UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA
CHRISTINA JEAN WILLIAMS, Plaintiff,
V. Civil Action No. 3:25-cv-00039 Judge D. Brooks Smith Sitting by Designation
FRANK BISIGNANO, Commissioner of Social Security, Defendant
MEMORANDUM and ORDER OF COURT
SMITH, Circuit Judge.”
Plaintiff Christina Jean Williams seeks review of the final decision! of the
Commissioner of Social Security denying her application under Title II of the
Social Security Act for an award of disability insurance benefits (DIB), as well as a
period of disability insurance benefits. See 42 U.S.C. § 401 et seq. Williams’s
motion for summary judgment, Cm/ecf no. 8, is ripe for disposition. Because the
* By order dated December 19, 2025, the Honorable Michael A. Chagares, Chief Judge of the U.S. Court of Appeals for the Third Circuit, designated and assigned Circuit Judge D. Brooks Smith pursuant to 28 U.S.C. § 291(b) to hold court in the Western District of Pennsylvania. ! Jurisdiction exists under 42 U.S.C. § 405(g) and 28 U.S.C. § 1331.
Commissioner’s final decision is supported by substantial evidence, the motion for
summary judgment will be denied, and the Commissioner’s final decision will be
affirmed.
I.
Williams filed for DIB in September 2022. CAR159.? She was 41 years old
at the time and alleged that she was disabled primarily on the basis of congestive
heart failure and the presence of an abnormal FLNC gene causing nonischemic
dilated cardiomyopathy,’ which “put her at risk for sudden cardiac death.”
CAR339; see also 180, 328. In addition to her cardiac problems, Williams had
hypertension and morbid obesity. CAR328.
Dr. Kathleen Zazzali, a cardiologist at Geisinger Health System, documented
in a progress note dated June 2022 that Williams complained of fatigue, chest pain,
2 CAR references the certified administrative transcript and the relevant page number. 3 Cardiomyopathy is a condition affecting the heart that “causes the heart to have a harder time pumping blood to the rest of the body.” Mayo Clinic, Cardiomyopathy, (Mar. 9, 2026) https://www.mayoclinic.org/diseases- conditions/cardiomyopathy/symptoms-causes/syc-20370709.
palpitations, and shortness of breath. CAR332. Diagnostic studies completed at
that time documented a left ventricular ejection fraction of 25-29%, which is
consistent with “severely reduced” heart function, together with abnormal
ventricular tachycardia and supraventricular tachycardia. CAR334. Dr. Zazzali
advised Williams that she “qualifie[d] for a dual chamber ICD,” CAR337, ie., an
implantable cardiac pacemaker/defibrillator. CAR340, 376. Williams agreed to
the ICD procedure, which Dr. Zazzali performed on July 13, 2022. CAR339.
During a follow-up visit in August 2022 at Geisinger with her primary
cardiologist, Dr. James Bradbury, Williams complained of “easy fatigability,”
which caused her to stop working. CAR390. She described having energy some
days, but on other days feeling “exhausted . . . like she has to nap every day. Jd.
Dr. Bradbury noted that Williams’s ejection fraction had improved post-[CD
placement to 39%. Jd. His physical assessment revealed a blood pressure of
108/80, a regular heart rate and rhythm, normal respirations, clear breath sounds,
and an absence of edema in the extremities. CAR391. He adjusted one of her
medications to address her complaint of fatigability. CAR392. He also noted that
the ICD diagnostics “revealed normal device function.” Jd. She applied for DIB
in September. CARI59.
On September 30, 2022, Williams had a follow-up visit at Geisinger with
Physician Assistant Chelsey Ernst (PA Ernst) and denied having dizziness,
palpitations or syncope. CAR651. But Williams, who raised chickens, CARSS,
informed a nurse that she was having jaw pain after she “tossed a heavy water
container” in her chicken coop and had “it bounce[] and hit her in the face.”
CAR653. PA Ernst examined Williams, documenting that she was not in distress
and that her cardiac assessment was normal. CAR654. An x-ray showed no
fracture of her jaw. CAR659. Dr. Zazzali opined that the ICD was functioning
normally. CAR652.
Williams followed up in the Geisinger Outpatient Surgery clinic in
November 2022 with Dr. James Bradbury, who documented that Williams
complained of “relatively stable symptoms of fatigue and dyspnea that have not
worsened.” CAR644, Dr. Bradbury noted there had been an “improvement” in her
ejection fraction heart function with an increase to “39%.” Id. He assessed that
Williams’s musculoskeletal system was normal. He also observed that she had no
gait disturbance or weakness, and exhibited no edema in her legs. CAR645. The
“diagnostics” for her ICD, which had been inserted in July 2022, were “stable.”
CAR646.
Dr. Bradbury saw her again in February 2023. Although Williams
complained of shortness of breath with exertion, Dr. Bradbury noted that she had
not “had any congestive heart failure admissions.” CAR682. Physical
examination revealed a regular heart rhythm, clear lungs, no edema and a normal
neurologic examination. CAR683. Dr. Bradbury did not detect any symptoms
indicative of “low cardiac output” and continued her current medication regime.
CAR684.
Dr. Bradbury referred Williams to Dr. Benjamin Pollock, a neurologist.
CAR674. In March 2023, Dr. Pollock noted Williams’s cardiac myopathy with the
abnormal FLNC gene and discussed the significance of these myofibrillar
myopathies for which the “main clinical feature [is] skeletal muscle weakness.”
CAR680. His assessment indicated that Williams had normal muscle tone in her
extremities and that her sensation was intact. CAR677. She was “able [to] stand
from a seated position with ease with her arms crossed.” CAR680. Dr. Pollock
also noted she had bilateral carpal tunnel syndrome. He planned to see Williams as ©
needed should she develop muscle weakness, which he noted is the “main clinical
feature” with the FLNC gene. CAR680.
Two months later, in May, diagnostic testing confirmed the presence of
bilateral carpal tunnel and “mild degenerative changes of the mid and lower
cervical spine,” CAR864, with radiculopathy on the left C7-8 and on the right C7.
CAR774. Physical examination at that time revealed no edema of the extremities.
CAR848. A course of conservative treatment, which included wearing a hand
brace, proved not to be beneficial. CAR847. During surgery on June 14, 2023,
Williams had a bilateral carpal tunnel release performed. CAR899.
As part of Williams’s medical evaluation for carpal tunnel surgery, she had a
cardiac evaluation in early May 2023 by Certified Registered Nurse Practitioner
Ashley Enciso (Nurse Enciso). Williams denied exertional chest pain, but
complained of shortness of breath, lightheadedness and fatigue. Her condition
resulted in taking naps “throughout the day with improvement in symptoms.”
CAR851. Her left ventricular ejection fraction was calculated at 39% and
characterized as “mildly improved.” CAR854. Heart rhythm was regular, and her
lungs were clear. She had no rales or rhonchi, and no edema in her extremities.
CAR854. Significantly, Nurse Enciso noted that Williams experienced no further
paroxysmal atrial fibrillation arrythmias on the ICD. CAR855.
On July 30, 2023, Williams visited the emergency room at UPMC Altoona
(ER) with complaints of abrupt dizziness and lightheadedness, accompanied by
low blood pressure. Her chest felt tight, and she was short of breath. CAR1033.
Physical examination showed Williams’s heart had a regular rhythm, her
respirations were not labored, and she had no edema. Jd. Evaluation of the ICD
showed no arrhythmias. CAR1034. Dehydration was suspected, and she was
discharged after being stabilized. Id.
The first week of August, Williams followed up her trip to the ER with a
visit to Geisinger where she was seen by PA Ernst. Williams related to PA Ernst
that the day before the July 30 ER visit, she had been “upstairs staining wood a lot
throughout the day.” Jd. PA Ernst conducted a physical examination, which
revealed that Williams’s neck range of motion was intact, heart rhythm and breath
sounds were normal. The examination also showed that Williams’s range of
motion in her extremities was normal, and that she had no gait disturbance or
edema. CAR1082.
Nurse Enciso later saw Williams on December 1, 2023, in a routine follow-
up visit. CAR1058. Williams related that she generally felt well but complained
of “palpitation[] symptoms that she described as a racing/pounding heartbeat,”
leaving her lightheaded and “more short of breath,” followed by “a head rush
sensation” and a headache. CAR1059. She denied any chest pain, but admitted
that temperature extremes caused her fatigue. Jd. She exhibited no lower
extremity edema and complained of no side effects from her medications. Jd.
Review of the ICD’s performance showed atrial pacing, “with no mode switches.
No [ventricular arrhythmias]. No [defibrillator] shocks.” CAR1058. Nurse
Enciso noted in her assessment that Williams had “[n]o further episodes of
paroxysmal AFib.” CAR1062.
Later that month, on December 26, 2023, Nurse Enciso completed a form
entitled Physical Residual Functional Capacity Questionnaire (RFC form).
CAR1066-1069. The diagnoses set forth on the RFC form related to Williams’s
cardiac condition, listing nonischemic cardiac myopathy, heart failure with reduced
ejection fraction, the FLNC gene mutation, paroxysmal atrial fibrillation, hypertension, and the permanent pacemaker with the ICD. CAR1066. The listed
symptoms were “fatigue, low activity tolerance, palpitations, fluid retention.” Jd.
The clinical findings set forth stated “low heart (E[jection] F[raction]) function,
edema/fluid retention.” Jd. Nurse Enciso listed Williams’s various medications
and noted that they caused fatigue, frequent urination, and risk of bleeding. Jd.
She opined that neither emotional factors nor psychological conditions contributed
to the severity of Williams’s presentation. CAR1066-67.
Nurse Enciso further noted that Williams occasionally experienced a lack of
attention, or concentration needed to perform simple tasks. Nurse Enciso
identified stress as an exacerbating factor as it caused “elevated BP, heart rate, and
fluid retention.” CAR1067. She placed Williams on the following limitations:
lifting 10-20 pounds; standing for no more than 15-20 minutes; and walking
without rest for no more than 5 minutes or 50 yards. Jd. She placed no limitations
on the RFC form with regard to movement of Williams’s neck. Jd. According to
Nurse Enciso, Williams should take unscheduled breaks of 5-10 minutes every two
hours during a workday. CAR1068 Nurse Enciso also directed Williams to elevate
her legs to the level of the heart for at least four hours a day. Jd. And Enciso
provided several postural limitations and opined that Williams should never use
ladders and only rarely engage in activity which required balancing. One positive
observation: Williams’s ability to handle and finger objects was unimpaired.
CAR1068-69. Notably, Nurse Enciso did opine that Williams’s condition was
“likely to produce” up to three absences a month from work. CAR1069.
A hearing on Williams’s application for benefits was conducted a little more
than two weeks later, on January 11, 2024. Both Williams and a vocational expert
(VE) testified at the hearing before an Administrative Law Judge (ALJ). CAR44.
Williams testified that she could not work full-time because she was “exhausted
most days,” had a “hard time getting up,” needed “to take naps during the day,”
had “brain fog,” and experienced shortness of breath and lightheadedness.
CARS53. She added during her testimony to these symptoms that her “legs swell”
and that she had “a lot of pain in the back of her neck.” Jd. Williams also claimed
that her symptoms interfered with doing her household chores, and that “every
three to four days” she could not “get out of bed.” CARS8.
The VE testified that Williams could not perform her past relevant work.
CAR61. But in the VE’s opinion, there was other work available in the national
economy that someone with limitations akin to those experienced by Williams
could still perform. CAR61-62.
Williams had a chest x-ray done on January 14, 2024, a few days after the
ALJ hearing. The x-ray was negative for any congestive heart failure. CAR1124-
25. Breathing ambient air, Williams’s oxygen saturation was 95%. CAR1129.
After considering all the evidence of record and applying the five-step
sequential evaluation required in 20 C.F.R. § 404.1520, the ALJ concluded that
Williams was not disabled for purposes of the Social Security Act. The ALJ found
that Williams had several severe impairments: “cervical degenerative disc disease
with radiculopathy, bilateral carpal tunnel syndrome, nonischemic dilated
cardiomyopathy with pathogenic variant of the FLNC gene, status post dual
chamber ICD placement, paroxysmal atrial fibrillation; pseudotumor cerebri,
idiopathic intracranial hypertension, obesity.” CAR29. None of these
impairments, however, met or equaled any of the listings of certain
musculoskeletal, neurologic or cardiac impairments in the regulations that establish
an impairment precluding the individual from performing any gainful activity.
CAR31-32 (citing 20 C.F.R. § 404, Subpart P, Appendix I).
The ALJ took into account the several restrictions limiting the type of work
Williams could perform. CAR32. Accordingly, the ALJ found that Williams’s
impairments limited her standing and walking to four hours per day and that she
was able to perform less than the full range of light work. Although Williams’s
severe impairments could be expected to cause the symptoms of which she
complained, the ALJ nonetheless found that Williams’s description of her
limitations was “not entirely consistent with the medical evidence and other
evidence” of record. CAR33. Having considered Williams’s restrictions, the ALJ
12 ,
credited the VE’s testimony that Williams could not perform her past relevant
work. Still, the ALJ concluded that there was other work available in the national
_ economy that Williams could perform, despite her limitations. CAR35-37.
Williams, the ALJ concluded, was not disabled under Title IT of the Act from the
time of her application through the date of the ALJ’s decision. CAR37.
II.
Williams sought judicial review. In reviewing the Commissioner’s final
decision, I must determine whether there is “substantial evidence” to support that
decision. 42 U.S.C. § 405(g). Substantial evidence means there is “such relevant
evidence as a reasonable mind might accept as adequate to support a conclusion.”
Richardson vy. Perales, 402 U.S. 389, 401 (1971) (internal quotation marks and
citation omitted). Such evidence need only be “more than a mere scintilla.” Jd.
(internal quotation marks and citation omitted). As the Supreme Court observed in
Biestek v. Berryhill, 587 U.S. 97, 103 (2019), “the threshold for such evidentiary
sufficiency is not high.” .
Williams contends that the ALJ erred in several respects. In Williams’s
view, the ALJ failed to discuss her congestive heart failure and whether it was a
medically determinable impairment. Cm/ecf no. 7 at 10. Yet this argument ignores
that the ALJ identified Williams’s nonischemic dilated cardiomyopathy caused by
the mutated FLNC gene, as well as the placement of the ICD and the paroxysmal
atrial fibrillation, as severe impairments. CAR29. The record, the ALJ explained,
did not establish the requirements for the listed impairments for cardiovascular
disorders, chronic heart failure, ischemic heart disease, or recurrent arrhythmias.
CAR32. And the ALJ discussed Williams’s cardiac conditions in assessing her
residual functional capacity (RFC). CAR34. The ALJ’s discussion highlighted
that the actual treatment records indicated that after the ICD placement in July of
2022, Williams had “no further episodes of paroxysmal atrial fibrillation.”
CAR34; see CAR1058. In addition, the ALJ pointed out that, after the placement
of the ICD, Williams’s left ventricular ejection fraction had improved to 39%.
CAR34; see CAR1058. Furthermore, the diagnostic findings highlighted by the
ALJ were consistent with Nurse Enciso’s earlier medical assessment of December
1, 2023.
Williams next contends that the ALJ failed to properly evaluate the
December 26, 2023 medical opinion of Nurse Enciso. Cm/ecf no. 7 at 11-12. The
error, according to Williams, is that the ALJ did not take into account the
symptoms of fatigue, fluid retention, and the need to elevate her legs. I am not
persuaded.
The ALJ accorded great weight to Nurse Enciso’s opinion and concluded
that less than the full range of light work accommodated Williams’s complaint of
fatigue. CAR34. In weighing Nurse Enciso’s opinion, the ALJ permissibly
concluded that the opinion was not fully supported by the documented medical
assessments. CAR35. As the ALJ noted, Williams was on diuretics, CAR34, yet
there was no mention in the records that suggests that her medication regime was
inadequate or that she had problems with “fluid retention.” Nor was there any
mention prior to the December 26, 2023 opinion that Williams had experienced
swelling in her legs requiring elevation. In fact, in the follow-up visit at the
beginning of December, Nurse Eneiso documented that Williams had no lower
extremity edema. CAR1059, 1061. As further support for discounting Nurse
Enciso’s opinion as to Williams’s ability to work, the ALJ cited to Williams’s own
statement about her activity the day before her July 30, 2023 ER visit, i.e., that she
had been “upstairs staining wood throughout the day.” CAR35; compare
CAR1081. I conclude that there is substantial evidence to support the ALJ’s
decision to discount Williams’s purported fluid retention and need to elevate her
legs during a workday.
Despite the ALJ having accorded weight to Nurse Enciso’s opinion by
addressing all the diagnoses she set forth in her medical assessment of December
26, 2023, Williams contends that the ALJ “rejected” Nurse Enciso’s “entire
opinion.” Cm/ecf no. 7 at 12. To support her argument, Williams takes aim at the
ALJ’s discounting of Nurse Enciso’s medical opinion that Williams’s condition
would result in three absences per month. Jd. This portion of Nurse Enciso’s
opinion, however, consisted of nothing more than checking a line on the RFC
form. CAR1069. No supporting documentation was set forth. Id. I conclude that
the ALJ did not err by discounting this restriction on Williams’s RFC, particularly
in light of the ALJ’s discussion of Williams’s cardiac impairments and other
medical evidence of record. See Galette v. Comm'r Soc. Sec., 708 F. App’x 88, 91
(3d Cir. 2017) (“[F]orms that “‘require[] the physician only to check boxes and
briefly to fill in blanks... are weak evidence at best.’”) (quoting Mason v. Shalala,
994 F.2d 1058, 1065 (3d Cir. 1993)).
In addition, Williams asserts that the ALJ’s RFC finding is legally erroneous
because it does not include most of the work limitations set forth in Nurse Enciso’s
December 26, 2023 opinion. She submits that the RFC did not account for the
degenerative disc disease in her neck or the difficulty she has in handling and
fingering. Cm/ecfno. 7 at 17-19. Yet the December 26 opinion specifically
opined that Williams may engage on a constant basis in looking up and down,
turning her head to both sides, and holding her head in one position. CAR1067.
The December 26 opinion also notes that Williams has no difficulties with
handling and fingering objects. CAR1069. This assessment is consistent with the
ALJ’s finding that, after the carpal tunnel surgery, Williams may frequently handle
and finger objects. CAR32. In the absence of documentation supporting or
otherwise explaining Nurse Enciso’s assessment that Williams needed an
accommodation for headaches, the ALJ did not err in discounting that symptom.
As explained above, the ALJ also permissibly discounted the need to account for
Williams’s alleged swelling in her legs. While Williams asserts that her limited
ability to walk was not credited, the ALJ reasoned that Williams’s “body habitus
and obesity are reasonably accommodated” with an RFC for less than a full range
of work. And the ALJ found that restricting Williams to less than a full range of
light work reasonably accounted for shortness of breath, palpitations, and
lightheadedness. CAR34. As the ALJ noted, the ICD failed to show any further
episodes of paroxysmal atrial fibrillation. Id.
Finally, Williams contends that the ALJ erred by not addressing whether she
was disabled for a closed period of disability. Cm/ecf no. 7 at 20. This argument
ignores that the ALJ did consider this and concluded that Williams was not
suffering a disability from July 2022 through the date of decision. See CAR37; see
also Phillips v. Barnhart, 91 F. App’x 775, 782 (3d Cir. 2004).
In sum, after reviewing the submissions of the parties and considering the
record “as a whole,” Jones v. Barnhart, 364 F.3d 501, 505 (3d Cir. 2004), I
conclude that there is “sufficient evidence to support the agency’s factual
determinations.” Biestek, 587 U.S. at 102 (internal quotation marks and citation
omitted). I do not diminish the severity of Williams’s condition or the discomfort
and inconvenience that she experiences. But as the Supreme Court has observed,
the threshold for showing substantial evidence to support the ALJ’s decision “is not
high.” Jd. at 103. Accordingly, Williams’s motion for summary judgment, Cm/ecf
no. 8, will be denied and the final decision of the Commissioner will be affirmed.
ORDER OF COURT
AND NOW, this Ya day of March, 2026, upon consideration of the record, Plaintiff’s Motion for Summary Judgment, cm/ecf no. 8, brief in support thereof, cm/ecf no. 7, Defendant’s Opposition thereto, cm/ecf no. 9, and Plaintiff's Reply, cm/ecf no. 10, it is hereby ORDERED that Plaintiff’s Motion for Summary Judgment, cm/ecf no. 8, is DENIED and the Commissioner’s final decision is AFFIRMED.
s/D. Brooks Smith
D. Brooks Smith US. Circuit Judge Sitting by Designation