Smith v. Astrue (961 F. Supp. 2d 620, 2013)

MEMORANDUM OPINION

BURKE, United States Magistrate Judge.

Plaintiff Robert Smith (“Smith” or “Plaintiff’) appeals from a decision of Defendant Michael J. Astrue, the Commissioner of Social Security (“Commissioner” or “Defendant”), denying him application for disability insurance benefits (“DIB”) under Title II of the Social Security Act, 42 U.S.C. §§ 401-434. The Court has jurisdiction over the matter pursuant to 42 U.S.C. § 405(g).

Presently pending before the Court are cross-motions for summary judgment filed by Smith and the Commissioner. (D.I. 12, 15) Smith asks the Court to reverse the Commissioner’s decision and order benefits or remand for further proceedings. (D.I. 13 at 25) The Commissioner opposes this motion and requests that the Court affirm his decision. (D.I. 16 at 35) For the reasons set forth below, Smith’s motion for summary judgment will be GRANTED-IN-PART and DENIED-IN-PART and the Commissioner’s motion for summary judgment will be DENIED. The case will be remanded for further proceedings consistent with this Memorandum Opinion.

I. BACKGROUND

A. Procedural History

Smith filed his claim for DIB on April II, 2007, alleging disability beginning on August 25, 2006. (D.I. 11 (“Transcript” and hereinafter “Tr.”) at 101-07, 124, 129; D.I. 13 at 1) His claimed period of disability ran through December 31, 2010, .the date he was last insured for disability benefits. (Id. at 10)

Smith’s application was denied on June 8, 2007. (Tr. at 74-78) On June 14, 2007, Smith filed a request for reconsideration, and on July 12, 2007, the application was denied again. (Id. at 79-84) On August 14, 2007, Smith filed a request for a hearing (the “hearing”) before an Administrative Law Judge (“ALJ”). (Id. at 85) The hearing, before ALJ Melvin D. Benitz, was held on May 1, 2008. (Id. at 21-68) On June 10, 2008, the ALJ issued a decision confirming the denial of benefits to Smith. (Id. at 7-20) Smith requested a review of this decision by the Appeals Council, but that request was denied on May 12, 2009. (Id. at 1-6) The June 10, 2008 decision therefore became the final decision of the Commissioner. (Id. at 1); see also 20 C.F.R. §§ 404.900(a)(4)-(5), 404.955, 404.981; Sims v. Apfel, 530 U.S. 103, 106-07, 120 S.Ct. 2080, 147 L.Ed.2d 80 (2000).

On June 9, 2009, Smith filed a Complaint in this Court seeking judicial review of the ALJ’s June 10, 2008 decision. (D.I. 2) On July 21, 2010, Smith filed his motion for summary judgment. (D.I. 12) The Commissioner opposed Smith’s motion and filed a cross-motion for summary judgment on August 19, 2010. (D.I. 15) On March 28, 2012, this case was referred to the Court by Judge Richard G. Andrews to hear and resolve all pretrial matters. On April 24, 2012, the parties consented to the Court presiding over all proceedings in this case, including trial, the entry of final judgment, and all post-trial proceedings. (D.I. 18)

B. Factual Background

At the time of the hearing, Smith was 48 years old. (Tr. at 26, 101) He has an eighth grade education (id. at 26, 134), and was last employed full-time in August of 2005, when he worked as a maintenance director at a nursing home (id. at 27-29, 59,129-30).

1. Plaintiffs Medical History, Treatment, and Condition

Smith alleges that he became disabled on or about August 25, 2006 because of coronary disease, hyperlipidemia, hypertension, and COPD. (Tr. at 101, 129) He asserts that he remains unable to work because these conditions cause him to suffer chronic fatigue and shortness of breath. (Id. at 31-32)

a. Medical History Through 2004

On April 9, 2002, Smith visited David Ramos, M.D., a cardiologist, for the first time, in order to determine whether Smith could take certain medication. (Tr. at 242) Smith reported to Dr. Ramos that he had not seen a cardiologist in the previous four years and was seeking further cardiac evaluation. (Id.) Smith told Dr. Ramos that he had his first episode of chest pain when he was 25 years old, but that he did not seek medical attention because it went away. (Id.) A few years later, he again experienced chest pain and was admitted to a hospital, where he was told he sustained myocardial infarction (a heart attack). (Id.) A few years after that, he had additional chest discomfort, was again admitted to a hospital, and was told he had another heart attack. (Id.) Smith reported that he had not had chest pain in approximately ten years. (Id.) Dr. Ramos noted that Smith had been told of the need to stop smoking but had been unable to do so and did not seem motivated to do so. (Id.; see also id. at 244)

Dr. Ramos reviewed an exercise stress test from a year and a half before Smith’s visit, and described it as “horrible looking” with a “severely diminished left ventricular ejection fraction [(“LVEF” or “ejection fraction”) ] of 11%.” (Tr. at 243-44) He ordered a new stress test on Smith. (Id. at 244) The results of that new stress test showed Smith’s ejection fraction had improved from 11% to 23%. (Id. at 241) The conclusion of the study indicates “normal treadmill stress test at an adequate level of exercise” and “no evidence of exercise induced ischemia....” (Id. at 240)

At a May 1, 2002 follow up visit, Dr. Ramos categorized the change in Smith’s ejection fraction as “a quite dramatic improvement,” noting that “[i]t is however still less than half of what it should be.” (Tr. at 238) Dr. Ramos noted that Smith’s multiple heart attacks were “directly related to him smoking since there is no evidence for critical coronary artery disease by cardiac catheterization” and noted that he told Smith that he “did not expect [Smith] would have anywhere near normal prognosis if he continues to smoke.” (Id.)

In visits in August and October 2002 with Dr. Ramos, Smith was reported to be “doing pretty well” from a cardiac standpoint. (Tr. at 232-36) Dr. Ramos had repeated discussions with Smith about how smoking “was the root cause of all his problems” and how Smith needed to quit. (Id. at 236)

At Smith’s March 14, 2003 visit to Dr. Ramos, Smith reported that he was “able to perform all his usual activities without difficulty.” (Tr. at 231) Dr. Ramos asked him to work harder on his diet and increasing his exercise (as Smith’s weight had continued to rise mildly) and to work harder to quit smoking, since that was Smith’s single biggest risk factor for his ischemic dilated cardiomyopathy. (Id.)

On October 7, 2004, Smith underwent an echocardiogram, which showed normal left ventricular systolic function and a left ventricular ejection fraction of 25%. (Tr. at 228-29) It further showed severe left ventricular cavity enlargement and moderate left atrial enlargement, as well as regional wall motion abnormalities consistent with ischemic dilated cardiomyopathy. (Id.)

b. 2005-2006

Smith was laid off from his job at the nursing home in August of 2005. (Tr. at 28)

On October 17, 2005, Smith returned to Dr. Ramos’ practice. Notes from that visit indicate that Smith had been noncompliant with follow-up for the previous two and a half years. (Tr. at 225) Smith explained that he had been taking his heart-related medications for most of the time since his last visit (having stopped for a period of time due to difficulty in affording them) and had not had a myocardial infarction in that time. (Id. at 226-227) Dr. Ramos noted that Smith needed to be on Coumadin to prevent the risk of recurrent cardioembolic stroke, but Smith’s “level of compliance does not make him a good candidate” for the drug. (Id.) An echocardiogram was ordered to reassess left ventricular functioning, and Dr. Ramos noted that if Smith had, indeed, been compliant with taking his medication, Dr. Ramos “would anticipate improvement in [Smith’s] LV ejection fraction.” (Id.) Dr. Ramos told Smith “that the root cause of his cardiovascular disease is his continued smoking” but noted that “he really shows zero inclination to quit.” (Id.)

Smith met again with Dr. Ramos’ office on December 15, 2005, following lab testing and cardiac studies ordered at the October visit. (Tr. at 217) Dr. Ramos’ colleague noted that the echocardiogram showed Smith’s LV ejection fraction was approximately 25%. (Id. at 218) A stress test was stopped after close to eight minutes, due to Smith’s shortness of breath; its results showed no ischemic EKG changes and a calculated LVEF at 13%. (Id. at 219) Smith reported no chest pain, pressure, heaviness, or tightness. (Id.) Dr. Ramos’ colleague noted “[i]t is amazing to me that he is as functional as he is able to be with the massive left ventricular enlargement and severely dilated cardiomyopathy that he has had for many years now. Indeed, his first myocardial infarction occurred at the age of 25 and he has had multiple myocardial infarctions primarily because of his extreme noncompliance. He has continued to smoke and has absolutely zero desire to quit and does not even want to discuss it.” (Id.) Upon Smith’s representation that he would be compliant, Smith was started on Coumadin. (Id.) An evaluation by an electrophysiologist for possible implantable defibrillator was ordered. (Id.)

On January 18, 2006, Smith was implanted with an implantable cardioverterdefibrillator (“ICD”), a surgery performed by Henry L. Weiner, M.D. (Tr. at 180)

On February 2, 2006, Rita Lucey, R.N., reported that Smith’s ICD check was normal. (Tr. at 210-11) Smith told Nurse Lucey that he had no chest discomfort, palpitations, dyspnea, shocks, dizzy spells or lightheadedness, chills or fever. (Id. at 210) Nurse Lucey noted that Smith was a carpenter and that his work involved lifting, “so he will need to be out of work for eight weeks secondary to limitations in lifting and arm motion restrictions.” (Id. at 211) Smith had later follow-up checks of his ICD in 2006, which were normal. (Id. at 197, 201)

On February 15, 2006, Smith again saw Dr. Ramos. (Tr. at 207-09) He told Dr. Ramos he had no chest pain, pressure, heaviness, or tightness. (Id. at 208) Smith reported that he had lost his job and has been “taking it easy.” (Id.) Dr. Ramos reported that Smith asked about going back to work. (Id.) Dr. Ramos noted that “[f]rom a cardiac standpoint he is actually currently asymptomatic and despite a dilated cardiomyopathy he had no areas of ischemia on a recent stress test. He has had a dilated cardiomyopathy for many years because of recurrent [myocardial infarctions] for which [he] has not followed [sic ] with therapies. I feel it likely he will be able to return to work but have asked him to call me if he runs into trouble.” (Id.)

On May 2, 2006, Smith returned to Dr. Ramos. (Tr. at 202) Smith reported that he was able to perform all of his regular activities without difficulty, but did get exertional dyspnea (shortness of breath) when he over exerts himself. (Id. at 203) Dr. Ramos noted that Smith intended to lead a Boy Scout troop on a camping trip in August 2006, but did not think he would be able to hike up the mountain, and required a doctor’s letter so that he would be permitted to drive instead. (Id.) Dr. Ramos agreed that Smith would have difficulty getting up the mountain and wrote a letter to that effect. (Id.)

On July 24, 2006, Smith visited Joseph Rubacky, D.O., his primary care physician. (Tr. at 264) He reported to Dr. Rubacky that he gets short of breath in climbing stairs or walking 100 feet, and occasionally feels tightness in his left arm. (Id.) Dr. Rubacky’s assessment was that Smith had coronary disease with severe ischemic cardiomyopathy symptomatic, hypertension, hyperlipidemia, that he was an active smoker, and that he had glucose intolerance. (Id.) Dr. Rubacky’s plan was for Smith to continue his medication, to follow up with Dr. Ramos, to discontinue smoking, and to try to lose 20 pounds. (Id.)

In August, 2006, Smith alleges that he became .disabled. (Tr. at 101,129)

Smith met again with Dr. Ramos in September 2006, and reported that he was able to perform all of his regular activities without difficulty. (Tr. at 195) Dr. Ramos did note that Smith got short of breath when he “tries to overdue [sic] things a bit” and that during the August 2006 camping trip he “did need help to get up the mountain.” (Id.) Dr. Ramos indicated that he would follow up with Smith in six months, when he would recheck Smith’s lab studies and check a stress test and an echocardiogram, with the hope that Smith’s LV ejection fraction would climb above 30% since Smith had been at least partially compliant with medication. (Id.)

In October through December 2006, Smith saw Dr. Rubacky on a number of different occasions. (Tr. at 261-63) Each time, Smith denied having any chest pain or shortness of breath. (Id.) Smith did report pain in his right knee in a November visit, which originated as a result of a moped accident a few months before, and reported a productive purulent cough in a December visit. (Id. at 261-62)

c. 2007

On January 9, 2007, Dr. Rubacky completed a Delaware Health and Social Services Medical Certification form. (Tr. at 260) Dr. Rubacky listed Smith’s diagnosis as “severe cardiomyopathy — [status post] defibrillator.” (Id.) By checking the appropriate boxes, Dr. Rubacky indicated that: (1) Smith was not able to work at his usual occupation; (2) he would not permit him to perform any other work on a full-time basis; and (3) the estimated duration of Smith’s illness is more than 12 months. (Id.) Finally, Dr. Rubacky noted, in the “remarks” section: “No work per cardiologist — Dr. Ramos.” (Id.)

Smith saw Dr. Rubacky again on January 25, 2007, where he reported no chest pain, but chronic shortness of breath. (Tr. at 258) Dr. Rubacky noted, “[Unfortunately, continues to smoke.” (Id.) Smith told Dr. Rubacky he had no dizziness except when coughing. (Id.)

On February 28, 2007, Smith underwent a stress test, the results of which indicated no evidence for exercise induced ischemia, but the presence of a severely dilated left ventricular cavity with severely reduced left ventricular systolic function and a calculated ejection fraction of 23%. (Tr. at 188-189) Test results noted that Smith was able to achieve 10 METs (units of energy expenditure based on oxygen consumption) during the test. (Id.); see also Konya v. Barnhart, 391 F.Supp.2d 273, 280 n. 1 (D.Del.2005).

On March 15, 2007, Smith again met with Dr. Ramos, who again reported that Smith was able to perform all of his regular activities without difficulty and was doing “pretty well from a cardiac standpoint.” (Tr. at 185) Dr. Ramos also reported that Smith gets short of breath when he “tries to overdo things[,]” but that this usually resolves with rest. (Id. at 186) Dr. Ramos also noted that he was “asking him to work harder with diet and exercise,” pointing out that “[h]e did well on his recent stress test. He had good exercise tolerance without chest discomfort, ischemic EKG changes or evidénee of ischemia on Cardiolite imaging.” (Id.) Finally, Dr. Ramos • noted that Smith’s ejection fraction had improved when compared with the previous study, but was “still severely diminished.” (Id.)

On May 11, 2007, Smith saw Dr. Rubacky, and reported no chest pain or shortness of breath. (Tr. at 257) Dr. Rubacky cleared Smith to participate in Boy Scout camp “at sedentary level only.” (Id.)

On May 24, 2007, Smith saw Roger Kerzner, M.D., for a consultation regarding possible upgrade to a bi-ventricular ICD. (Tr. at 337-39) Dr. Kerzner noted that Smith had severe cardiomyopathy and New York Heart Association Class III congestive heart failure (“Class III CHF”). (Id. at 338) At this visit, Smith told Dr. Kerzner that he was “quite limited in his activity due to dyspnea” and that “with just walking down his driveway, he has extreme dyspnea that prevents him from going the whole way. If he climbs even just flight of stairs, he is quite exhausted.” (Id. at 337) Smith also told Dr. Kerzner that he had not been able to work due to his severe limiting heart failure symptoms. (Id.) Dr. Kerzner noted that Smith had “severe heart failure,” and that he would benefit from an upgrade of his defibrillator to a bi-ventricular ICD, so that he could receive cardiac resynchronization therapy. (Id. at 338)

On June 6, 2007, M.H. Borek, M.D., a medical consultant, prepared a Physical Residual Functional Capacity Assessment for Smith. (Tr. at 267-73) Dr. Borek found that Smith could occasionally lift or carry 10 pounds, frequently lift or carry less than 10 pounds, stand or walk for a total of at least 2 hours in an 8-hour work day, sit for a total of about 6 hours in an 8-hour work day, that he had an unlimited ability to push or pull, could occasionally climb ramps or stairs, could balance, stoop, kneel, crouch, or crawl, but could never climb ladders, ropes, or scaffolds. (Id. at 267-69) Dr. Borek concluded that Smith had no manipulative, visual, or communicative limitations, but should avoid concentrated exposure to extreme cold or heat, wetness, humidity, noise, vibration, fumes, odors, dusts, gases, poor ventilation, and hazards, as all could increase cardiac stress. (Id. at 269-70) Dr. Borek noted that Smith had conditions that could cause Smith’s alleged symptoms and dysfunction, but found that the magnitude of Smith’s reported dysfunction (including that Smith was only able to walk 200 feet before resting) was only “partially eredible[,]” in light of Smith’s February 2007 stress test (in which Smith was able to achieve 10 METs of cardiac work without any ischemia) and Dr. Rubacky’s May 2007 clearance of Smith to participate in sedentary activities with the Boy Scouts. (Id. at 273) Dr. Borek concluded that Smith’s maximum Residual Functional Capacity (or “RFC”) was “[s]edentary[.]” (Id.) In doing so, he gave “controlling” weight to Dr. Rubacky’s treating source opinion in the file (i.e., Dr. Rubacky’s May 2007 allowance of sedentary activity), noting this was an appropriate RFC, especially with the “AICD in place',” and further noting that Smith had limits for hazards and cardiac stressors. (Id.)

On August 1, 2007, Smith’s ICD was checked and was normal. (Tr. at 329-30) At that time, Smith reported dizziness when he gets up quickly and chronic dyspnea on exertion. (Id. at 329) On September 6, 2007, after a second attempt at a venoplasty was successful (a first attempt had failed), Dr. Weiner upgraded Smith’s ICD. (Id. at 291-96, 325, 341-43, 350) The procedure was successful. (Id. at 325)

On September 18, 2007, Smith saw John W. Shuck, M.D., a cardiologist, to have the newly implanted device checked. (Tr. at 325) At this visit, Smith told Dr. Shuck that he had worsening light-headedness and dizziness, indicating that every time he changed positions from sitting to standing or laying to sitting he got light-headed. (Id.) Smith denied chest discomfort, but stated that he continued to experience shortness of breath on exertion and had no improvement in his energy level. (Id.) The ICD check revealed that Smith was currently “in atrial fibrillation in the 70s at rest,” which began the day before his visit. (Id. at 326) Dr. Shuck further noted that “[t]he patient continues to exhibit class III heart failure symptoms.” (Id.)

The visit with Dr. Shuck led to a followup visit with Dr. Ramos on September 21, 2007. Dr. Ramos noted that the atrial fibrillation continued despite initiation of amiodarone,' antiarrhythmic medication. (Tr. at 322-23) At this visit, Smith denied lightheadedness or dizziness and reported to Dr. Ramos that he could perform most of his usual activities without much difficulty. (Id. at 322-23) Smith did complain of fatigue, which Dr. Ramos thought had gotten worse since he went into atrial fibrillation. (Id. at 323) Dr. Ramps planned to increase the dose of amiodarone and meet with Smith again in a few weeks. (Id.) Smith had a similar visit with Dr. Ramos on October 10, 2007. (Id. at 320-321)

On October 22, 2007, Smith met with Dr. Ramos again. (Tr. at 318) Smith continued to complain of fatigue, which he had said was worse with the increased amiodarone, prompting Dr. Ramos to decrease the dose between visits. (Id. at 318) An EKG at this visit showed Smith was “back in sinus or atrial paced rhythm.” (Id. at 319) Dr. Ramos noted that he “anticipate[d] further improvement in [Smith’s] energy levels once the amiodarone kicks in and if he remains in sinus rhythm for an extended period.” (Id.) Dr. Ramos also sent Smith for an ICD check on November 7, 2007, which was normal. (Id. at 316-17) During that check up, Smith complained of dizziness and shortness of breath, and it was noted that the “patient thinks he feels worse [with] ICD than he did before.” (Id. at 316)

On December 10, 2007, Smith saw Roberto Scaffidi, M.D. for a routine visit. (Tr. at 312) Dr. Scaffidi noted that, following Smith’s prior complaints of fatigue and shortness of breath, multiple lab studies were ordered to search for a cause. (Id.) Smith reported to Dr. Scaffidi that he felt worse since the bi-ventricular ICD was placed and continued to have shortness of breath upon exertion. (Id.) He also noted occasional stabbing pain in the left side of his chest, unrelated to exertion, and occasional dizziness when he bent over or stood up rapidly. (Id.) Dr. Scaffidi noted that Smith’s CBC was normal, as were several other tests. (Id. at 313) He further stated “[i]t is unclear at this point whether ongoing ventricular dyssynchronous could be a determining factor to his ongoing dyspnea on exertion. However, he does continue to smoke, and has physical examination signs consistent with chronic frontal pulmonary disease. I suspect that this at least in part is contributing to his overall clinical picture at this time.” (Id. at 313) Accordingly, Dr. Scaffidi referred Smith to pulmonology for a workup for suspected COPD as a contributing cause of dyspnea. (Id. at 314) Dr. Scaffidi, further noted: “Strongly encourage patient to discontinue tobacco abuse.” (Id.)

On December 11, 2007, Smith met with Aditya N. Dubey, M.D., of Kent Pulmonary Associates. (Tr. at 305) Dr. Dubey noted that Smith complained of dyspnea on exertion, which he said had been ongoing for at least three months. (Id.) Smith also complained of a cough and occasional left-sided pain. (Id.) Dr. Dubey noted Smith had no history of dizziness or lightheadness, but that he does complain of excessive daytime sleepiness and noted he will “doze off at inappropriate times.” (Id.) Dr. Dubey’s notes indicate that Smith “works as a carpenter.” (Id.) Dr. Dubey’s diagnosis was chronic obstructive pulmonary disease. (Id. at 306) She ordered a further evaluation, started Smith on additional medication and strongly advised him to quit smoking. (Id.) She further indicated that Smith’s history suggested obstructive sleep apnea and ordered a diagnostic polysomnogram. (Id.)

On March 10, 2008, Smith saw Dr. Scaffidi for a follow up visit. (Tr. at 309) Dr. Scaffidi noted that Smith’s status was essentially unchanged since the last visit; Smith continued to complain of shortness of breath after limited exertion and of occasional stabbing chest discomfort that resolved on its own. (Id.) Smith’s pulmonary function testing revealed that his lungs were functioning at 80% capacity. (Id.) Dr. Scaffidi noted that Smith was “somewhat limited in his physical activity secondary to his [chronic heart failure] symptoms.” (Id. at 310) He also noted that “[b]y history, he may very well have obstructive sleep apnea which contributes to his overall symptoms. I suspect that his continued smoking and some degree of COPD are also concerning factors. He does not follow a specific diet and he is clearly overweight, which also puts further strain on his heart and ... likely contributes to his dyspnea as well.” (Id.) Dr. Scaffidi adjusted some of Smith’s medications, referred him to cardiac rehabilitation to establish an exercise program, instructed him on dietary changes, referred him for a sleep study to assess for sleep apnea, and strongly encouraged him to quit smoking. (Id. at 310-11)

On or about April 2, 2008, Dr. Ramos completed a “Physician’s Statement” regarding Smith; the statement appears to have been typewritten by another person, and Dr. Ramos made handwritten changes to portions of the statement. (Tr. at 369) Dr. Ramos agreed that he was Smith’s treating cardiologist from April 2002 through March 2003, and then again from October 2005 through March 2007. (Id.) He agreed that Smith reported fatigue and chest pains when he attempted to work and that he reported shortness of breath going up and down steps. (Id.) He stated that Smith’s heart condition is so severe that if he were able to improve compliance he would refer him to a tertiary medical center which performs cardiac transplantation. (Id.) He noted that Smith’s most recent LVEF was 23% and that a normal LVEF is between 50% and 60%. (Id.) He agreed that Smith’s heart was operating at less than 50% efficiency and that, accordingly, he is subject to chronic fatigue. (Id.) Dr. Ramos agreed that, although there has been some slight improvement in Smith’s condition recently, the condition of his heart is such that he could not maintain any kind of regular work on a 40-hour a week basis. (Id.)

However, Dr. Ramos did not agree with the statement that “[e]ven if [Smith] were to have some kind of sedentary work for which he might be qualified, the normal stress of almost any job would put [Smith] at risk for heart failure,” noting instead that such “stress” was for the primary care physician to evaluate. (Tr. at 369) Dr. Ramos agreed that Smith’s reports of shortness of breath, heaviness, tightness and chest pain are all consistent with his condition, but did not agree with the statement that “[e]ven normal activities of everyday living would cause cardiac symptoms for Mr. Smith,” adding instead that this would only be the case when Smith “doesn’t take his meds.” (Id. at 370) Under the “other comments” section, Dr. Ramos noted “ICD does place limits on certain types of work.” (Id.)

2. The Administrative Hearing

a. Mr. Smith’s Testimony

At his administrative hearing, Smith testified that he lived with his wife and stepson, who was then fifteen years old. (Tr. at 38) He said that since he began working he has held positions as a carpenter, a well-driller, an employee at medical supply companies, a maintenance supervisor in a nursing home, and a handyman. (Id. at 27) The last time he was regularly employed was in August 2005, at which time he was fired from his job at the nursing home. (Id. at 28) Smith testified that he became disabled and that his health “starting going down” when “they started putting machines in [him].” (Id.)

Smith said that in January of 2006 he received a defibrillator because his doctors did not know when his heart might stop. (Tr. at 29) Though it never “went off,” Smith testified that it did not help his condition; instead, his condition got worse. (Id. at 30). He “was getting a lot weaker, more tired.” (Id.) Smith said he tried to do some work after that — including installing a small floor for his neighbors — and it took him days to do what should have only taken hours. (Id.) At that point, Smith said he “knew that things [weren’t] going right.” (Id.)

Smith said he next contacted vocational rehabilitation personnel, to see if he could find work, but they were only able to help him find part-time work, which was sporadic. (Tr. at 30-31) He testified that he did not think he could do any kind of job on a regular 40-hour a week basis, because he could barely walk around Wal-Mart without getting tired and having to sit down and because carrying things “would take [his] wind away.” (Id. at 31) He said that climbing one flight of steps makes him feel “like I’m going to collapse” and that walking to the end of the driveway with his trash can that is on wheels leaves him “totally wore out.” (Id.) Smith testified that his major problem is that he is tired but that he also gets short of breath, sometimes even when he is not doing anything. (Id. at 31-32)

Smith stated that he does help around the house. He said that he and his wife take turns cooking and he does laundry occasionally. (Tr. at 32) He would do some vacuuming, but he can not do the whole house at one time. (Id.) He can cut the grass on the riding mower, but that “wears [him] out too, because it’s not power steering.” (Id.) He cannot trim the grass, as “[t]he weed whacker is just too much.” (Id.) Smith testified that when he does do any of these activities, he has to rest when he is done. (Id. at 32-33)

With regard to his daily routine, Smith testified that he usually makes coffee upon getting up, then smokes a cigarette, drinks his coffee and takes a shower. (Tr. at 33) After that, he might run an errand, such as go to a store, as he did on the morning of the hearing. (Id.) When he gets home, he is “beat.” (Id.) If he tried to do any activities around the house, such as painting or repairs, he testified that it would “take a lot out of’ him. (Id. at 34) In particular, he noted that he gets dizzy and feels like he is going to pass out when he bends over, which happens several times a day. (Id.)

In the afternoons, Smith testified that he used to sit in his chair and do small crafts with his hands, but he had to stop because his hands cramp up and go to sleep. (Tr. at 34) He said that he is not able to sit in his chair for extended periods of time because he “get[s] squirmy” and has to get up because of his hips. (Id. at 34-35)

Smith testified that he falls asleep randomly throughout the day. (Tr. at 35) He cannot sit through a movie without falling asleep and when he does fall asleep, he may stay asleep anywhere from five minutes to half an hour. (Id.) Smith testified that he was diagnosed with sleep apnea just two weeks before the hearing, for which he uses a CPAP machine, but that it does not help. (Id. at 36, 42) Smith stated he gets short of breath every day, sometimes even when just sitting still. (Id. at 36-37)

Smith testified that he can read and write, but has difficulty spelling and understanding things. (Tr. at 36) He needed his wife’s help to fill out the Social Security application. (Id.)

Upon questioning from the ALJ, Smith testified that he can lift about 50 pounds, but that his doctor says he should not lift more than 20 pounds. (Tr. at 40) He then stated that carrying a gallon of milk from the car to the kitchen “wears [him] out.” (Id.) Smith testified that he can only stand for about five minutes, and then his legs start aching and he has to move around. (Id.) He does not know what is wrong with his legs but said that his muscles tighten and he gets leg cramps. (Id.) He admitted he has not received treatment from a doctor for his legs and has never injured them. (Id.) Smith testified that he can only walk about 100 feet before getting tired and could probably go up to 250 feet before he would have to sit down. (Id. at 41) He said he can only sit for about 15 or 20 minutes before his lower back starts to bother him, though he admitted there is nothing wrong with his back. (Id.) He further testified that, once this happens, if he stands up and twists his body, then he can sit back down and be “okay for another short period.” (Id. at 41-42)

Smith said he did not believe he had any lung problems, as his “lung test” showed that his lungs “were working at 80%. ” (Tr. at 42) He testified that his shortness of breath is due to his heart, not his lungs. (Id.) He does have chest pain occasionally but has never had to take Nitroglycerin pills. (Id. at 43)

Smith confirmed that he has had four heart attacks, the last one of which was ten years prior to the hearing. (Tr. at 43) The only surgery he has had was to implant a defibrillator and pacemaker. (Id. at 43-44)

Smith acknowledged that his doctors suggested that he should not be smoking, but noted that he was down to half or one pack a day from the four packs a day he used to smoke. (Tr. at 33) He testified that he has been smoking for approximately 38 years. (Id.)

b. Mrs. Smith’s Testimony

Mr. Smith’s wife, Catherine Smith, testified next. (Tr. at 47) She testified that she has been a registered nurse for 23 years, mostly working in hospices, nursing homes and most recently at a psychiatric center. (Id. at 48)

Mrs. Smith testified that her husband suffers from cardiomyopathy, which she explained is “when the heart muscle is dying” and that “part of the heart ... is actually dead and does not beat effectively.” (Tr. at 48) Mrs. Smith said prior to the time that her husband had a pacemaker and defibrillator put in, she had begun to see a decline in the things that he was able to do, such as the ability to go for walks around the neighborhood. (Id. at 49)

Mr. Smith’s attorney asked Mrs. Smith about her husband’s ejection fraction. He first asked her “what the ejection rate is supposed to be” to which she responded that “between 50 and 60 is what would be normal.” (Tr. at 50) The attorney next asked “what effect does that have on you when the ejection rate is low?” (Id.) Mrs. Smith answered that “[t]he heart is not beating effectively. The blood is not getting to where it needs to go....” (Id.) Smith’s attorney then asked if the below normal ejection fraction would make a person tired, to which Mrs. Smith answered yes, explaining that “[w]hen you have a poor ejection fraction ... if the oxygen isn’t getting to the brain the brain starts to shut down. The body wants to rest and he falls asleep.” (Id.) Smith’s attorney then asked Mrs. Smith if she was familiar with the “METs” referenced in Smith’s stress test; she testified that she was not, noting that she “didn’t focus on cardiology.” (Id. at 50-51)

Smith’s attorney asked Mrs. Smith about her husband’s activities. She testified that he attempts to do yard work “which might last for half-an-hour and then he’s got to sit down.” (Tr. at 51) She said that “turning of the wheel” of the riding lawn mower is “stressful.” (Id.) Mrs. Smith testified that, though her husband dresses himself, “he is very short of breath after he’s done” and “[tjaking a shower he’s short of breath.” (Id. at 52) She said he falls asleep when they watch the news in the morning. (Id.) He might walk down to the mailbox and “putter in the backyard ... [b]ut he comes in and he sits down and he falls asleep.” (Id.) In the evening, Mrs. Smith testified, they watch television “and it might be five minutes into the show and he’s asleep.” (Id.) She said her husband has no problem sleeping at night. (Id.) When he falls asleep during the day, Mrs. Smith said he will sleep for anywhere between half-an-hour to an hour, depending on if she wakes him up. (Id. at 52-53)

Mrs. Smith testified that when Smith tries to help out with things like vacuuming “he’ll do one room” and be very short of breath. (Tr. at 53) She said that he is sometimes short of breath even when he is sitting at rest. (Id.) She further testified that his respiratory rate, while resting, is “twice as fast” as hers. (Id.)

Smith’s attorney next asked Mrs. Smith about her husband’s activities before his health declined. (Tr. at 53) She agreed that he did “a lot of carpentry type work and did work at places,” and was “an active person.” (Id.) When asked if she thought he could do any kind of job where he had to show up at work 40 hours a week, Mrs. Smith answered “[i]f he could sleep on the job.” (Id. at 53-54) If he could not sleep on the job, Mrs. Smith’s answer was no, “because first of all, he’s very fatigued very quickly” and “[e]ven walking from not even 100 feet, he gets very fatigued, very short of breath.” (Id. at 54) She added that “when he stands up from places at times, a lot of times he’s dizzy. He gets numbness in his hands a lot.... And to sit sedentary he would fall asleep.” (Id.)

The attorney asked Mrs. Smith if her husband has any problem with memory. (Tr. at 54) She said that he did and gave examples, such as when she will tell him things and then later have to remind him about what she said. (Id. at 54-55)

The ALJ asked Mrs. Smith a few questions. (Tr. at 55) He asked her whether she thought Smith fell asleep while watching television because of his heart, or because of his sleep apnea; Mrs. Smith replied that she thought it was a combination of both. (Id. at 56-57) She testified that she does not know how well the CPAP machine is working for his sleep apnea because she does not sleep with him often, noting that “he doesn’t sleep very well at times.” (Id.)

c. The Vocational Expert’s Testimony

Vocational expert Diana Simms also testified at the hearing. (Tr. at 57) She stated that Smith’s work as a director of maintenance for the nursing home was skilled and heavy in exertion, which would be a Skilled Vocational Preparation (“SVP”) Level 7. (Id. at 59) His prior work as a driver delivering medical supplies was a medium exertion job, with an SVP of 3. (Id.) His prior work as a maintenance supervisor, similar to his role as director of maintenance, was heavy in exertion and had an SVP of 7. (Id. at 59-60). Smith’s prior work as a “warehouse person” and “driver” were jobs that are heavy in exertion, with an SVP of 3, and his prior work as a well driller carried an SVP of 4. (Id. at 60) His work as a handyman was heavy in exertion with an SVP of 7. (Id.) Simms testified that the only transferable skill in the previous jobs would be light driving. (Id.)

The ALJ asked Simms the following hypothetical question:

Assume a person [of Smith’s age, education level, and work history], suffering mainly and generally from cardio mypoathy with the latest ejection fraction ... of 23 percent ... If I find a person can lift ... 10 pounds occasionally and lesser amounts frequently and can even lift 10 pounds frequently and 20 on occasion, and sit for 30 minutes, stand for 10 minutes consistently on an alternate basis during an eight-hour day, five days a week, but would have to avoid heights and hazardous machinery due to his dizziness he sometimes has. Avoid prolonged climbing, balancing, stooping, no more than one or twice an hour. Avoid temperature and humidity extremes, probably odors, gases, fumes and like substances, chemicals. Little reading and writing ability due to his educational background, but he seems to be able to read and write but not on an efficient basis. He would need simple, routine, unskilled jobs, of course. Low stress, low concentration due to his fatigue. He seems to be able to attend tasks and complete schedules and with those limitations be able to do sedentary, light work activities. Would there be jobs such a person can do, in your opinion, with those limitations in significant numbers in the national economy?

(Tr. at 61-62) Simms answered “yes.” (Id. at 62) She further testified that, at the sedentary exertional level, there would be “bench work” jobs as a “checker,” (approximately 500 jobs available in the region and 150,000 in the national economy), or as a “bench worker” (approximately 500 jobs available in the region and 190,000 in the national economy); that at the light exertional level there would be jobs as a “bench assembler” (approximately 900 jobs available in the region and 180,000 in the national economy) or a “hand finisher” (approximately 450 jobs available in the region and 150,000 in the national economy). (Id. at 62-63) The ALJ asked Simms if these jobs would allow a person to sit and stand on an alternate basis, to which Simms testified that they would, although she noted that the Dictionary of Occupational Titles (the “DOT”) does not use the “sit/stand” terminology. (Id. at 63-64) Simms further testified that she did not believe Smith could perform his previous work. (Id. at 64)

Smith’s attorney was then provided with an opportunity to question Simms. (Tr. at 64) The attorney asked Simms whether she would agree that there would be no jobs available for Smith if she assumed Smith’s testimony was credible. (Id. at 65) Simms said she would agree that “based on the testimony that he provided in regard to his shortness of breath, his fatigue[, she] would definitely agree.” (Id.) The attorney next asked if Simms agreed that “if someone, on an unscheduled basis, tends to fall asleep on the job, that person could not hold a competitive job.” (Id.) Simms again agreed. (Id.) The ALJ asked Simms whether the person could sleep a little bit on the jobs Simms had referenced; Simms responded that one could during lunchtime. (Id.)

Smith’s attorney next asked Simms if she was familiar with the “New York Association heart classifications,” to which Simms responded “I’ve seen them.” (Tr. at 65) Smith’s attorney indicated that there is a reference in the medical records to a “Class 3” classification, and asked Simms whether she was familiar with it, to which she responded she was. (Id.) The attorney represented that Class 3 patients have “cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain.” (Id. at 65-66) He then asked Simms, “[a]ssuming that this medical information is correct, that Mr. Smith is a Class 3 patient, how would that impact on his ability to work?” (Id. at 66) Simms responded “I would indicate that such a person in that category would not be able to do [substantial gainful activity (“SGA”) ].” (Id.)

In response, the ALJ noted that he and the YE were “still confronted” with the “METs ten” classification reported on Smith’s February 2007 stress test. (Tr. at 66)The ALJ noted that he “know[s] what [this classification] means” and he had “seen it many, many times and [knows] what exertional level it is classified by the ... Department of Labor.” (Id.)

3. The ALJ’s Findings

On June 10, 2008, the ALJ issued the following findings:

1. The claimant meets the insured status requirements of the Social Security Act through December 31, 2010.

2. The claimant has not engaged in substantial gainful activity since August 25, 2006, the alleged onset date (20 C.F.R. 404.1520(b) and 404.1571 et seq.).

3. The claimant has the following severe impairments: coronary artery disease, congestive heart failure, cardiomyopathy status post embolic myocardial infarctions and defibrillator placement, chronic obstructive pulmonary disease, and obesity (20 C.F.R. 404.1520(c)).

4. The claimant does not have an impairment or combination of impairments that meets or medically equals one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (20 C.F.R. 404.1520(d), 404.1525 and 404.1526).

5. After careful consideration of the entire record, the undersigned finds that the claimant has the residual functional capacity to perform sedentary work as defined in 20 C.F.R. 404.1567(a) except that he can sit for only 30 minutes at a time and stand for ten minutes, must avoid exposure to heights and hazards due to dizziness, no prolonged climbing, balancing, or stooping, no concentrated exposure to humidity or temperature extremes, or odors, gases, chemicals or similar substances due to his COPD, and is further limited to simple, routine jobs requiring little reading or writing, and jobs with low stress and requiring low concentration due to fatigue.

6. The claimant is unable to perform any past relevant work (20 C.F.R. 404.1565).

7. The claimant was born on August 6, 1959 and was 47 years old, which is defined as a younger individual age 45-49, on the alleged disability onset date (20 C.F.R. 404.1563).

8. The claimant has a limited education and is able to communicate in English (20 C.F.R. 404.1564).

9. Transferability of job skills is not material to the determination of disability because using the Medical-Vocational Rules as a framework supports a finding that the claimant is “not disabled,” whether or not the claimant has transferable job skills (See [Social Security Ruling (“SSR”) ] 82-41 and 20 C.F.R. Part 404, Subpart P, Appendix 2).

10. Considering the claimant’s age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform (20 C.F.R. 404.1560(c) and 404.1566).

11. The claimant has not been under a disability, as defined in the Social Security Act, from August 25, 2006 through the date of this decision (20 C.F.R. 404.1520(g)).

(Tr. at 10-20)

4. Mr. Smith’s Second Disability Application

Following the issuance of the ALJ’s June 10, 2008 decision, Smith filed a second disability application. On October 8, 2009, ALJ Joseph F. Leary (“ALJ Leary”) issued a decision finding that Smith was disabled under sections 216(i) and 223(d) of the Social Security Act since June 11, 2008. (D.1.14, ex. A)

ALJ Leary found that Smith had the following severe impairments: non-ischemic cardiomyopathy, chronic obstructive pulmonary disease, obstructive sleep apnea, and obesity. (Id. at 10) Further, ALJ Leary found that Smith’s impairments medically equaled “the criteria of section 3.02 and 4.02 of 20 C.F.R. Part 404, Sub-part P, Appendix 1 (20 C.F.R. 404.1520(d), 404.1525 and 404.1526).” (D.1.14, Ex. A at 10)

II. STANDARD OF REVIEW

A. Motion for Summary Judgment

Both parties filed motions for summary judgment pursuant to Federal Rule of Civil Procedure 56. In determining the appropriateness of summary judgment, the Court must “review the record as a whole, ‘drawing] all reasonable inferences in favor of the non-moving party’ but not weighing the evidence or making credibility determinations.” Hill v. City of Scranton, 411 F.3d 118, 124-25 (3d Cir.2005) (alterations in original) (quoting Reeves v. Sanderson Plumbing Prods., Inc., 530 U.S. 133, 150, 120 S.Ct. 2097, 147 L.Ed.2d 105 (2000)). “The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R.Civ.P. 56(a).

B. Review of the ALJ’s Findings

The Court must uphold the Commissioner’s factual decisions if they are supported by “substantial evidence.” See 42 U.S.C. §§ 405(g), 1383(c)(3); Knepp v. Apfel 204 F.3d 78, 83 (3d Cir.2000). “Substantial evidence” means less than a preponderance of the evidence but more than a mere scintilla of evidence. Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir.2005). The United States Supreme Court has explained that substantial evidence “does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Pierce v. Underwood, 487 U.S. 552, 564-65, 108 S.Ct. 2541, 101 L.Ed.2d 490 (1988) (internal quotation marks and citation omitted). The United States Court of Appeals for the Third Circuit has also held that a “single piece of evidence will not satisfy the substantiality test if the [Commissioner] ignores, or fails to resolve, a conflict created by countervailing evidence.” Kent v. Schweiker, 710 F.2d 110, 114 (3d Cir.1983). “Nor is evidence substantial if it is overwhelmed by other evidence — particularly certain types of evidence (e.g., that offered by treating physicians) — or if it really constitutes not evidence but mere conclusion.” Id. (citation omitted).

In analyzing whether substantial evidence supports the Commissioner’s findings, the Court may not undertake a de novo review oí the Commissioner’s decision and may not re-weigh the evidence of record. See Monsour Med. Ctr. v. Heckler, 806 F.2d 1185, 1190-91 (3d Cir.1986). The Court’s review is limited to the evidence that was actually presented to the ALJ. See Matthews v. Apfel, 239 F.3d 589, 594 (3d Cir.2001). Thus, the Court’s inquiry is not whether the Court would have made the same determination as the Commissioner; instead, the question is whether the Commissioner’s conclusion is reasonable. See Brown v. Bowen, 845 F.2d 1211, 1213 (3d Cir.1988). Even if the reviewing court would have decided the case differently, it must defer to the ALJ and affirm the commissioner’s decision, so long as the decision is supported by substantial evidence. Hartranft v. Apfel, 181 F.3d 358, 360 (3d Cir.1999); Monsour, 806 F.2d at 1190-91.

In addition to conducting an inquiry into whether substantial evidence supports the ALJ’s determination, the Court must also review the ALJ’s decision for the purpose of determining whether the correct legal standards were applied. Sykes v. Apfel, 228 F.3d 259, 262 (3d Cir.2000). The Court’s review of legal issues is plenary. Id.

III. DISCUSSION

A. Disability Determination Process

Title II of the Social Security Act, 42 U.S.C. § 423(a)(1), “provides for the payment of insurance benefits to persons who have contributed to the program and who suffer from a physical or mental disability.” Bowen v. Yuckert, 482 U.S. 137, 140, 107 S.Ct. 2287, 96 L.Ed.2d 119 (1987). In order to qualify for DIB, the claimant must establish that she was disabled prior to the date she was last insured. 20 C.F.R. § 404.131; Matullo v. Bowen, 926 F.2d 240, 244 (3d Cir.1990). A “disability” is defined as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A). A claimant is disabled “only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy.” 42 U.S.C. § 423(d)(2)(A); Barnhart v. Thomas, 540 U.S. 20, 21-22, 124 S.Ct. 376, 157 L.Ed.2d 333 (2003).

To determine whether a person is disabled, the Commissioner is required to perform a five-step sequential analysis. 20 C.F.R. § 404.1520; see also Plummer v. Apfel, 186 F.3d 422, 428 (3d Cir.1999). If a finding of disability or non-disability can be made at any point in the sequential process, the Commissioner will not review the claim further. See 20 C.F.R. § 404.1520(a)(4).

At step one, the Commissioner must determine whether the claimant is engaged in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(i) (mandating a finding of nondisability when claimant is engaged in substantial gainful activity). If the claimant is not engaged in substantial gainful activity, step two requires the Commissioner to determine whether the claimant is suffering from a severe impairment or a combination of impairments that is severe. 20 C.F.R. § 404.1520(a)(4)(h) (mandating a finding of non-disability when claimant’s impairments are not severe). If the claimant’s impairments are severe, then the Commissioner proceeds to step three, and must compare the claimant’s impairments to a list of impairments (the “listings”) that are presumed severe enough to preclude any gainful work. 20 C.F.R. § 404.1520(a)(4)(iii); Plummer, 186 F.3d at 428. When a claimant’s impairment or its equivalent matches an impairment in the listings, the claimant is presumed disabled. See 20 C.F.R. § 404.1520(a)(4)(iii). If a claimant’s impairment, either by itself or in combination, fails to meet or medically equal any listing, the Commissioner should proceed to steps four and five. 20 C.F.R. § 404.1520(e).

At step four, the Commissioner determines whether the claimant retains the RFC to perform her past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv) (stating claimant is not disabled if able to return to past relevant work); Plummer, 186 F.3d at 428. A claimant’s RFC is “that which an individual is still able to do despite the limitations caused by his or her impairment(s).” Johnson v. Comm’r of Social Sec., 529 F.Sd 198, 201 (3d Cir.2008) (internal quotations and citations omitted). “The claimant bears the burden of demonstrating an inability to return to her past relevant work.” Plummer, 186 F.3d at 428 (citation omitted).

If the claimant is unable to return to her past relevant work, step five requires the Commissioner to determine whether the claimant’s impairments preclude her from adjusting to any other available work. 20 C.F.R. § 404.1520(g) (mandating a finding of non-disability when the claimant can adjust to other work); Plummer, 186 F.3d at 428. At this last step, the burden is on the Commissioner to show that the claimant is capable of performing other available work before denying disability benefits. Id. In other words, the ALJ must show that “there are other jobs existing in significant numbers in the national economy which the claimant can perform, consistent with her medical impairments, age, education, past work experience, and [RFC].” Id. When making this determination, the ALJ must analyze the cumulative effect of all of the claimant’s impairments. Id. At this step, the ALJ often seeks the assistance of a vocational expert. Id. (citation omitted).

B. Mr. Smith’s Arguments On Appeal

On appeal, Smith presents three sets of arguments, and asserts that: (1) in various ways, the ALJ improperly assessed the medical evidence; (2) the ALJ failed to properly weigh the testimony of Mrs. Smith; and (3) the ALJ’s RFC finding is inconsistent with the nature of the jobs upon which he relied to find that Smith could perform substantial gainful activity. (D.I. 13 at 2-3) The Court considers each set of arguments in turn.

1. The ALJ’s Assessment of the Medical Evidence

a. The ALJ’s Consideration of Opinions of Mr. Smith’s Treating Physicians and of a State Agency Physician

Smith first argues that the ALJ failed to follow the “treating physician doctrine” in not giving sufficient weight to the opinions of six doctors who treated Smith and by failing to properly credit certain aspects of those physicians’ opinions. (D.I. 13 at 8-18) Relatedly, Smith alleges that the ALJ also erred in assigning more weight to the opinion of the state agency physician than the treating physician opinions. (Id.)

“A cardinal principle guiding disability eligibility determinations is that the ALJ accord treating physicians’ reports great weight, especially ‘when their opinions reflect expert judgment based on a continuing observation of the patient’s condition over a prolonged period of time.’” Morales v. Apfel, 225 F.3d 310, 317 (3d Cir.2000) (quoting Plummer, 186 F.3d at 429); see also Dougherty v. Astrue, 715 F.Supp.2d 572, 580 (D.Del.2010). The applicable Social Security regulations instruct that:

Generally, we give more weight to opinions from your treating sources, since these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of [a claimant’s] medical impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations, such as consultative examinations ....

20 C.F.R. § 404.1527(c)(2); see also Fargnoli v. Massanari, 247 F.3d 34, 43 (3d Cir.2001).

These regulations instruct that if a treating source’s opinion as to the nature and severity of a claimant’s impairments is “well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record,” it will be given “controlling weight.” 20 C.F.R. § 404.1527(c)(2); see also SSR 96-2p, 61 Fed.Reg. 34490-01 (July 2, 1996). After undertaking this analysis, if an ALJ determines that a treating physician’s opinion is not entitled to controlling weight, he or she must then determine what weight to give the opinion. The ALJ must do so by considering the following factors: length of the treatment relationship and frequency of examination, nature and extent of the treatment relationship, the degree to which the physician presents relevant medical evidence in support of the opinion, the consistency of the opinion with the record as a whole, the degree to which the opinion relates to an area in which the physician specializes, and any other factors “which tend to support or contradict the opinion.” 20 C.F.R. § 404.1527(c) (2)-(6); Ongay v. Astrue, Civil No. 09-0610 RMB, 2010 WL 5463070, at *9 (D.Del. Dec. 29, 2010).

“Where a treating physician’s medical opinion conflicts with [that of] a non-examining physician, the ALJ may choose whom to credit but ‘cannot reject evidence for no reason or for the wrong reason.’” Ongay, 2010 WL 5463070, at *10 (quoting Morales, 225 F.3d at 317). An ALJ may reject a treating physician’s opinion as long as the rejection is due to contradictory medical evidence, rather than the ALJ’s “own credibility judgments, speculation, or lay opinion.” Morales, 225 F.3d at 317 (citation omitted).

Here, the ALJ specifically addressed the opinions of three medical sources: (1) Dr. Rubacky, Smith’s family physician; (2) Dr. Ramos, Smith’s cardiologist; and (3) Dr. Borek, a state agency physician. (Tr. at 17-18) In examining Dr. Rubacky’s and Dr. Ramos’ opinions regarding Smith’s ability to work, the ALJ accurately set out the appropriate legal standards, discussed above, regarding how to assess a treating physician’s opinion. (Id.) Ultimately, the ALJ did not give controlling weight to either treating physician’s opinion, finding that both were inconsistent with the record evidence, but did give the opinion of the state agency physician, Dr. Borek, “significant weight.” (Id. at 18) For the reasons that follow, the Court finds that the ALJ’s approach to these opinions did not constitute reversible error.

i. Dr. Rubacky’s and Dr. Ramos’ Opinions

Dr. Rubacky completed a single page Medical Certification form at the request of Delaware Health and Social Services in January 2007, in order to assist the agency in evaluating Smith’s request for benefits. (Tr. at 260) Dr. Rubacky checked boxes indicating that Smith was unable to work at his usual occupation, that he would not permit Smith to perform any other work on a full time basis, and added, in the “Remarks” section: “No work per cardiologist — Dr. Ramos.” (Id.) The ALJ assigned “some weight” to Dr. Rubacky’s opinion that Smith could not perform his usual job, but did not give controlling weight, or any significant weight, to the portions of Dr. Rubacky’s opinion indicating that Smith could not maintain any job on a full time, 40-hour-a-week basis. (Id. at 18) In coming to this conclusion, the ALJ noted that Dr. Rubacky’s opinion was “not supported by his own treatment records and is inconsistent with the lack of work restrictions in his contemporaneous notes and his advice that [Smith] could attend Boy Scout camp and do sedentary activities.” (Id.) The Court finds that the ALJ’s conclusion is supported by substantial evidence.

For one thing, Dr. Rubacky’s treatment notes do not indicate that Smith experienced significant heart-related physical limitations in this time period, let alone limitations that would impact Smith’s work ability in the way Dr. Rubacky suggested. Dr. Rubacky prepared the form on January 9, 2007, after at least four visits with Smith in 2006. (Tr. at 260) Though Smith did complain in a July 2006 visit of becoming winded after climbing stairs or walking 100 feet, (id. at 264), during a number of other visits with Dr. Rubacky later in 2006, Smith repeatedly denied the existence of chest pain, dizziness, weakness, shortness of breath and heart palpitations. (Id. at 261-64) And at no time during the period before he issued his opinion did Dr. Rubacky place any limitations on Smith’s ability to work, nor even on the extent of Smith’s physical activities.

Moreover, even in the months following Dr. Rubacky’s report, although Smith complained of shortness of breath and occasional dizziness on one follow-up visit, (Tr. at 258), by May 2007 (as the ALJ noted), Dr. Rubacky cleared Smith for “sedentary level” participation in Boy Scout activities. (Id. at 257; see also id. at 18) This came after Smith once again reported no dizziness, chest pain or shortness of bre