Weidman v. Colvin (164 F. Supp. 3d 650, 2015)

MEMORANDUM

MALACHY E. MANNION, United States District Judge

Pending before the court is the report of Judge Cohn, the magistrate judge to whom the above matter was referred, (Doc. 18), which recommends that the Court enter judgment in favor of the Commissioner of the Social Security Administration and against Plaintiff Teresa Weidman. More specifically, the report recommends that the Court affirm the Commissioner’s final decision denying the plaintiffs application for benefits under the Social Security Act, as the Commissioner’s decision was supported by substantial evidence. Based upon the court’s review of the record, the court will ADOPT Judge Cohn’s Report and Recommendation.

I. STANDARD OF REVIEW

When objections are timely filed to the report and recommendation of a magistrate judge, the district court must review de novo those portions of the report to which objections are made. 28 U.S.C. § 636(b)(1); Brown v. Astrue, 649 F.3d 193, 195 (3d Cir.2011). Although the standard is de novo, the extent of review is committed to the sound discretion of the district judge, and the court may rely on the recommendations of the magistrate judge to the extent it deems proper. Rieder v. Apfel, 115 F.Supp.2d 496, 499 (M.D.Pa.2000) (citing United States v. Raddatz, 447 U.S. 667, 676, 100 S.Ct. 2406, 65 L.Ed.2d 424 (1980)).

For those sections of the report and recommendation to which no objection is made, the court should, as a matter of good practice, “satisfy itself that there is no clear error on the face of the record in order to accept the recommendation.” Fed. R. Civ. P. 72(b), advisory committee notes; see also Univac Dental Co. v. Dentsply Intern., Inc., 702 F.Supp.2d 465, 469 (M.D.Pa.2010) (citing Henderson v. Carlson, 812 F.2d 874, 878 (3d Cir.1987) (explaining judges should give some review to every report and recommendation)). Nevertheless, whether timely objections are made or not, the district court may accept, not accept, or modify, in whole or in part, the findings or recommendations made by the magistrate judge. 28 U.S.C. § 636(b)(1); Local Rule 72.31.

When reviewing the denial of disability benefits, the court must determine whether the denial is supported by substantial evidence. Brown v. Bowen, 845 F.2d 1211, 1213 (3d Cir.1988); Johnson v. Commissioner of Social Sec., 529 F.3d 198, 200 (3d Cir.2008). 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, 108 S.Ct. 2541, 101 L.Ed.2d 490 (1988); Hartranft v. Apfel, 181 F.3d 358, 360 (3d Cir.1999), Johnson, 529 F.3d at 200. It is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971). If the ALJ’s decision is supported by substantial evidence, the court is “bound by those findings.” Fargnoli v. Massanari, 247 F.3d 34, 38 (3d Cir.2001) (citation omitted). Furthermore, in determining if the ALJ’s decision is supported by substantial evidence the court may not parse the record but rather must scrutinize the record as a whole. Smith v. Califano, 637 F.2d 968, 970 (3d Cir.1981).

To receive disability benefits, the plaintiff must demonstrate an “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. § 432(d)(1)(A). Furthermore, •

[a]n individual shall be determined to be under a disability only if [her] physical or mental impairment or impairments are of such severity that [she] is not only unable to do [her] previous work but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which [she] lives, or whether a specific job vacancy exists for [her], or whether [she] would be hired if [she] applied for work. For purposes of the preceding sentence (with respect to any individual), ‘work which exists in the national economy’ means work which exists in significant numbers either in the region where such individual lives or in several regions of the country.

42 U.S.C. § 423(d)(2)(A).

The Commissioner of Social Security must follow a five-step process to determine if an applicant is disabled under the Act. This legal framework requires the Commissioner to sequentially determine: (1) whether the applicant is engaged in substantial gainful activity; (2) whether the applicant has a severe impairment; (3) whether the applicant’s impairment meets or equals a listed impairment; (4) whether the applicant’s impairment prevents the applicant from doing past relevant work, and; (5) whether the applicant’s impairment prevents the applicant from doing any other work. 20 C.F.R. §§ 404.1520, 416.920. Since the five-step legal framework for addressing a disability claim was properly stated in the R & R, (Doc. 18, at 55-56), this portion of the R & R is incorporated by reference.

II. RELEVANT MEDICAL BACKGROUND

Judge Cohn’s report and. recommendation (“R & R”) contains a thorough review of the plaintiffs medical history. (Doc. 18, at 9-54). The plaintiff did not file any objection to Judge Cohn’s factual determinations regarding her medical history, so they will be adopted. See Butterfield v. Astrue, 2010 WL 4027768, *3 (E.D.Pa. Oct. 14, 2010) (“To obtain de novo determination of a magistrate[ ] [Judge’s] findings by a district court, 28 U.S.C. § 636(b)(1) requires both timely and specific objections to the report.”) (quoting Goney v. Clark, 749 F.2d 5, 6 (3d Cir.1984)). The court will restrict its discussion below to the relevant medical background as it pertains to the plaintiffs objections.

III. DISCUSSION

On March 24, 2014, Plaintiff Teresa Weidman filed her Complaint in the instant action, (Doc. 1), seeking judicial review of the Commissioner of the Social Security Administration’s (“Commissioner”) denial of her claim for Disability Insurance Benefits and Supplemental Security Income under Titles II and XVI of the Social Security Act. 42 U.S.C. § 405(g); 42 U.S.C. § 1383(c)(3). The Commissioner filed an answer as well as an administrative transcript of the relevant proceedings on April 30, 2014 (Doc. 7, 8). And, on August 4, 2014, the Court referred this case to Judge Cohn. Plaintiff filed a brief in support of her appeal on August 4, 2014, (Doc. 12), and on September 5, 2014, the Commissioner filed a response brief. (Doc. 13). Finally, on September 16, 2014, the plaintiff filed a reply brief. (Doc. 14).

Judge Cohn issued a comprehensive R & R on August 7, 2015 recommending that the plaintiffs appeal be denied and the action dismissed. On August 23, 2015, the plaintiff filed objections to the report recommending dismissal of her action, on three bases: that Judge Cohn erred in finding that substantial evidence supports (1) the ALJ’s credibility assessment; (2) the ALJ’s Step Three Findings; and (3) the ALJ’s RFC Assessment. The defendant Commissioner waived its opportunity to respond to the plaintiffs objections on September 4, 2015. This court will review each of the plaintiffs objections in turn.

A. Whether Substantial Evidence Supports the ALJ’s Credibility Assessment

The plaintiff argues that the ALJ’s credibility assessment, finding the plaintiff, Weidman, not credible, was not supported by substantial evidence. The plaintiff points to four specific findings by the Commissioner, and affirmed by the Magistrate Judge’s R & R, regarding her credibility and the severity of her symptoms. Upon review, the court finds that the ALJ’s credibility determination was proper and supported by substantial evidence.

1. Somatoform Disorder Is Consistent with a Finding of Adverse Credibility

The plaintiff first contends that Judge Cohn erred in affirming the ALJ’s finding that the plaintiff had “a severe impairment of undifferentiated somatoform disorder and ... that she was not entirely credible and feigned or exaggerated the severity of her symptoms.” (Doc. 18, at 61-62); (Doc. 19, at 2). The plaintiffs argument is based upon the ALJ’s failure to conduct the “legally correct analysis” in light of the plaintiffs diagnosis of a somatoform disorder.

The issue of credibility in this case, as Judge Cohn accurately noted in the R & R, presents an issue of first impression in the Third Circuit, namely, “whether it is error for an ALJ to make an adverse credibility finding when a claimant has been diagnosed with a somatoform disorder (a diagnosis which requires a determination regarding malingering) and when the ALJ determines that the somatoform disorder was a severe impairment under step two.” (Doc. 18, at 57-58). Judge Cohn’s R & R notes the importance of credibility determinations with respect to “somatization and undifferentiated somato-form disorders where their diagnostic criteria explicitly require a finding that the reported symptoms are ‘not intentionally produced or feigned (as in Factitious Disorder or Malingering).’ ” (Doc. 18, at 58). Ultimately, Judge Cohn determined, “[w]hile the diagnostic criteria require a finding that the symptoms were not produced by malingering, it is possible [ ] for a mixed diagnosis of both undifferentiated somatoform disorder symptoms and malingering to coexist.” Id. at 59. Thus, this court adopts in full Judge Cohn’s rigorously examined and reasoned conclusion that “where a claimant has been diagnosed with undifferentiated somatoform disorder and an ALJ concludes that the disorder was a severe impairment, it is legally possible for an ALJ to make an adverse credibility finding.” Id. at 67, 58-67; see also Carradine v. Barnhart, 360 F.3d 751, 756-81 (7th Cir.2004) (J. Coffey, dissenting); Minner v. Am. Mortgage & Guar. Co., 791 A.2d 826, 871-72 (Del.Super.2000).

Credibility may be analyzed despite a diagnosis of undifferentiated somatoform disorder. Therefore, plaintiffs objection that the ALJ analyzed the plaintiffs credibility “without doing legally correct analysis” must fail.

In addition, the plaintiff, in her objections, contends that no medical opinion in the record supports a finding of malingering or factitious disorder, and that the Magistrate Judge erred in basing its entire credibility assessment on “baseless malingering and factitious disorder allegations.” (Doc. 19, at 2-3).

“Allegations of pain and other subjective symptoms must be supported by objective medical evidence.” Hartranft v. Apfel, 181 F.3d 358, 362 (3d Cir.1999) (citing 20 C.F.R. § 404.1529); see also 20 C.F.R. § 404.1508. If objective medical evidence fails to substantiate the severity of the claimant’s pain or symptoms, then the ALJ must make a credibility finding regarding the claimant’s subjective statements. Social Security Ruling (SSR) 96-7p. An ALJ’s credibility finding with respect to the severity of a claimant’s symptoms requires consideration of the entire record. Id. More specifically, the ALJ must consider the following seven factors, in totality: 1) claimant’s daily activities; (2) the location, duration, frequency, and intensity of claimant’s pain or other symptoms; (3) precipitating and aggravating factors; (4) the type, dosage, effectiveness, and side effects of any medication claimant takes or has taken to alleviate pain or other symptoms; (5) treatment, other than medication, claimant receives or has received for relief of pain or other symptoms; (6) any measures claimant uses or has used to relieve pain or other symptoms; and (7) other factors concerning claimant’s functional limitations and restrictions due to pain or other symptoms. SSR 96-7p; 20 C.F.R. § 404.1529; Seney v. Comm’r Soc. Sec., 585 Fed.Appx. 805, 808-09 (3d Cir.2014) (unpublished decision).

In the instant case, the ALJ examined the record and, while she did not explicitly enumerate her findings according to the seven categories mentioned above, she addressed the entire record and concluded that the plaintiffs “allegations regarding her symptoms and limitations [are] not fully credible” (Tr. 840, 333-344). Judge Cohn, in his R & R examined the ALJ’s decision and correctly found that each of the seven factors was assessed by the ALJ, and that the totality of the evidence supported the ALJ’s finding that the plaintiff was not fully credible. (Doc. 18, at 69-79). More specifically, the ALJ identified “several occasions where the claimant gave poor effort, malingered and alleged excessive symptoms, which tends to question the extent to which her allegations are believable.” (Doc. 15, at 334-35).The objective record supports the ALJ’s observations, and provides substantial evidence that the plaintiff may have feigned or exaggerated her symptoms, thus calling into question her credibility. These instances of possible malingering in conjunction with the totality of the evidence provides ample support for the ALJ’s adverse credibility finding.

2. The ALJ Properly Assessed Plaintiffs Syncopal Episodes

The plaintiff next contends that the ALJ’s assessment of the plaintiffs synco-pal episodes, which formed part of the seven factor analysis to determine credibility, was incorrect and unsupported by substantial evidence. The ALJ noted that the plaintiff “has never hurt herself’ during one of her syncopal episodes. (Doc.-15, at 333). The plaintiff states that this allegation is not supported by substantial evidence; she points to one instance, documented in the record, when she suffered neck pain as a result of a syncopal episode (a fall) and was given morphine for pain relief as support that she has in fact hurt herself during an episode. (Doc. 19, at 4 (citing Doc. 15, at 860)).

As Judge Cohn accurately noted in his R & R, the record indicates that the during the instance cited by the plaintiff, the plaintiff only complained of subjective neck pain. (Doc. 15, at 860). This does not constitute a physical injury, and thus, the plaintiffs objection must fail. Furthermore, the entirety of the record supports the ALJ’s determination that there is no evidence of objective indicia of falls (e.g. contusions or bruising) arising from synco-pal episodes. See Doc. 18, at 85-86. Thus, the ALJ did not err in concluding that the syncopal episodes have never resulted in physical injury to the plaintiff and correctly noted this fact as part of its seven factor credibility analysis.

3. The ALJ’s Inference Regarding Plaintiffs Past Drug Use Is a Harmless Error

In addition, the plaintiff argues that the ALJ drew an adverse inference concerning the plaintiffs credibility due to testimony about past crack cocaine use. (Doc. 19, at 4-5). The record demonstrates that plaintiff previously used crack cocaine from 2000 to 2004. The plaintiff stated that she quit “cold turkey” without aid of any substance abuse treatment programs. (Doc. 15, at 1067, 1071, 1074, 1234). The ALJ’s decision found the plaintiffs statement that she “quit cold turkey” to be implausible, and the ALJ further stated that the testimony contributed to her finding that the plaintiff was not credible. (Doc. 15, at 333).

As Judge Cohn noted, “evidence can be used to discount credibility if such evidence demonstrates a contradiction or inconsistency.” (Doc. 18, at 89 (quoting Gleason v. Colvin, No. 3:14-CV-00021-GBC, 152 F.Supp.3d 364, 380-81, 2015 WL 4232569, at *13-14 (M.D.Pa. July 13, 2015)). The record contains no contradictory or inconsistent evidence that would suggest the plaintiff did not quit cold turkey. Despite the absence of any contrary evidence, the ALJ found the plaintiffs testimony that she “quit cold turkey” implausible and used this determination to support a finding that the plaintiff is not credible. (Doc. 15, at 333). This court agrees with Judge Cohn’s finding that the ALJ erred in drawing an improper inference about the method in which the plaintiff stopped using crack cocaine. (Doc. 18, at 90). The ALJ determined the plaintiffs credibility by looking to the totality of the circumstances, and as discussed previously, the record includes extensive evidence, other than the abovementioned drug use testimony, to support the ALJ’s adverse credibility finding. Therefore, like Judge Cohn, this court finds that the ALJ’s improper inference solely amounts to harmless error and does not negate a finding that the plaintiff is not credible. (Doc. 18, at 91).

4. ALJ’s Mischaracterization of the Findings of Different Doctors Is a Harmless Error

Finally, the plaintiff objects to the ALJ’s mischaracterization of the findings of different doctors. The plaintiff alleges that the ALJ erroneously stated that doctors used words “such,as feigning, malingerer, factitious and exaggerated” in then-diagnosis of the plaintiff. (Doc. 19, at 5). Judge Cohn agreed that the plaintiff “correctly pointed out that the ALJ erroneously stated that doctors explicitly determined that Plaintiff was a malingerer.” (Doc. 18, at 86-87; Doc. 19, at 5). However, Judge Cohn correctly determined that the mischaracterization resulted in a harmless error. The plaintiff objects that this mischaracterization “clouded the entire decision” and amounts to a harmful error. However, this court agrees with the standard identified in Judge Cohn’s analysis:

The Court in Williams v. Barnhart, upheld an ALJ decision where although “[s]ome of the discrepancies pointed out in the ALJ’s opinion are not great and might not alone support an adverse credibility determination,” other record evidence, supported the ALJ’s finding of incredibility. Williams v. Barnhart, 87 Fed.Appx. 240, 243-44 (3d Cir.2004).

(Doc. 18, at 88). See also Napoli v. Colvin, No. 3:13-CV-01815, 2014 WL 2808603, at *11 at n. 23 (M.D.Pa. June 20, 2014) (finding harmless error under the totality of the evidence); Bivins ex rel. N.B. v. Astrue, No. 5:11-CV-51 MSH, 2011 WL 5859954, at *5 (M.D.Ga. Nov. 22, 2011) (“Considering the totality of the medical evidence, the ALJ’s erroneous reference to a statement ... is harmless.... A remand to have the ALJ perfect the record as to this statement would serve no practical purpose, would not alter the ALJ’s findings, and would be a waste of judicial and administrative resources”).

In the instant action, the medical records by six different doctors contain statements relating to or identifying the possibility that the plaintiffs description of her symptoms was exaggerated or intentional. See supra Footnote 2. In addition, other evidence found in the record contributes to and support the ALJ’s credibility finding, including the plaintiffs history of writing bad checks and initial lying about past drug use. (Doc. 15, at Therefore, looking at the totality of the evidence, substantial evidence supports the adverse credibility finding despite the ALJ’s mischaracterization error, which this court concludes is harmless.

B. Substantial Evidence Does Not Support the ALJ’s Step Three Findings

At step three of the disability benefits evaluation process, the ALJ must determine whether a claimant’s alleged impairment matches a number of listed impairments that are acknowledged as so severe as to preclude substantial gainful activity. 20 C.F.R. § 416.920(a)(4)(iii); 20 C.F.R. pt. 404, subpt. P, App. 1; Sullivan v. Zebley, 493 U.S. 521, 529, 110 S.Ct. 885, 107 L.Ed.2d 967 (1990); Burnett v. Comm. of SSA, 220 F.3d 112, 119 (3d Cir.2000). A claimant bears the burden of establishing each element of a Listing, or “all of the criteria in the listing.” 20 C.F.R. § 404.1525(d). If even one element is not satisfied, then the ALJ has substantial evidence to conclude that the claimant’s impairment is not equivalent and does not meet a Listing. Williams v. Sullivan, 970 F.2d 1178, 1186 (3d Cir.1992).

Plaintiff objects to Judge Cohn’s determination that the ALJ was correct in finding that the plaintiff does not meet the requirements of Listing 12.07B. (Doc. 19, at 6-9). Listing 12.07B requires that the claimant demonstrate that his medical symptoms (from the 12.07A finding) result in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marked difficulties in maintaining social functioning; or

3. Marked difficulties in maintaining concentration, persistence, or pace; or

4. Repeated episodes of decompensation, each of extended duration.

20 C.F.R. pt. 404, subpt. P, app. 1, § 12.07. The ALJ found that the plaintiff did not suffered from marked restriction of activities of daily life; did not suffer marked difficulties in maintaining social functioning or concentration, persistence, or pace; and did not undergo repeated episodes of decompensation of extended duration. (Doc. 15, at 329-31). The plaintiff objects to the ALJ’s determination as to 12.07B(2)-(4), and also to Judge Cohn’s “summarized and unfounded reasoning” that affirms the determination. (Doc. 19, at 6)'. This court agrees that the ALJ’s determination was supported by substantial evidence, but for slightly different reasons, which will be discussed below.

First, plaintiff states that she has marked impairment in maintaining social functioning, and presents several facts from the consultative examination performed by Dr. Laguna to support the assertion. These facts indicate that the plaintiff sometimes feels frustrated by her family and others, and suffers from “emotional numbing and dissociative disorders.” (Doc. 19, at 7; Doc. 15, at 957-59). However, the ALJ looked at the entire record, not simply the examination of Dr. Laguna. The ALJ noted the plaintiffs testimony at the hearing, where the plaintiff stated she talks on the phone with others, she lives with her husband and children, and a friend takes her to appointments. (Doc. 15, at 330). The plaintiffs behavior clearly demonstrates an ability to get along with others and interact effectively. In addition, Dr. Fretz’ report, which reviewed the plaintiffs medical record and history, stated that the plaintiff suffered solely from moderate impairment in maintaining social functioning, (Doc. 15, at 438), and as will be discussed below, the ALJ properly placed great weight on Dr. Fretz’ opinion. (Doc. 15, at 343). The ALJ’s determination, which relied on objective record evidence, medical opinions, and hearing testimony, clearly amounts to substantial evidence and must be upheld.

Next, the plaintiff objects on the basis that the plaintiff suffers from a marked impairment in maintaining concentration, persistence, or pace, and that the ALJ incorrectly found otherwise. (Doc. 19, at 7). This 12.07B criterion refers to the ability of the claimant to “sustain focused attention and concentration sufficiently long to permit the timely and appropriate completion of tasks.” 20 C.F.R. pt. 404, subpt. P, app. 1. “Marked” impairment here refers to the “nature and overall degree of interference” with work functioning, and is generally assessed through mental status examinations (e.g. serial sevens or threes) or simulated work tasks that require short term memory and completion of the task. Id. The plaintiff claims that she has marked difficulties, and supports her assertion by identifying Dr. La-guna’s assessment that she had “a poor capacity for calculating serial threes,” and that treatment records that assign low GAF scores. (Doc. 19, at 7).

The ALJ, on the other hand, focused on objective evidence from the record showing that the plaintiffs condition improves with treatment and that she left her last job due to a physical hand problem, not a problem sustaining the job mentally. (Doc. 15, at 330). Later in the ALJ’s opinion, she places only partial weight on Dr. Laguna’s reports, but great weight on Dr. Fretz’ report which concludes that the plaintiff has only “mild” difficulties with concentration, persistence, or pace. (Doc. 15, at 343, 438). The ALJ also addresses the low GAF scores by noting the range of scores the plaintiff received through years of treatment (25 to 55). The ALJ further explains that GAF scores are subjective and attach only to a particular moment in time, but fail to take into account “a longitudinal view of the claimant’s functioning.” (Doc. 15, at 342). Thus, because the plaintiffs functioning and GAF scores improved with treatment, the lower scores do not reflect the plaintiffs functional ability today.

While the ALJ did give some weight to the plaintiffs poor capacity calculating threes and following instructions, the remainder of the objective evidence, particularly the medical treatment reports and Dr. Fretz’s report, supports the conclusion that the plaintiff has greater than mild, but less than marked impairment. Thus, the ALJ’s determination that the plaintiff has moderate restrictions in this area of functioning is supported by substantial evidence and will be upheld.

Finally, the plaintiff contends that she has experienced multiple ■ episodes of de-compensation, each of which was of extended duration, which satisfy the fourth criterion under 12.07B. (Doc. 19, at 6-8). The plaintiff states that Judge Cohn incorrectly found that substantial evidence supported the ALJ’s determination that this criterion was not satisfied. (Doc. 19, at 9). Episodes of decompensation are defined by 20 C.F.R. Part 404, Subpart P, Appendix I as “exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning, as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace.” 20 C.F.R. pt. 404, subpt. P, app. 1. These episodes must be repeated and of extended duration, which means there must be three episodes in one year (or an average of once every four months), and each must last for “at least 2 weeks.” Id.

Judge Cohn’s analysis in the R & R arrived at the correct conclusion, namely that substantial evidence supported the ALJ’s determination that the plaintiff did not experience multiple episodes of decom-pensation of extended duration, but we will affirm for a different reason. Judge Cohn stated that the ALJ’s finding that the plaintiff is not credible effectively prevents the plaintiffs emergency room visits from counting as episodes of decompensation because her symptoms during those visits were likely feigned. (Doc. 18, at 92). However, this issue can be decided without consideration of the plaintiffs credibility. Credible or not, the alleged episodes of decompensation are not of extended duration. Extended duration, as stated previously, requires that each episode last for at least two weeks. All alleged episodes, except for the plaintiffs attendance at Phil-haven Acute Partial Program from July 15, 2011 to August 12, 2011, do not meet the two week requirement. (Doc. 19, at 8). The ALJ accurately noted these facts and properly concluded that “[w]hile there is evidence of multiple exacerbations in symptoms or signs associated with the claimant’s mental impairments, the lack of extended duration and evidence of improvement with treatment ... do[ ] not meet the requisite adaptive functioning deficits to meet this listing.” (Doc. 15, at 331). Therefore, substantial evidence supports the ALJ’s finding that this criterion is not met.

And, furthermore, because the plaintiff cannot satisfy any of the four 12.07B criteria, substantial evidence supports the ALJ’s finding that the plaintiff does not meet the criteria required for a 12.07 Listing.

C. Whether Substantial Evidence Supports the ALJ’s Residual Functional Capacity (RFC) Assessment

The plaintiff lastly objects on the grounds that the residual functional capacity (RFC) assessment was not supported by substantial evidence because the ALJ incorrectly weighed medical opinion testimony and thus failed to include limitations related to the plaintiffs somatoform disorder in her RFC assessment. Specifically, the plaintiff points to the ALJ’s reliance upon Dr. Fretz, a non-treating, non-examining medical source and the ALJ’s failure to give any weight to Ms. Yevtukh, a non-acceptable medical source.

An RFC assessment, or residual functional capacity assessment, is required after Step 3 but before moving on to Step 4 of the Commissioner’s sequential evaluation process. 20 C.F.R. §§ 404.1520(e), 416.920(e). Residual functional capacity is defined as the most a claimant can do in a work setting despite the physical and mental limitations resulting from all of her impairments. Id. at § 404.1545(a)(1). The Commissioner must use all relevant evidence in the record to make the RFC assessment. Id.

In reviewing the record to make the RFC assessment, the ALJ must take into account all the medical opinion evidence along with all other relevant evidence in the record, 20 C.F.R. § 404.1527(b), and must allocate weight to each medical opinion upon which it relies. In the R & R, Judge Cohn accurately described what qualifies as medical opinion evidence and the process by which it is then analyzed and weighed:

“Medical opinions are statements from ... acceptable medical sources that reflect judgments about the nature and severity of [a claimant’s] impair- ■ ment(s), including ... symptoms, diagnosis and prognosis, what [a claimant] can still do despite impairment(s), and [a claimants] physical or mental restrictions.” 20 C.F.R. §§ 404.1527(a)(2), 416.927(a)(2) (emphasis added). Only licensed physicians (medical or osteopathic doctors), licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language pathologists are considered “acceptable medical sources.” See 20 C.F.R. §§ 404.1513(a) & 416.913(a). Evidence from “other sources” that are not “acceptable medical sources” ... are not entitled controlling weight. See 20 C.F.R. §§ 404.1513(a) and (d)(1), 404.1527(a)(2), 416.913(a) and (d)(1), 416.927(a)(2); Social Security Ruling (SSR) 96-2p (rule for according controlling weight to “treating source medical opinions”); SSR 06-03p; Hartranft v. Apfel, 181 F.3d 358, 361 (3d Cir.1999); cf. Gomez v. Chater, 74 F.3d 967, 970-71 (9th Cir.1996) (Opinions from “other sources” can be accorded “less weight than opinions from acceptable medical sources”).

(Doc. 18, p. 94) (emphasis added).

Any medical opinion from an. acceptable medical source, unless it is designated a controlling treating medical opinion, must be analyzed according to factors set forth in the Code of Federal Regulations. 20 C.F.R. § 404.1527(c). These factors include: the examining and treating relationship; the length and frequency of the relationship; the extent and nature of the relationship; the amount of objective medical evidence supporting the opinion; consistency with the entire record; specialization of the medical professional; and other factors that tend to support or contradict an opinion. Id.

1. The ALJ Did Not Err in Giving “Great Weight” to Dr. Fretz’ Opinion

The plaintiff specifically objects to the R & R because it affirms the ALJ’s allocation of “great weight” to the opinion of Dr. Fretz, a non-treating, non-examining medical source. The plaintiff argues that a non-treating, non-examining acceptable medical opinion can only be given “little, if any, weight.” (Doc. 19, p. 9). However, a non-treating, non-examining medical opinion must be analyzed according to the factors set forth above to determine its weight, and may ultimately be entitled to more than “little, if any, weight.” In fact, a non-treating, non-examining medical opinion may be allocated greater weight than other acceptable and non-acceptable medical sources, provided the ALJ gives adequate explanation for its determination. SSR 96-6p; 20 C.F.R. § 404.1527(c); Morales v. Apfel, 225 F.3d 310, 317 (3d Cir.2000); Hartranft v. Apfel, 181 F.3d 358, 361 (3d Cir.1999).

In the instant action, the ALJ clearly explained why it afforded Dr. Fretz’ opinion great weight:

Dr. Fretz, opined the [plaintiff] can understand, remember and carry out simple tasks. (Exhibit 2A). This is consistent with the medical records from Dr. Laguna, Philhaven Hospital, Hershey Medical Center and Good Samaritan Hospital, which all reveal the [plaintiff] having depression and anxiety, and related symptoms, that would reasonably limit the [plaintifffs ability to carry out more detailed tasks and instructions. (See generally Exhibits 2F; 3F; 4F; 6F; 8F-12F; 13F; 16F; 17F). Moreover, Dr. Fretz’s opinion is based on his specialty in mental health and his familiarity with the Social Security Administration disability program. His opinion reasonably comports with the evidence contained in the record at the time of the assessment, and evidence received at the hearing level did not demonstrated a worsening or deterioration in [Plaintifffs condition requiring more restrictive limitations.

(Doc. 15, p. 343). This explanation includes consideration of numerous factors, as required by section 404.1527(c) of the regulations, namely the specialty and knowledge of Dr. Fretz, objective medical evidentiary support, consistency with other evidence at the hearing, and other factors. Thus, the ALJ’s decision to place great weight on Dr. Fretz’ opinion is proper, and the plaintiffs objection must be denied.

2. The ALJ Did Not Err in Giving “No Weight” to Ms. Yevtukh’s Opinion

The plaintiff also raises an objection regarding the ALJ’s decision to give “no weight” to treating Nurse Practitioner, Ms. Yevtukh’s opinion. Ms. Yev-tukh is a Nurse Practitioner who treated the patient every 6 months for two years, from 2010 to 2012. (Doc. 15, p. 1245). As stated above, “[o]nly licensed physicians (medical or osteopathic doctors), licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language pathologists are considered ‘acceptable medical sources.’ ” (Doc. 18, p. 94). A nurse practitioner is not an acceptable medical source under the regulations; therefore, a nurse practitioner’s opinion cannot be given controlling weight. However, an ALJ may consider a non-acceptable medical opinion to assess severity of impairments and functional effect, and may reject or accept the opinion after explaining the reasons for doing so. (Doc. 18, p. 95); SSR 06-03p; Burnett v. Comm’r of Soc. Sec. Admin., 220 F.3d 112, 122 (3d Cir.2000) (explaining that an ALJ must consider all nonmedical evidence and explain why it rejects or accepts such testimony).

The plaintiff, in her objections, admits that Ms. Yevtukh is not an acceptable medical source, but states that the ALJ failed by not giving her opinion any weight in the RFC assessment. (Doc. 19, p. 11). The plaintiff states, more specifically, that the ALJ incorrectly found Ms.-.Yevtukh’s opinion to be inconsistent with objective evidence in the record, thus requiring that it be given “no weight.” To support her objection, the plaintiff points to consistencies between the RFC questionnaire completed by Ms. Yevtukh and Ms. Yevtukh’s own previous treatment notes. However, the plaintiff fails to address the contradictory and inconsistent evidence found throughout the voluminous record for this case.

The ALJ found inconsistencies between Ms. Yevtukh’s RFC questionnaire and both her own findings regarding the plaintiff as well as objective evidence in the record. Judge Cohn thoroughly reviewed the medical evidence presented in this case and identified numerous pieces of evidence that are inconsistent with or contradict Ms. Yevtukh’s opinion. See Doc. 18, p. 97-98. Furthermore, Ms. Yevtukh herself states that she is not a neurologist and she does not treat the plaintiffs depression; these statements further weaken her conclusions with regard to the plaintiffs physical limitations. (Doc. 15, p. 342, 1245). Therefore, Judge Cohn properly found that the ALJ adequately explained her allocation of weight to Ms. Yevtukh’s opinion, and that the record supported such determination. This objection will, thus, be denied.

IV. CONCLUSION

For the foregoing reasons, the ALJ’s decision to deny the plaintiffs Social Security claim is supported by substantial evidence. Accordingly, the R & R issued by Judge Cohn, (Doc. 18), is ADOPTED. The final decision of the Commissioner is AFFIRMED, and the plaintiffs appeal, (Doc. 1), is DENIED. An appropriate order shall issue.

ORDER

In accordance with the accompanying memorandum, IT IS HEREBY ORDERED THAT:

1. The plaintiffs objections to the report and recommendation, (Doc. 19), are DENIED.

2. The report .and recommendation, (Doc. 18), is ADOPTED.

3. The plaintiffs appeal, (Doc. 1), of the defendant Commissioner’s decision, is DENIED.

4. The Clerk of Court shall close this case.

REPORT AND RECOMMENDATION TO DENY PLAINTIFF’S APPEAL

GERALD B. COHN, UNITED STATES MAGISTRATE JUDGE

REPORT AND RECOMMENDATION

I. Introduction Summary

The administrative law judge (“ALJ”) thoroughly reviewed and accurately characterized the record. Substantial evidence supports the ALJ conclusion that Plaintiffs claims were not credible and that a number of her symptoms were the result of malingering. Plaintiff contends that the ALJ erred in rejecting her credibility on these grounds because she was diagnosed with a somatoform disorder, not malingering.

A somatoform disorder may produce impairments severe enough to warrant an award of social security benefits. A soma-toform disorder is characterized by symptoms that cannot be fully explained by a known medical reason, another mental disorder, or the direct effects of a substance. Although the diagnostic criteria require ruling out whether symptoms are the result of malingering, a somatoform diagnosis may coexist with malingering. In other words, it is possible for an individual to have a “mixed” diagnosis where some symptoms are due to a somatoform disorder, while other symptoms are intentionally feigned or exaggerated. Hence, soma-toform disorders and malingering are not mutually exclusive. A somatoform diagnosis does not automatically preclude an ALJ from making an adverse credibility determination.

Plaintiff reported to have been raped at the age of five-years-old and reported head trauma from a domestic violence incident in 2007. The records received prior to the June 2012 ALJ decision, reveal that Plaintiff has been seen by at least forty different doctors and other healthcare professionals over a span of roughly four years. Plaintiff has underwent a number of outpatient medical visits, clinical tests, consultations, outpatient psychiatric treatment, therapy, has underwent inpatient psychiatric treatment twice (July 2011 and April 2012), and has visited the emergency department approximately one time in 2008, two times in 2009, three times in 2010, eight times in 2011, and once in 2012. During these many instances of seeking treatment, Plaintiff reported symptoms of dizziness, chest-pounding, and syncopal episodes where she would pass out and not remember what happened. Examination and testing throughout this four year span generally revealed benign findings.

Six different physicians whose reports were reviewed and approved by six additional attending physicians (on January 26, 2011, February 6, 2011, February 15, 2011, February 16, 2011, April 9, 2011, and April 13, 2011), observed indicia of Plaintiff intentionally feigning symptoms. Plaintiff has a criminal conviction for writing bad checks and initially lied in testimony about prior illegal drug use.

Plaintiffs inconsistent reporting of her symptoms and repeated indicia of feigned symptoms support the ALJ’s determination that Plaintiff did not actually experience a number of the symptoms and that she exaggerated other symptoms. Agency mental health experts concluded that Plaintiff exaggerated her level of dysfunction and did not diagnose Plaintiff with any type of somatoform disorder. Rather, agency mental health experts found that Plaintiff met the diagnostic criteria for major depressive disorder; posttraumatic stress disorder (“PTSD”); and personality disorder, not otherwise specified, Cluster B traits. “Cluster B traits,” encompasses traits of antisocial, borderline, narcissistic and histrionic disorders, and histrionic disorder is characterized by “pervasive and excessive emotionality and attention-seeking behavior.”

The ALJ based her credibility determination on the totality of the evidence and the ALJ did not rely solely on the lack of objective medical evidence to support Plaintiffs subjective symptoms, which may be explained by a somatoform disorder. The ALJ also relied on Plaintiffs inconsistent statements, doctors’ observations of indicia of intentionally feigning symptoms, a conviction for writing bad checks, and initially lying diming testimony regarding prior illegal drug use. The ALJ properly relied on a state agency psychiatrist who reviewed the record, acknowledged Plaintiffs somatoform diagnosis, yet still concluded she could work, based, in part, on an examination by another state agency psychiatrist who observed that Plaintiff was overstating her level of dysfunction.

Under the deferential substantial evidence standard, the Court is bound by the reasonable conclusions of the ALJ. Even if Plaintiff offers an alternative, reasonable interpretation of the evidence, the Court must uphold the decision of the ALJ if any reasonable person could find the relevant evidence as adequate to reach the decision. All of the opinions relied upon by the ALJ support her assessment. In addition to the inconsistencies between objective and subjective evidence, the ALJ pointed to multiple other legitimate reasons to find Plaintiff less than credible. Plaintiffs so-matoform diagnosis does not preclude this determination or automatically entitle her to benefits. Consequently, the Court concludes that the ALJ’s decision was reasonable and recommends the appeal be denied.

II. Procedural Background

On January 27, 2011, Teresa Weidman (“Plaintiff’) filed as a claimant for disability insurance benefits under Title II and XVI of the Social Security Act, 42 U.S.C. §§ 401-34, 1181 — 1183f, with a last insured date of September 30, 2012, and claimed a disability onset date of November 30, 2010. (Administrative Transcript (hereinafter, “Tr.”), 326, 526-547). After the claim was denied at the initial level of administrative review on June 21, 2011 (Tr. 426-445), the administrative law judge (“ALJ”) held a hearing on May 15, 2012. (Tr. 354-425). On June 8, 2012, the ALJ found that Plaintiff was not disabled within the meaning of the Act. (Tr. 323-350). On August 7, 2012, Plaintiff filed a request for review with the Appeals Council (Tr. 315-320), which the Appeals Council denied on January 28, 2014, thereby affirming the decision of the ALJ as the “final decision” of the Commissioner. (Tr. 1-7).

On March 24, 2014, Plaintiff filed the above-captioned action pursuant to 42 U.S.C. § 405(g) and pursuant to 42 U.S.C. § 1383(c)(3), to appeal a decision of the Commissioner of the Social Security Administration denying social security benefits. (Doc. 1). On May 22, 2014, the Commissioner (“Defendant”) filed an answer, and an administrative transcript of proceedings. (Doc. 7, 8). On April 30, 2014, the Court referred this case to the undersigned Magistrate Judge. On August 4, 2014, Plaintiff filed a brief in support of the appeal. (Doc. 12 (“PI. Brief’)). On September 5, 2014, Defendant filed a brief in response. (Doc. 13 (“Def. Brief’)). On September 16, 2014, Plaintiff filed a reply brief. (Doc. 14).

III. Relevant Facts in the Record

Plaintiff was born in July 1971 and thus was classified by the regulations as a younger person through the date of the ALJ decision rendered on June 8, 2012. (Tr. 344, 364-65); 20 C.F.R. § 404.1563(c). Plaintiff initially alleged the following impairments: 1) seizures; 2) double vision; 3) brain problems; 4) depression; and 5) dizziness. (Tr. 571) (application for benefits). In a letter dated May 14, 2012, through counsel, Plaintiff additionally alleged to have: 1) undifferentiated somato-form disorder; 2) anxiety disorder; 3) PTSD; 4) major depressive disorder; and, 5) personality disorder. (Tr. 351).

Plaintiff completed the twelfth grade. (Tr. 366, 572). Although Plaintiff testified that she was in the special education program at her high school, the records department from her former high school indicated that no records existed indicating that she took special education classes. (Tr. 366, 572, 951). Plaintiff reported that she cared for her mentally and emotionally impaired children (who receive social security disability benefits), pets, and was able to meet personal needs unassisted and without reminders. (Tr. 366, 578-79). Plaintiff reported that she had never obtained a drivers’ license because a former abusive boyfriend of eleven years forbade her from driving and so she depends on her husband or a friend to drive her to appointments. (Tr. 367, 415).

Earnings reports demonstrate that Plaintiff has worked off and on since the age of eighteen with the following annual earnings from the most recent eight years: 1) 2004: met earning threshold for four quarters of coverage, totaling $16818.66; 2) 2005: met earning threshold for four quarters of coverage, totaling $4192.64; 3) 2006: met earning threshold for first three quarters of coverage, totaling $3481.25; 4) 2007: did not meet earning threshold for any quarter of coverage, totaling $32.83; 5) 2008: no earnings; 6) 2009: met earning threshold for four quarters of coverage as self-employed, totaling $15,863; 7) from 2010 through 2012, no earnings. (Tr. 558-563). Her past relevant work includes working as a packer and cashier/stock-er/storekeeper. (Tr. 344, 593). Plaintiff had not engaged in substantial gainful activity since her alleged onset date of November 30, 2010. (Tr. 328.558-563).

A. Relevant Treatment History and Medical Opinions

1. Good Samaritan Hospital

In a treatment record dated September 24, 2009, in preparation for a tarsal tunnel procedure, it was noted that her medical history included depression and syncopal episodes for two years and although testing was inconclusive, the syncopal episodes may have been due to panic attacks. (Tr. 734).

On January 31, 2010, Plaintiff was brought by an ambulance to the emergency room. (Tr. 716-17). The treatment record noted “panic attack” and that Plaintiff was experiencing gastrointestinal symptoms, dizziness, and hand numbing. (Tr. 716-724). Dr. Michael Rusli diagnosed Plaintiff with viral gastroenteritis and with a panic attack, as evidenced through the hyperventilation. (Tr. 716-726).

On July 6, 2010, Plaintiff arrived by ambulance to the ER due to chest pain radiating into the left arm with the left arm feeling numb and tingly. (Tr. 697-99). Plaintiff reported that she had similar pain three days prior, the pain waxed and waned, and that she also experienced left lower quadrant pain. (Tr. 699-670). Plaintiff also reported that two weeks pri- or, she had a syncopal episode and hit her sternum on a banister. (Tr. 699, 701).

On November 30, 2010, Plaintiff was hospitalized after she “passed out” after going to the bathroom. (Tr. 682, 686). Her children called 9-1-1 and Plaintiff complained of chest pain when she got into the ambulance and was pain free later at the hospital. (Tr. 682, 686). On examination, Plaintiff was alert and coherent, and she exhibited a normal gait. (Tr. 688). An MRI of her chest revealed no evidence of cardiopulmonary disease. (Tr. 695).

In a treatment record dated April 26, 2012, Plaintiff went to the ER seeking medical attention for suicidal ideation. (Tr. 1253). Once she was at the hospital, Plaintiff reported that her symptoms had improved. (Tr. 1250-55).

2. Hershey Medical Center: Michelle A. Fischer, M.D.; Krishnamoorthy Thamburaj; Steven M. Stuic, D.O.; Dr. Fauzia Mahr; Krista M. Todoric, M.D.; Aiesha Ahmed, M.D.; Diu-preet Kaur, M.D.; Sandra J. Williams, D.O.; Kimberly R. Schol-field, M.D., F.A.C.E.P.; Nina Rig-gins, M.D.; Matthew P. Wicklund, M.D.; Nancy S. Graves, M.D.; Todd M. Felix, M.D.; Olympia P. Robert, M.D.; Brandon Bryce, M.D.; Thya-garajan Subramanian, M.D.; Divpreet Kaur, M.D.; Michelle Fischer, M.D., MPH, Fernando L. Cortes, MD; David Ermak, D.O.; David J. Gill, M.D.; Matthew L. Sil-vis, M.D.; Dr. Keith C. Kaplan, M.D.; Thomas Dykes, M.D.; El Centro Coffey, M.D.; Mark J. Ki-mak, M.D.; Alexandria N. Nickless, D.O.; Rory M. O’Neill, D.O.; Barbara A. Bentz, C.R.N.P.; Sveltana M. Yevtukh C.R.N.P.; Suzanne Frazier, C.R.N.P.

On January 2, 2008, Plaintiff reported that over the past few days she had experienced dizziness, nausea, headaches, and twenty-four hours of diarrhea. (Tr. 674). According to Plaintiff, a week prior, she passed out onto the floor from similar symptoms. (Tr. 674). Her daughter called EMS and Plaintiff was transported to Good Samaritan Hospital (“GSH”) emergency department around December 26th or December 27th. (Tr. 674). Plaintiff reported that she had been having episodes like this periodically, and that with these episodes she often experienced right neck pain radiating sometimes down to her chest and felt as if her heart was pounding. (Tr. 674). Ms. Frazier noted that Plaintiff had been seen over the last few months for varying symptoms and had “encountered a domestic violence incident” a number of months ago and had developed chronic headaches and neck pain. (Tr. 674).

Ms. Frazier noted that Plaintiff had a “myriad of complaints [after the domestic encounter] of fatigue and facial numbness along with just feeling very weak.” (Tr. 674). Plaintiff had been evaluated by neurology and there were no neurological deficits noted and she received physical therapy for what was believed to be cervical strain and paresthesias from the “domestic incident.” (Tr. 674). Ms. Frazier noted that:

[Plaintiffs] fatigue has been ongoing. She has had numerous blood tests done most recently being December 17th. At that time she had normal thyroid function, normal Iron profile and CBC and her monospot was negative. Her electrolytes and fasting glucose have been normal.... When questioned further about the syncopal episode, she tells me that recently these episodes are different than the past times we have discussed. [During the previous syncopal episodes], she had felt very panicked and that was the explanation for her weakness and chest pounding. She has been treated for her depression and panic in the past. The most two recent episodes, she feels that she blacked out and had not felt panicked before the event.

(Tr. 674). Regarding the recent change in symptoms, Plaintiff stated that she had been experiencing headaches, not feeling well, not drinking as much fluids and her appetite had been waxing and waning over the last six months. (Tr. 674). At the time of the January 2008 visit, Plaintiff was not experiencing any chest pain, heart pounding, or paresthesias, and reported only feeling extremely weak. (Tr. 674). The examination was unremarkable and Ms. Frazier noted no focal neurological deficits, no neurovascular deficits, and that Plaintiffs cranial nerves II though XIII were intact. (Tr. 675). Ms. Frazier noted that tests including the EKG were normal and assessed Plaintiff with dizziness, chest pain, gastroenteritis, and a history of depression. (Tr. 675).

On March 11, 2008, Plaintiff sought follow-up treatment for depression. (Tr. 670). Ms. Frazier noted that Plaintiff:

has had many chronic complaints over the last year including physical aches, dizziness, low mood, and chronic headaches; she also has been treated for depression/anxiety. She has in the past been on Celexa and Lexapro with minimal results. She had recurring episodes of fatigue and dizziness. She wondered if that might have been related to the Lexapro. She had been checked for orthostasis and had a negative cardiology evaluation. Since she has been on the Cymbalta, the symptoms have resolved. It is possible that the Lexapro may have been a piece of the problem, although I don’t believe that we can blame all her symptoms on the medication. Nonetheless, the medication did not seem to be benefiting her. She has been on Cymbalta for 2 months and tells me that her mood is much improved. She is sleeping without medication and overall her physical aches are much less.

(Tr. 670).

On May 12, 2008, Plaintiff complained of left wrist pain after trying to move some furniture. (Tr. 668). According to a treatment record dated June 23, 2008, Plaintiff complained of a sore throat and came after a visit with the ER and stated that prior to starting the medication from the ER she was experiencing fevers of 99 to 101. (Tr. 666). July 2, 2008, Plaintiff complained of a sore throat and reported that she was seen at the ER of GSH on June 22, 2008 and treated for pharyngitis. (Tr. 664). After completing a five-day treatment of another medication, she reported that her overall achiness and other body symptoms were improved but, her ears hurt and her throat still itched and burned. (Tr. 664). She tested positive for Strep and diagnosed with Strep pharyngitis. (Tr. 664).

On August 5, 2008, Plaintiff complained of foot pain which she had experienced for three to four weeks but had increased four days prior. (Tr. 660). On August 14, 2008, in response to foot pain, Plaintiff had X-rays which were normal and upon examination, a small plantar spur was noted. (Tr. 652-59). On August 26, 2008, Plaintiff reported pain and swelling in the right leg with nothing alleviating or aggravating the pain. (Tr. 648). Ms. Frazier noted that “[Plaintiff] complains of 10/10 pain, although this seems excessive based on the fact that I am able to push and pull on her leg without her having an extreme reaction. She is able to weight bare, flex, and extend the leg without difficulty.” (Tr. 648). Plaintiff voiced concern that her symptoms may be due to a blood clot (Tr. 649), tests were normal (Tr. 650).

In a treatment record dated September 16, 2008, Plaintiff reported of ear pain and dizziness which had persisted for a few weeks. (Tr. 645). Plaintiff had no fever or ear-related symptoms. (Tr. 645). Plaintiff reported a history of having severe dizziness in January of 2008 followed by extensive testing which included cardiac factors, but there were no findings to explain the January 2008 symptoms. (Tr. 645). Ms. Frazier concluded that there were no clinical findings for Plaintiffs dizziness.

On January 5, 2009, Plaintiff went to the ER with complaints of feeling dizzy and sleepy all of the time. (Tr. 641). Ms. Yevtukh noted that three days prior, on January 2, 2009, Plaintiff visited the ER at the GSH due to a syncopal episode with shortness of breath. (Tr. 641). Ms. Yev-tukh noted that blood work, CAT scan of her head, and EKG results were within normal limits and Plaintiff was discharged from GSH without any medications. (Tr. 641). Plaintiff reported pain of six out of ten, with Tylenol relieving a dull headache and Ms. Yevtukh assessed her with dizziness. (Tr. 641).

On December 2, 2010, Plaintiff was evaluated by Ms. Yevtukh. (Tr. 888). Plaintiff reported of pre-syncopal episodes two to four times a day over the preceding three weeks. (Tr. 888). Plaintiff reported that the episodes would cause dizziness, fatigue, occasional paresthesias in her hands, blurred vision, decreased hearing, chest pain, and palpitations. (Tr. 888).

After initial treatment at GSH, Plaintiff sought follow-up treatment and tests at Hershey Medical Center on December 2, 2010; December 4, 2010; December 6, 2010, and; December 13, 2010. (Tr. 881-919). Physical examination findings were within normal limits with exception of an EKG which revealed evidence of sinus bra-dycardia. (Tr. 881-83, 888-89). Plaintiff experienced fatigue and lightheadedness during an exercise echocardiogram, however, an MRI of her brain revealed normal results. (Tr. 883, 885-86).

On January 1, 2011, Plaintiff sought treatment from the ER (Tr. 863-66), due to reported recurrent and persistent dizziness and syncope since November 2010. (Tr. 856). Plaintiff was taken to the hospital after having a “blackout spell” along with daily symptoms of dizziness. (Tr. 856). Plaintiff described these episodes as starting out with dizziness, followed by double vision, and then she would pass out. (Tr. 851). These episodes would happen once or twice a day and she would experience confusion upon waking up. (Tr. 851). During the latest episode just before her “blackout spell,” she felt dizzy and remembers waking up after the paramedics arrived. (Tr. 856).

Neurological and physical examinations conducted on January 1, 2011, revealed unremarkable results, and a series of CT scans of Plaintiffs head, abdomen, pelvis, and spine all revealed normal results. (Tr. 864, 869-80, 867-80). Drs. Coffey and Ki-mak noted that physical examination and diagnostic testing revealed no evidence of acute injury. (Tr. 865-66). In an examination conducted on January 1, 2011, while under the supervision of Dr. Dykes, Dr. Kaplan noted no evidence of mediastinal injury and no local contusions (bruising). (Tr. 859, 879, 880). Examination revealed no abnormalities, and Dr. Felix diagnosed Plaintiff with vertigo, recurrent; diplopia; a syncopal episode possibly related to or-thostasis; and, depression. (Tr. 857-59).

On January 20, 2011, Plaintiff reported that she became dizzy and developed double vision. (Tr. 854). During her evaluation, she described repeated episodes of loss of consciousness. (Tr. 854). When asked about other factors in her life, Plaintiff reported that she was having problems with her daughter, but did not go into details. (Tr. 855). Dr. Graves noted that the laboratory work was unremarkable and Plaintiff was referred to further testing with other departments. (Tr. 855).

On January 21, 2011, Ms. Bentz, of the Hershey Cardiology Clinic wrote an outpatient letter to Ms. Yevtukh. (Tr. 851-852). The letter stated that Plaintiff had been evaluated for her syncope episodes. (Tr. 851). Plaintiff had a CT of the head which showed no abnormalities, she also had a stress echocardiogram using the treadmill, but she was unable to complete the test due to dizziness and fatigue. (Tr. 851). However, a dobutamine stress echo determined that her heart was in good condition. (Tr. 851). The summary of other tests and physical examination revealed no abnormal results. (Tr. 851-52).

On January 26, 2011, Plaintiff stated to neurologist Dr. Riggins that she ran out of the medications that helped her symptoms. (Tr. 847). Plaintiff reported a history of having experiencing double vision and dizziness followed by a loss consciousness which started about a month prior and subsequently experienced four to six similar episodes since that time. (Tr. 847). Dr. Riggins noted that Plaintiffs medical history included daily persistent headaches reported after head trauma in 2007 due to domestic violence. (Tr. 847). Plaintiff reported that she stopped using rock cocaine approximately four years ago and reported no other substance abuse. (Tr. 847). Upon examination, Plaintiff reported being unable to see all of Dr. Riggins’ fingers and those she saw were blurry. (Tr. 848). Dr. Riggins observed no neurological abnormalities. (Tr. 848). With regard to motor skills and strength, Dr. Riggins stated that such was “difficult to assess completely as [Plaintiff] create[d] very poor effort,” however, assessed Plaintiffs gross motor abilities as 5/5 bilaterally. (Tr. 848). Upon evaluation of Plaintiffs sensation, Dr. Riggins observed, intact reflexes for all of the extremities, except Plaintiff reported “inconsistantly [sic] mild questionable decrease in sensation to the touch, pinprick from the different areas on her left arm.” (Tr. 848).

From February 2, 2011, to February 5, 2011, Plaintiff underwent an EEG study wherein Plaintiff pressed a button to indicate symptoms of dizziness and blacking out. (Tr. 825-26, 843). However, “[n]o electrographic abnorma