letter was completed and no neurological abnormalities were discovered. (See, e.g., id. 412 (results of evaluation conducted one month after Dr. Butcher’s report).)

Plaintiff contends that the ALJ should not have credited the opinion of Dr. Evans. Dr. Evans examined Plaintiff on June 27, 2004, and concluded that she would be able to do work-related activities on a light or moderate duty basis. (Id. 209.) The ALJ found Dr. Evans’ report to be credible, primarily because it was consistent with the overall record. (Id. 31.) Dr. Evans noted that Plaintiff could walk unassisted, although with a limp favoring her left leg, and squat and arise with some difficulty. (Id. 208.) She also displayed a normal range of motion, normal muscle strength, and normal behavior. (Id. 208-09.) As the ALJ noted, these findings were consistent with the bulk of the medical evidence. See supra Part II.B.1. Thus, the ALJ’s decision to credit Dr. Evans’ findings is supported by substantial evidence.

Lastly, Plaintiff asserts that “neither Dr. Lim’s nor Dr. Go’s reports can be given significant weight.” (Objs. 12.) The Court does not consider this to be a properly raised objection. The ALJ does not cite Dr. Lim or Dr. Go’s reports as the basis for any of his findings. The only mention of their reports in the ALJ’s decision is the following statement: “As required by [SSR] 96-6p, the undersigned has also considered thé opinions of [Dr. Lim and Dr. Go], who opined that the claimant is capable of performing work at the medium exertional level.” (Tr. 31-32.)

The Court FINDS that the ALJ afforded proper weight to the various medical reports in the record.

2. Impact of Depression and Anxiety

. [9] Plaintiff objects to the ALJ’s finding that her depression and anxiety were not debilitating. The ALJ considered Plaintiffs mental impairments, including her concentration and memory problems, and concluded that Plaintiff could not perform “jobs that require performing more than simple, routine, repetitive tasks.” (Id. 31.)

Assessing the effect of mental impairments on RFC requires a much more precise analysis of a claimant’s abilities than is necessary when determining, the degree of the impairments’ severity at step two of the sequential evaluation. The regulations explain:

The psychiatric review technique described in 20 CFR 404.1520a and 416.920a and summarized on the Psychiatric Review Technique Form (PRTF) requires adjudicators to assess an individual’s limitations and restrictions from a mental impairment(s) in categories identified in the “paragraph B” and “paragraph C” criteria of the adult mental disorders listings. The adjudicator must remember that the limitations identified in the “paragraph B” and “paragraph C” criteria are not an RFC assessment but are used to rate the severity of mental impairment(s) at steps 2 and 3 of the sequential evaluation process. The mental RFC assessment used at steps 4 and 5 of the sequential evaluation process requires a more detailed assessment by itemizing various functions contained in the broad categories found in paragraphs B and C of the adult mental disorders listings in 12.00 of the Listing of Impairments [20 C.F.R. pt. 404, app. 1, § 12.00], and summarized on the PRTF.

SSR 96-8p.

Plaintiff cites the reports of Dr. Rhonda L. Hamm and Dr. Khalid Hasan as supporting her claim that she is debilitated by her depression and anxiety. In Dr. Hamm’s report, Plaintiff points to her GAF score of 3 5 as “indicative of a mental impairment which may significantly impede useful functioning.” (Obj. 13 (citing Tr. 295).) As discussed above, a GAF score of 35 indicates a degree of impairment, but it does not specify the nature of the impairment or specific limitations. Thus, Plaintiffs GAF score may be relevant in a more generalized assessment of the severity of mental impairment at step two, but, without more, it is not particularly helpful in the RFC context. Other portions of Dr. Hamm’s report are more instructive of Plaintiffs work-related capabilities. For example, Dr. Hamm noted that Plaintiff was on time for the evaluation, was alert and oriented, was not suicidal, was only “slightly depressed,” and had shown psychological improvement. (Tr. 295.)

Plaintiff selectively highlights portions of Dr. Hasan’s report of June 26, 2006, which purportedly indicate that Plaintiffs mental impairments are debilitating. Dr. Hasan’s report lists various work-related abilities and scores each on a range from “None” (i.e. “No useful ability to function in this area”) to “Unlimited” (i.e. “Ability to function in this area is not limited by a mental impairment.”). (Id. 17.) Plaintiffs scores ranged from “Poor” to “Good.” (Id. 17-18.) “Good” means that ability is “more than satisfactory” and “Poor” means that the ability is “seriously limited but not precluded.” (Id. 17.) In areas relevant to the ALJ’s conclusion that Plaintiffs mental RFC permits “simple, routine, repetitive tasks,” Plaintiff scored either “Good” or “Fair.” For instance, her abilities to interact with a supervisor and function independently are “Fair.” (Id. 17.) Her ability to “[understand, remember and carry out simple job instructions” was “Good.” (Id. 18.) Although her abilities to follow work rules, use judgment, maintain attention, carry out complex job instructions, and be socially reliable are “Poor,” these abilities are generally not required for simple, routine, repetitive tasks. Moreover, a “Poor” listing does not mean that Plaintiff does not have these abilities; it simply means that they are limited. Notably, Plaintiff did not receive a “None” for any work-related ability.

Accordingly, the Court FINDS that there is substantial evidence in the record to support the AL J’s conclusion that Plaintiffs depression and anxiety were not debilitating impairments.

3. Pain Assessment

Plaintiff states that the ALJ conducted an improper assessment of Plaintiffs claims that debilitating pain and other symptoms limit her ability to engage in substantial gainful activity. Plaintiffs objection arises from the following statement in the ALJ’s decision:

After considering the claimant’s testimony and statements, in light of the medical evidence of record, the undersigned finds that the claimant is not entirely credible. Specifically, while the claimant alleges that she suffers from debilitating pain, which renders hér unable to walk, stand or sit for prolonged periods of time, the objective medical evidence of record reveals that the claimant does not have conditions, which could reasonably be expected to cause such limitations____Nonetheless, giving the claimant the benefit of the doubt, the undersigned finds that given her mild cervical disc disease and mild carpal tunnel syndrome, she is limited to work at the light exertional level.

(TR at 30.) Relying on this excerpt, Plaintiff reasons that the ALJ improperly “first attacked the claimant’s credibility rather than [] make a finding regarding whether the objective medical evidence established the existence of anatomical, physiological or psychological abnormalities which could reasonably cause the claimant to have the pain or other non-exertional limitations alleged” as required by Craig v. Chater, 76 F.3d 585 (4th Cir.1996). (Objs. 15.(empha-sis in original)) As is discussed below, the ALJ applied the proper legal standard to discount the weight of Plaintiffs subjective claims to the extent that they were inconsistent with the objective evidence and his conclusions. are supported by substantial evidence.

A two-step analysis must be followed when a claimant raises the issue of pain and related symptoms: 1) does objective medical evidence show the existence of a medical impairment that reasonably could be expected to produce pain or other alleged symptoms; and, if yes, 2) is the pain so continuous and/or severe that it prevents- the claimant from working? See SSR 96-7p; 20 C.F.R. §§ 416.929(a), 404.1529(a); see also Craig, 76 F.3d at 593-94. For the second prong, the claimant is “entitled to rely exclusively on subjective evidence.” Hines v. Barnhart, 453 F.3d 559, 565 (4th Cir.2006); see also Fulcher v. Astrue, 554 F.Supp.2d 606, 610 (E.D.N.C.2008) (“[P]ain alone can be disabling. So long as a condition exists that would cause the alleged pain, there need not be objective medical evidence of the intensity of such pain, or even evidence of the pain existing at all.”). This does not mean,-however, that a claimant’s subjective claims of pain - and other symptoms must be accepted without question. Where the claimant’s statements about pain and other symptoms are not “substantiated by objective medical evidence,” the ALJ must make a credibility assessment of claimant. SSR 96-7p.

In assessing the credibility of a claimant, the ALJ is entitled to rely on all the evidence on the record, including the claimant’s testimony. Id. Although objective medical evidence is not required to substantiate a claimant’s subjective statements regarding pain, such evidence is relevant to the extent that it is inconsistent with the claimant’s subjective claims and gives reasons to doubt those claims. Further, because the ALJ had the opportunity to personally observe the claimant and other witnesses, his determination of credibility is to be afforded great weight. See Shively v. Heckler, 739 F.2d 987, 989 (4th Cir.1984).

In the instant action, a review of the ALJ’s decision reveals that he properly applied the two-step pain analysis called for in SSR 96-7p and Craig. As Plaintiff points out, the text of ALJ’s decision contains a sentence discounting Plaintiffs credibility with regard to pain and related symptoms prior to his discussion of predicate medical conditions that could reasonably be expected to produce pain. The ordering of the discussion does not indicate that the ALJ “improperly plaee[d] step two of the Craig criteria before step one.” (Ojbs. 16.) On the contrary, this appears to be little more than a drafting choice; the ALJ stated his conclusion first and then proceeded to explain how he arrived at that conclusion.

The ALJ’s decision was supported by substantial evidence. At step one of the analysis, the ALJ found that the objective medical evidence did not reveal conditions that would reasonably be expected to produce Plaintiffs alleged symptoms. He noted that although Plaintiff had cervical disc disease and carpal tunnel syndrome, these conditions were “mild.” (Tr. 30; see also 264.) Further, the objective evidence does not suggest that either of these conditions is associated with radicular or peripheral neuropathy in her lower extremities — i.e. neither has been shown to be causing pain in her legs. (Id. 198, 412.)

Upon finding that Plaintiff did not have a documented medical condition that could be responsible for her claimed symptoms, the ALJ did not have to proceed to step two. See Craig, 76 F.3d at 595 (“It is only after a claimant has met her threshold obligation of showing by objective medical evidence a medical impairment reasonably likely to cause the pain claimed, that the intensity and persistence of the claimant’s pain ... must be evaluated”). Thus, the ALJ did not have to opine on Plaintiffs credibility. The ALJ’s decision to do a more detailed analysis of Plaintiffs claims than was required did not prejudice Plaintiff in any way, and is not grounds for remand.

Accordingly, the Court FINDS that the ALJ applied the proper legal standard in conducting his analysis of Plaintiffs claims of pain and other non-exertional symptoms and that there is substantial evidence in the record to support his conclusions on this matter.

For the reasons stated above, Plaintiffs third objection is OVERRULED in its entirety.

D. Fourth Objection: Vocational Expert’s Assessment

In her fourth objection, Plaintiff argues that the ALJ’s use of the vocational expert was improper in two respects. First, the ALJ’s hypothetical questions to the VE at the hearing on November 3, 2005, did not include all of Plaintiffs limitations. Second, the ALJ’s decision failed to account for Plaintiffs counsel’s question to the VE.

A VE’s testimony is relevant to steps four and five of the sequential disability analysis — whether the claimant can perform her past relevant work or other kinds of work. VEs serve the function of identifying jobs in the national economy that could be performed by the claimant notwithstanding the claimant’s impairments. See Walker v. Bowen, 889 F.2d 47, 50 (4th Cir.1989). In order to for the VE to accurately identify jobs available to the claimant, the ALJ must present hypothetical questions to the VE that are “based on medical assumptions supported by substantial evidence in the record that reflect[ ] each of the claimant’s limitations.” Osenbrock v. Apfel, 240 F.3d 1157, 1163 (9th Cir.2001); see also Chrupcala v. Heckler, 829 F.2d 1269, 1276 (3d Cir.1987). Although the ALJ’s hypothetical questions must include severe limitations, it may omit limitations that are not severe. See Benenate v. Schweiker, 719 F.2d 291, 292 (8th Cir.1983).

Obviously, the hypothetical questions presented to the VE are highly dependent on the ALJ’s findings of severe impairments. The ALJ is under no duty to present the VE with hypothetical questions that include Plaintiff’s claimed impairments if the ALJ has found those impairments to be not severe or not credible. In this action, Plaintiff faults the ALJ for not questioning the VE about the impact of several of Plaintiffs claimed impairments, including visions problems, depression, porphyria, and urinary incontinence. With regard to the impairments that the ALJ found to be not severe or not credible, the ALJ was not obligated to structure hypothetical questions accounting for these impairments. Likewise, the ALJ did not have to give weight to Plaintiffs counsel’s hypothetical questions to the VE to the extent that they were based on non-severe or non-credible limitations. With regard to Plaintiffs acknowledged severe impairments, the ALJ’s questions properly presented her limitations. The ALJ’s first hypothetical stated:

[A]ssume an individual the claimant’s age, education, work experience, who has a residual functional capacity for light work. Non-exertionally, the individual’s limited to routine, repetitive tasks. Non-exertional restrictions include no outdoor work involving extensive and concentrated exposure to sunlight. No concentrated exposure to extreme cold or dampness. No operation of motor vehicles or exposure to dangerous situations, such as unprotected heights or dangerous equipment.

(Tr. 470.) It is not necessary that the hypothetical mention the underlying diagnoses, cf. Johnson v. Barnhart, 434 F.3d 650, 659 (4th Cir.2005) (approving similarly styled hypothetical); what is important is that the VE is presented with an accurate picture of the Plaintiffs limitations. The ALJ properly stated Plaintiffs severe impairments and limitations to the VE. Accordingly, the Court FINDS that the ALJ’s use of the VE was appropriate and Plaintiffs fourth objection is OVERRULED.

III. CONCLUSION

For the reasons stated above, the Court ADOPTS and incorporates herein the PF & R of Magistrate Judge VanDervort. The Court DENIES Plaintiffs Motion for Judgment on the Pleadings [Docket 15], GRANTS Defendant’s Motion for Judgment on the Pleadings [Docket 21], AFFIRMS the final decision of the Commissioner, and DISMISSES this action from the Court’s docket. A separate Judgment Order will issue this day.

IT IS SO ORDERED.

The Court DIRECTS the Clerk to send a certified copy of this Order to Magistrate Judge VanDervort, counsel of record, and any unrepresented party.

PROPOSED FINDINGS AND RECOMMENDATION

R. CLARKE VanDERVORT, United States Magistrate Judge.

This is an action seeking review of the final decision of the Commissioner of Social Security denying the Plaintiffs application for Disability Insurance Benefits (DIB) and Supplemental Security Income (SSI), under Titles II and XVI of the Social Security Act, 42 U.S.C. §§ 401-433, 1381 — 1383f. By Standing Order entered June 7, 2007 (Document No. 4.), this case was referred to the undersigned United States Magistrate Judge to consider the pleadings and evidence, and to submit Proposed Findings of Fact and Recommendation for disposition, all pursuant to 28 U.S.C. § 636(b)(1)(B). Presently pending before the Court are the parties’ erossMotions for Judgment on the Pleadings. (Document Nos. 15 and 21.)

The Plaintiff, Barbarah J. McPherson, (hereinafter referred to as “Claimant”), filed applications for SSI and DIB on February 3, 2004 (protective filing date), alleging disability as of February 1, 2004, due to temporary vision loss; temporary weakness of her extremities; pain in her hands, arms, legs, feet, and back; and hearing problems. (Tr. at 23, 59, 70-72, 94, 418-20.) Claimant’s DIB application was denied initially because she did not meet the insured status requirements. (Tr. at 23.) The SSI claim was denied initially and upon reconsideration. (Tr. at 422-24, 430-32.) On March 10, 2005, Claimant requested a hearing before an Administrative Law Judge (ALJ). (Tr. at 433.) Prior to the hearing, Claimant filed on September 7, 2005, a subsequent application for DIB. (Tr. at 23.) Claimant was found to have met the insured status requirements through March 31, 2008, based on her work activity in 2004.(M) Given that the SSI claim was at the hearing level, Claimant’s DIB claim was escalated to the hearing level. (Id.) The hearing was held on November 3, 2005, before the Honorable Theodore Burock. (Tr. at 440-74.) By decision dated February 24, 2006, the ALJ determined that Claimant was not entitled to benefits. (Tr. at 23-34.) The ALJ’s decision became the final decision of the Commissioner on April 6, 2007, when the Appeals Council denied Claimant’s request for review. (Tr. at 6-10.) Claimant filed the present action seeking judicial review of the administrative decision on June 7, 2007, pursuant to 42 U.S.C. § 405(g). (Document No. 1.)

Under 42 U.S.C. § 423(d)(5) and § 1382c(a)(3)(H)(I), a claimant for disability benefits has the burden of proving a disability. See Blalock v. Richardson, 483 F.2d 773, 774 (4th Cir.1972). A disability is defined as the “inability to engage in any substantial gainful activity by reason of any medically determinable impairment which can be expected to last for a continuous period of not less than 12 months....” 42 U.S.C. § 423(d)(1)(A).

The Social Security Regulations establish a “sequential evaluation” for the adjudication of disability claims. 20 C.F.R. §§ 404.1520, 416.920 (2006). If an individual is found “not disabled” at any step, further inquiry is unnecessary. Id. §§ 404.1520(a), 416.920(a). The first inquiry under the sequence is whether a claimant is currently engaged in substantial gainful employment. Id. §§ 404.1520(b), 416.920(b). If the claimant is not, the second inquiry is whether claimant suffers from a severe impairment. Id. §§ 404.1520(c), 416.920(c). If a severe impairment is present, the third inquiry is whether such impairment meets or equals any of the impairments listed in Appendix 1 to Subpart P of the Administrative Regulations No. 4. Id. §§ 404.1520(d), 416.920(d). If it does, the claimant is found disabled and awarded benefits. Id. If it does not, the fourth inquiry is whether the claimant’s impairments prevent the performance of past relevant work. 20 C.F.R. §§ 404.1520(e), 416.920(e). By satisfying inquiry four, the claimant establishes a prima facie case of disability. Hall v. Harris, 658 F.2d 260, 264 (4th Cir.1981). The burden then shifts to the Commissioner, McLain v. Schweiker, 715 F.2d 866, 868-69 (4th Cir.1983), and leads to the fifth and final inquiry: whether the claimant is able to perform other forms of substantial gainful activity, considering claimant’s remaining physical and mental capacities and claimant’s age, education and prior work experience. 20 C.F.R. § § 404.1520(f), 416.920(f) (2006). The Commissioner must show two things: (1) that the claimant, considering claimant’s age, education, work experience, skills and physical shortcomings, has the capacity to perform an alternative job, and (2) that this specific job exists in the national economy. McLamore v. Weinberger, 538 F.2d 572, 574 (4th Cir.1976).

When a claimant alleges a mental impairment, the Social Security Administration “must follow a special technique at every level in the administrative review process.” 20 C.F.R. § § 404.1520a(a) and 416.920a(a). First, the SSA evaluates the claimant’s pertinent symptoms, signs and laboratory findings to determine whether the claimant has a medically determinable mental impairment and documents its findings if the claimant is determined to have such an impairment. Second, the SSA rates and documents the degree of functional limitation resulting from the impairment according to criteria as specified in 20 C.F.R. §§ 404.1520a(c) and 416.920a(c). Those sections provide as follows:

(c) Rating the degree of functional limitation. (l)Assessment of functional limitations is a complex and highly individualized process that requires us to consider multiple issues and all relevant evidence to obtain a longitudinal picture of your overall degree of functional limitation. We will consider all relevant and available clinical signs and laboratory findings, the effects of your symptoms, and how your functioning may be affected by factors including, but not limited to, chronic mental disorders, structured settings, medication and other treatment.

(2) We will rate the degree of your functional limitation based on the extent to which your impairment(s) interferes with your ability to function independently, appropriately, effectively, and on a sustained basis. Thus, we will consider such factors as the quality and level of your overall functional performance, any episodic limitations, the amount of supervision or assistance you require, and the settings in which you are able to function. See 12.00C through 12.00H of the Listing of Impairments in appendix 1 to this subpart for more information about the factors we consider when we rate the degree of your functional limitation.

(3) We have identified four broad functional areas in which we will rate the degree of your functional limitation: Activities of daily living; social functioning; concentration, persistence, or pace; and episodes of decompensation. See 12.00C of the Listings of Impairments.

(4) When we rate the degree of limitation in the first three functional areas (activities of daily living, social functioning; and concentration, persistence, or pace), we will use the following five-point scale: None, mild, moderate, marked, and extreme. When we rate the degree of limitation in the fourth functional area (episodes of decompensation), we will use the following four-point scale: None, one or two, three, four or more. The last point on each scale represents a degree of limitation that is incompatible with the ability to do any gainful activity.

Third, after rating the degree of functional limitation from the claimant’s impairments), the SSA determines their severity. A rating of “none” or “mild” in the first three functional areas (activities of daily living, social functioning; and concentration, persistence, or pace) and “none” in the fourth (episodes of decompensation) will yield a finding that the impairments) is/are not severe unless evidence indicates more than minimal limitation in the claimant’s ability to do basic work activities. 20 C.F.R. §§ 404.1520a(d)(l) and 416.920a(d)(l). Fourth, if the claimant’s impairments) is/are deemed severe, the SSA compares the medical findings about the severe impairment(s) and the rating and degree and functional limitation to the criteria of the appropriate listed mental disorder to determine if the severe impairments) meet or are equal to a listed mental disorder. 20 C.F.R. §§ 404.1520a(d)(2) and 416.920a(d)(2). Finally, if the SSA finds that the claimant has a severe mental impairment(s) which neither meets nor equals a listed mental disorder, the SSA assesses the Claimant’s residual functional capacity. 20 C.F.R. § § 404.1520a(d)(3) and 416.920a(d)(3). The Regulation further specifies how the findings and conclusion reached in applying the technique must be documented at the ALJ and Appeals Council levels as follows:

At the administrative law judge hearing and the Appeals Council levels, the written decision issued by the administrative law judge and the Appeals Council must incorporate the pertinent findings and conclusions based on the technique. The decision must show the significant history, including examination and laboratory findings, and the functional limitations that were considered in reaching a conclusion about the severity of the mental impairment(s). The decision must include a specific finding as to the degree of limitation in each of the functional areas described in paragraph (c) of this section.

20 C.F.R. §§ 404.1520a(e)(2) and 416.920a(e)(2).

In this particul