IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
HELEN WHITE, : Civil No. 1:24-CV-1900 : Plaintiff, : : v. : : (Chief Magistrate Judge Bloom) FRANK BISIGNANO, : Commissioner of Social Security,1 : : Defendant. :
MEMORANDUM OPINION
I. Introduction Helen White filed an application under Titles II and XVI of the Social Security Act for disability and disability insurance benefits and supplemental security income on February 1, 2022. Following a hearing before an Administrative Law Judge (“ALJ”), the ALJ found that White was not disabled from her alleged onset date of December 31, 2020, through January 31, 2024, the date of the ALJ’s decision.
1 Frank Bisignano became the Commissioner of Social Security on May 7, 2025. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure and 42 U.S.C. § 405(g), Bisignano is substituted as the defendant in this suit. White now appeals this decision, arguing that the ALJ’s decision is not supported by substantial evidence. After a review of the record, and
mindful of the fact that substantial evidence “means only—‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion,’”2 we conclude that substantial evidence supports the ALJ’s
findings in this case. Therefore, we will affirm the decision of the Commissioner denying this claim.
II. Statement of Facts and of the Case
Helen White filed for disability and disability insurance benefits, as well as supplemental security income, alleging disability due to moderate spinal stenosis, scoliosis, bulging and herniated discs in the lower back, degenerative disc disease, arthritis, type 2 diabetes, high cholesterol, and high blood pressure.3 White was 60 years old at the time of her alleged
onset of disability and had past relevant work as a kitchen supervisor.4 The medical record regarding White’s impairments revealed that White treated for persistent lower back and extremity pain prior to the
2 , 139 S. Ct. 1148, 1154 (2019). 3 Tr. 67. 4 Tr. 26, 67. 2 alleged disability period. Thus, in September of 2020, at a visit to Lebanon Valley Family Medicine for a diabetes follow up, Dr. Mark
Leach, M.D., noted White’s persistent back pain radiating to her legs.5 White reported that her legs felt like they would give out at times, and that her pain was worse with prolonged standing and walking.6 Dr.
Leach noted that White was taking narcotic pain medications and had received epidural shots with no relief.7 She was advised to continue with
the pain clinic for pain management.8 White was seen at the Lebanon Pain Relief Center in November, at which time she reported taking more Percocet due to increased lower
back and leg pain.9 Notes from this visit detail White’s history of treatment for her chronic pain, including a lumbar spine MRI from 2017 showing moderate to severe spinal stenosis, a 2017 lumbar spine x-ray
showing moderate right scoliosis and marked degenerative changes at all
5 Tr. 400-01. 6 Tr. 400. 7 Tr. 400-01. 8 Tr. 403. 9 Tr. 578. 3 levels, and that White received injections for her pain in 2017 and 2018.10 A physical examination revealed that White walked with an antalgic gait
with a cane and had moderately reduced range of motion in her lumbar spine.11 In December, White reported she had missed a lot of work and had resigned.12
Treatment notes from the Pain Relief Center in February of 2021 indicate that White reported increased pain, which was aggravated by
daily activities, bending, lifting, sitting, standing, and walking.13 A physical examination revealed an antalgic gait with a cane and moderately reduced range of motion, as well as normal balance,
coordination, and fine motor skills.14 Dr. Daniel Lorenzo filled White’s medications, and she was advised to follow up in one month.15 In March, White reported that while the Butrans patch she was using was
providing some relief, and she was taking fewer Percocet since starting
10 Tr. 578-79. 11 Tr. 582. 12 Tr. 571. 13 Tr. 564. 14 Tr. 568-69. 15 Tr. 569. 4 the patch, she could no longer afford it.16 Dr. Lorenzo prescribed her a fentanyl patch.17 White reported in June that the fentanyl patch
provided good pain relief, and the side effects she initially had were resolved.18 White made a similar report to Dr. Lorenzo in September, at which time a physical examination revealed an antalgic gait with a cane,
tenderness of the lumbar spine, and normal balance, coordination, and fine motor skills.19
In November, treatment notes from the Pain Relief Center indicate that White’s pain level was a four, and that her pain was fluctuating and intermittent.20 She took Percocet only for exacerbations, which provided
some relief.21 White reported experiencing increased pain for a week in December, but she was still getting good relief from the fentanyl patch.22 A physical examination was similar to her prior visits, indicating an
antalgic gait with a cane and moderate pain with range of motion, but
16 Tr. 557. 17 Tr. 562. 18 Tr. 543. 19 Tr. 520, 524-25 20 Tr. 514. 21 22 Tr. 499. 5 normal balance, coordination, and fine motor skills.23 Treatment notes from her family doctor around this time indicate that White injured her
foot when she hit her recliner.24 An x-ray showed a traumatic fracture, and White was prescribed a walker to help maintain her self-sufficiency and daily activities.25 Dr. Lorenzo noted in January of 2022 that White
was wearing a boot after fracturing her foot, but that her lower back pain symptoms were about the same.26
White underwent an x-ray of her right knee in March of 2022, which showed tricompartmental osteoarthritis.27 White was diagnosed with primary osteoarthritis of the right knee in April and underwent
injections.28 An examination at this time revealed an antalgic gait with a cane, no tenderness, and normal sensation to light touch.29 Around this time, White followed up with the Pain Relief Center, where it was noted
23 Tr. 504. 24 Tr. 385. 25 Tr. 365-66, 387. 26 Tr. 489. 27 Tr. 364. 28 Tr. 432, 435. 29 Tr. 434. 6 she experienced partial relief from the knee injection.30 Her back pain was noted to be at a severity level of eight, and a physical examination
was similar to prior examinations, showing an antalgic gait, moderate pain with range of motion, and normal balance, coordination, and fine motor skills.31 In May, White reported that her knee pain was back to its
baseline, and her back pain was a severity level of five.32 White received injections in her knee between July and September
of 2022.33 In August, White reported to her family doctor that she was experiencing leg aches and swelling.34 Dr. Leach advised her to elevate her legs and watch her salt intake.35 In September, White advised that
she had not experienced much improvement in her pain from the injections.36 At a visit to the Pain Relief Center in October, White reported increased pain and swelling in her lower extremities.37 It was
30 Tr. 457. 31 Tr. 457, 462. 32 Tr. 450. 33 Tr. 801-09. 34 Tr. 691-92. 35 Tr. 692. 36 Tr. 670. 37 Tr. 715. 7 noted that an increase in Gabapentin helped with her leg spasms and cramps.38 A physical examination revealed an antalgic gait with a cane,
mild pain with range of motion, and normal balance, coordination, and fine motor skills.39 Treatment notes from a November 2022 visit contained largely identical findings, but in January of 2023, White
reported increased pain.40 In March of 2023, White underwent surgery for carpal tunnel
syndrome in her right hand.41 Prior to surgery, she reported difficulty with everyday tasks, such as opening a water bottle.42 At her two-week post operative appointment in April, White reported numbness and
tingling in her right hand but noted improvement in strength, pain, and sensation.43 Around this time, White also underwent another injection for her knee pain.44 In May, treatment notes from the Pain Relief Center
indicate that White was receiving adequate relief from her pain
38 39 Tr. 720. 40 Tr. 707-13, 846. 41 Tr. 795. 42 Tr. 798. 43 Tr. 788. 44 Tr. 784. 8 medications, although her back pain was persistent but fluctuating.45 A physical examination revealed an antalgic gait with a cane, facet joint
loading, and moderate pain with range of motion.46 White reported increased pain to Dr. Lorenzo in July of 2023, at which time he discussed the possibility of trying CBD oil.47
White continued to treat at the Pain Relief Center throughout 2023. Treatment notes from October to December indicate that White’s pain
was persistent but stable, she was receiving adequate relief from her medications, and she had no new concerns.48 Examinations in November and December revealed positive face joint loading, positive straight leg
raise testing, and no edema.49 White also continued to receive knee injections around this time.50 Additionally, throughout the relevant period, White’s body mass index (“BMI”) was indicative of obesity.51
45 Tr. 817. 46 Tr. 821. 47 Tr. 934, 938. 48 Tr. 927, 965, 1174. 49 Tr. 970, 1179. 50 Tr. 1200-04. 51 , Tr. 382, 397, 873, 1217. 9 It is against the backdrop of this record that an ALJ held a hearing on White’s disability application on January 9, 2024.52 White and a
Vocational Expert both appeared and testified at this hearing.53 Following this hearing, on January 31, 2024, the ALJ issued a decision denying White’s application for disability benefits.54 The ALJ first
concluded that White had not engaged in substantial gainful activity since her alleged onset date of December 31, 2020.55 At Step 2 of the
sequential analysis that governs disability claims, the ALJ found that White suffered from severe impairments of lumbar degenerative disc disease, right carpal tunnel syndrome, and right knee osteoarthritis.56
The ALJ found White’s obesity to be nonsevere, and noted that there was little evidence to suggest that her obesity more than minimally affected her abilities or contributed to the effects of her other impairments.57 At
Step 3, the ALJ concluded that none of these impairments met or equaled
52 Tr. 34-60. 53 54 Tr. 15-33. 55 Tr. 21. 56 57 Tr. 21-22. 10 the severity of a listed impairment under the Commissioner’s regulations.58
Between Steps 3 and 4, the ALJ then concluded that White: [H]a[d] the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) except the claimant can lift and carry no more than 10 pounds on either a frequent or occasional basis. The claimant can sit 6 hours, stand 2 hours, and walk 2 hours during an 8-hour workday; can occasionally perform postural activities except that the claimant can never climb ladders/ropes/scaffolds, kneel, or crouch; can never push or pull with the right lower extremity; can frequently handle and finger with the right upper extremity; and can tolerate no concentrated exposure to extreme heat, vibration, unprotected heights, and moving machinery parts.59
In reaching this RFC determination, the ALJ considered the objective medical record detailed above, the medical opinion evidence, and White’s reported symptoms. With respect to the medical opinion evidence, the ALJ considered the opinions of state agency consultants, Drs. Sasnauskas and Deleo, and found these opinions persuasive.60 These opinions found that White could perform a range of sedentary work
58 Tr. 22. 59 Tr. 23. 60 Tr. 25-26. 11 with some additional postural limitations.61 The ALJ reasoned that these opinions were generally consistent with White’s allegations and
with the treatment records reviewed by these physicians.62 However, the ALJ accounted for a more restrictive limitation as it related to White’s right lower extremity.63 He also increased White’s capacity to stand and
walk from 2 hours total to 2 hours each occasion due to White’s later- reported response to her pain medications.64
With respect to White’s symptoms, the ALJ found that White’s statements concerning the intensity, persistence, and limiting effects of her impairments were not entirely consistent with the medical
evidence.65 White testified that her diabetes, cholesterol, and blood pressure were managed well with medication.66 She reported lower back pain that radiated into her legs, and that she used a cane to help her
walk.67 She further testified that she was able to perform some
61 Tr. 69-71, 86-89. 62 Tr. 26. 63 64 65 Tr. 23-25. 66 Tr. 39. 67 Tr. 40. 12 household chores with breaks, but that she needed help to grocery shop.68 White stated that she could not sit, stand, or walk for long periods of time
due to pain, but that her pain medications helped her symptoms.69 The ALJ ultimately found White’s testimony to be inconsistent with the objective clinical findings.70 The ALJ recounted the objective medical
evidence, including the abnormal findings of an antalgic gait and reduced range of motion and unremarkable findings of normal balance, sensation,
coordination, and motor skills.71 He further recognized that White’s treatment records and testimony indicated her pain was managed with medications.72 Ultimately, the ALJ concluded that White was not as
limited as she alleged. Having made these findings, the ALJ found at Step 4 that White could perform her past work as a kitchen supervisor.73 Accordingly, the
68 Tr. 46-47. 69 Tr. 51-53. 70 Tr. 23-25. 71 Tr. 23. 72 73 Tr. 26-27. 13 ALJ found that White had not met the stringent standard prescribed for disability benefits and denied her claim.74
This appeal followed. On appeal, White argues that the ALJ’s decision is not supported by substantial evidence because he failed to account for White’s use of a cane, address her obesity, and adequately
develop the record. This case is fully briefed and is therefore ripe for resolution. For the reasons set forth below, we will affirm the decision of
the Commissioner. III. Discussion A. Substantial Evidence Review – the Role of this Court
This Court’s review of the Commissioner’s decision to deny benefits is limited to the question of whether the findings of the final decision- maker are supported by substantial evidence in the record.75 Substantial
evidence “does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as
74 Tr. 27. 75 42 U.S.C. §405(g); , 529 F.3d 198, 200 (3d Cir. 2008); , 901 F. Supp. 2d 533, 536 (M.D. Pa. 2012). 14 adequate to support a conclusion.”76 Substantial evidence means less than a preponderance of the evidence but more than a mere scintilla.77
A single piece of evidence is not substantial evidence if the ALJ “ignores, or fails to resolve, a conflict created by countervailing evidence.”78 However, where there has been an adequately developed
factual record, substantial evidence may be “something less than the weight of the evidence, and the possibility of drawing two inconsistent
conclusions from the evidence does not prevent [the ALJ’s decision] from being supported by substantial evidence.”79 The court must “scrutinize the record as a whole” to determine if the decision is supported by
substantial evidence.80 The Supreme Court has explained the limited scope of our review, noting that “[substantial evidence] means—and means only—‘such
relevant evidence as a reasonable mind might accept as adequate to
76 , 487 U.S. 552, 565 (1988). 77 , 402 U.S. 389, 401 (1971). 78 , 994 F.2d 1058, 1064 (3d Cir. 1993) (quoting , 710 F.2d 110, 114 (3d Cir. 1983)) (internal quotations omitted). 79 , 383 U.S. 607, 620 (1966). 80 , 304 F. Supp.2d 623, 627 (M.D. Pa. 2003). 15 support a conclusion.’”81 Under this standard, we must look to the existing administrative record to determine if there is “‘sufficient
evidence’ to support the agency’s factual determinations.”82 Thus, the question before us is not whether the claimant is disabled, but rather whether the Commissioner’s finding that he or she is not disabled is
supported by substantial evidence and was based upon a correct application of the law.83
When conducting this review, we must remain mindful that “we must not substitute our own judgment for that of the fact finder.”84 Thus, we cannot re-weigh the evidence. Instead, we must determine whether
81 , 139 S. Ct. at 1154 (quoting , 305 U.S. 197, 229 (1938)). 82 83 , No. 3:12-CV-02417, 2014 WL 940205, at *1 (M.D. Pa. Mar. 11, 2014) (“[I]t has been held that an ALJ’s errors of law denote a lack of substantial evidence”) (alterations omitted); , 512 F. Supp. 913, 914 (W.D. Pa. 1981) (“The Secretary’s determination as to the status of a claim requires the correct application of the law to the facts”); , 900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal matters is plenary); , 901 F. Supp. 2d at 536 (“[T]he court has plenary review of all legal issues . . . .”). 84 , 777 F.3d 607, 611 (3d Cir. 2014) (citing , 399 F.3d 546, 552 (3d Cir. 2005)). 16 there is substantial evidence to support the ALJ’s findings. In doing so, we must also determine whether the ALJ’s decision meets the burden of
articulation necessary to enable judicial review; that is, the ALJ must articulate the reasons for his decision.85 This does not require the ALJ to use “magic” words, but rather the ALJ must discuss the evidence and
explain the reasoning behind his or her decision with more than just conclusory statements.86 Ultimately, the ALJ’s decision must be
accompanied by “a clear and satisfactory explication of the basis on which it rests.”87 B. Initial Burdens of Proof, Persuasion, and Articulation for the ALJ
To receive disability benefits under the Social Security Act, a claimant must show that he or she is unable 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
85 , 220 F.3d 112, 119 (3d Cir. 2000). 86 , 577 F.3d 500, 504 (3d Cir. 2009) (citations omitted). 87 , 642 F.2d 700, 704 (3d Cir. 1981). 17 than 12 months.”88 This requires a claimant to show a severe physical or mental impairment that precludes him or her from engaging in previous
work or “any other substantial gainful work which exists in the national economy.”89 To receive benefits under Title II of the Social Security Act, a claimant must show that he or she is under retirement age, contributed
to the insurance program, and became disabled prior to the date on which he or she was last insured.90
In making this determination, the ALJ follows a five-step evaluation.91 The ALJ must sequentially determine whether the claimant: (1) is engaged in substantial gainful activity; (2) has a severe
impairment; (3) has a severe impairment that meets or equals a listed impairment; (4) is able to do his or her past relevant work; and (5) is able to do any other work, considering his or her age, education, work
experience and residual functional capacity (“RFC”).92
88 42 U.S.C. §423(d)(1)(A); 42 U.S.C. §1382c(a)(3)(A); 20 C.F.R. §§404.1505(a), 416.905(a). 89 42 U.S.C. §423(d)(2)(A); 42 U.S.C. §1382c(a)(3)(B); 20 C.F.R. §§404.1505(a), 416.905(a). 90 42 U.S.C. §423(a); 20 C.F.R. §404.131(a). 91 20 C.F.R. §§404.1520(a), 416.920(a). 9220 C.F.R. §§404.1520(a)(4), 416.920(a)(4). 18 Between Steps 3 and 4, the ALJ must also determine the claimant’s residual functional capacity (RFC). RFC is defined as “that which an
individual is still able to do despite the limitations caused by his or her impairment(s).”93 In making this assessment, the ALJ must consider all the claimant’s medically determinable impairments, including any non-
severe impairments identified by the ALJ at step two of his or her analysis.94 Our review of the ALJ’s determination of the plaintiff’s RFC
is deferential, and that determination will not be set aside if it is supported by substantial evidence.95 The claimant bears the burden at Steps 1 through 4 to show a
medically determinable impairment that prevents him or her from engaging in any past relevant work.96 If met, the burden then shifts to the Commissioner to show at Step 5 that there are jobs in significant
numbers in the national economy that the claimant can perform
93 , 220 F.3d at 121 (citations omitted); 20 C.F.R. § 404.1545(a)(1). 94 20 C.F.R. §§404.1545(a)(2), 416.945(a)(2). 95 312 F.3d 113, 129 (3d Cir. 2002). 96 , 994 F.2d at 1064. 19 consistent with the claimant’s RFC, age, education, and work experience.97
With respect to the RFC determination, courts have followed different paths when considering the impact of medical opinion evidence on this determination. While some courts emphasize the necessity of
medical opinion evidence to craft a claimant’s RFC, other courts have taken the approach that “[t]here is no legal requirement that a physician
have made the particular findings that an ALJ adopts in the course of determining an RFC.”98 Additionally, in cases that involve no credible medical opinion evidence, courts have held that “the proposition that an
ALJ must always base his RFC on a medical opinion from a physician is misguided.”99 Given these differing approaches, we must evaluate the factual
context underlying an ALJ’s decision. Cases that emphasize the importance of medical opinion support for an RFC assessment typically
97 20 C.F.R. §§404.1512(f), 416.912(f); , 994 F.2d at 1064. 98 , 174 F. App’x 6, 11 (3d Cir. 2006); 962 F. Supp. 2d 761, 778–79 (W.D. Pa. 2013). 99 , 129 F. Supp. 3d 209, 214–15 (W.D. Pa. 2015). 20 arise in the factual setting where well-supported medical sources have found limitations to support a disability claim, but an ALJ has rejected
the medical opinion based upon an assessment of other evidence.100 These cases simply restate the notion that medical opinions are entitled to careful consideration when making a disability determination. On the
other hand, when no medical opinion supports a disability finding or when an ALJ relies upon other evidence to fashion an RFC, courts have
routinely sustained the ALJ’s exercise of independent judgment based upon all the facts and evidence.101 Ultimately, it is our task to determine, considering the entire record, whether the RFC
determination is supported by substantial evidence.102 C. Legal Benchmarks for the ALJ’s Assessment of Medical Opinions For applications filed after March of 2017, the regulations require
ALJs to consider several factors to determine the persuasiveness of a medical opinion: supportability, consistency, relationship with the
100 , 962 F. Supp. 2d at 778–79. 101 , 174 F. App’x 6; 129 F. Supp. 3d at 214– 15. 102 312 F.3d 113. 21 claimant, specialization, and other factors tending to support or contradict a medical opinion.103 Supportability and consistency are the
two most important factors, and an ALJ must explain how these factors were considered in his or her written decision.104 Supportability means “[t]he more relevant the objective medical evidence and supporting
explanations . . . are to support his or her medical opinion(s) . . . . the more persuasive the medical opinions . . . will be.”105 The consistency
factor focuses on how consistent the opinion is “with the evidence from other medical sources and nonmedical sources.”106 While there is an undeniable medical aspect to the evaluation of
medical opinions, it is well settled that “[t]he ALJ – not treating or examining physicians or State agency consultants – must make the ultimate disability and RFC determinations.”107 When confronted with
several medical opinions, the ALJ can choose to credit certain opinions
103 20 C.F.R. § 404.1520c(c). 104 20 C.F.R. §§ 404.1520c(b)(2), 416.920c(b)(2); , 615 F. Supp. 3d 308, 316 (E.D. Pa. 2022). 105 20 C.F.R. §§ 404.1520c(c)(1), 416.920c(c)(1). 106 20 C.F.R. §§ 404.1520c(c)(2), 416.920c(c)(2). 107 , 667 F.3d 356, 361 (3d Cir. 2011). 22 over others but “cannot reject evidence for no reason or for the wrong reason.”108 Further, the ALJ can credit parts of an opinion without giving
credit to the whole opinion and may formulate a claimant’s RFC based on different parts of different medical opinions, so long as the rationale behind the decision is adequately articulated.109 On the other hand, in
cases where no medical opinion credibly supports the claimant’s allegations, “the proposition that an ALJ must always base his RFC on a
medical opinion from a physician is misguided.”110 D. Legal Benchmarks for the ALJ’s Assessment of a Claimant’s Alleged Symptoms
When evaluating lay testimony regarding a claimant’s reported degree of pain and disability, the ALJ must make credibility determinations.111 Our review of those determinations is deferential.112 However, it is incumbent upon the ALJ to “specifically identify and explain what evidence he found not credible and why he found it not
108 , 994 F.2d at 1066. 109 , 191 F. Supp. 3d 429, 455 (M.D. Pa. 2016). 110 , 129 F. Supp. 3d at 214–15. 111 577 F.3d 500, 506 (3d Cir. 2009). 112 23 credible.”113 An ALJ should give great weight to a claimant’s testimony “only when it is supported by competent medical evidence.”114 As the
Third Circuit has noted, while “statements of the individual concerning his or her symptoms must be carefully considered, the ALJ is not required to credit them.”115
The Social Security Rulings and Regulations provide a framework for evaluating the severity of a claimant’s reported symptoms.116 Thus,
the ALJ must follow a two-step process: first, the ALJ must determine whether a medically determinable impairment could cause the symptoms alleged; and second, the ALJ must evaluate the alleged symptoms
considering the entire administrative record.117 Symptoms such as pain or fatigue will be considered to affect a claimant’s ability to perform work activities only if medical signs or
113 , 777 F.3d 607, 612 (3d Cir. 2014) (citations omitted). 114 , 150 F. Supp. 3d 406, 415–16 (M.D. Pa. 2015) (citations omitted). 115 667 F.3d 356, 363 (3d. Cir. 2011) (referencing 20 C.F.R. §404.1529(a) (“statements about your pain or other symptoms will not alone establish that you are disabled”). 116 20 C.F.R. §§ 404.1529, 416.929; SSR 16–3p. 117 SSR 16-3p. 24 laboratory findings establish the presence of a medically determinable impairment that could reasonably be expected to produce the alleged
symptoms.118 During the second step of this assessment, the ALJ must determine whether the claimant’s statements regarding the intensity, persistence, or limiting effects of his or her symptoms are substantiated
considering the entire case record.119 This includes, but is not limited to, medical signs and laboratory findings; diagnoses; medical opinions
provided by treating or examining sources and other medical sources; and information regarding the claimant’s symptoms and how they affect his or her ability to work.120
The Social Security Administration recognizes that individuals may be limited by their symptoms to a greater or lesser extent than other individuals with the same medical impairments, signs, and laboratory
findings.121 Thus, to assist in the evaluation of a claimant’s subjective symptoms, the Social Security Regulations set forth seven factors that
118 20 C.F.R. §§ 404.1529(b), 416.929(b); SSR 16–3p. 119 20 C.F.R. § 404.1529(c), 416.929(c); SSR 16–3p. 120 121 SSR 16-3p. 25 may be relevant to the assessment of the claimant’s alleged symptoms.122 These factors include: the claimant’s daily activities; the “location,
duration, frequency, and intensity” of the claimant’s pain or symptoms; the type, dosage, and effectiveness of medications; treatment other than medications; and other factors regarding the claimant’s functional
limitations.123 E. The ALJ’s Decision is Supported by Substantial Evidence.
Our review of the ALJ’s decision denying an application for benefits is significantly deferential. Our task is simply to determine whether the ALJ’s decision is supported by substantial evidence in the record; that is
“only— ‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.’”124 Judged against this deferential standard of review, we conclude that substantial evidence supported the
ALJ’s decision in this case. White first argues that the ALJ erred in failing to account for her use of a cane in the RFC or in the hypothetical to the vocational expert.
122 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3). 123 124 , 139 S. Ct. at 1154. 26 In some cases, the claimant’s use of a cane may be outcome- determinative. However, the burden lies with the claimant initially to
show that the cane is medically required by providing “medical documentation establishing the need for a hand-held assistive device to aid in walking or standing, and describing the circumstances for which it
is needed[.]”125 If the claimant demonstrates such a medical necessity, then the ALJ must directly “address the evidence concerning Plaintiff's
use of” an assistive device.126 The failure to do so may require a remand.127 Additionally, when the evidence demonstrates the medical necessity of the assistive device, and a vocational expert testifies that the
claimant’s use of an assistive device would render him or her unable to work, the ALJ must set forth the reasons for rejecting this expert testimony.128
125 , 53 F. App’x 318, 222 (3d Cir. 2002) (citing SSR 96- 9p). 126 , 2009 WL 1783533, at *5 (W.D. Pa. June 23, 2009). 127 128 , 394 F. Supp. 2d 678, 682 (E.D. Pa. 2005). 27 In the instant case, the ALJ acknowledged White’s testimony that she required a cane for walking, as well as the medical records that
indicated White used a cane.129 But as we have noted, the ALJ found that White’s testimony was not entirely consistent with the medical evidence. Additionally, there are no medical records establishing that
the use of the cane was medically necessary or describing the circumstance for which a cane was needed. Indeed, while the treatment
notes during the relevant period and the state agency opinions reference White’s use of a cane, simply “[n]oting that Plaintiff used a cane throughout treatment records . . . is insufficient to overcome the
threshold showing that the cane was medically necessary.”130 Accordingly, we find this argument unavailing. White next argues that the ALJ failed to adequately consider her
obesity in accordance with SSR 19-2p. The Third Circuit has explained that the ALJ need not “use particular language or adhere to a particular
129 Tr. 23-25. 130 , 2024 WL 4906490, at *10 (E.D. Pa. Nov. 27, 2024) (citing , 53 F. App’x at 222). 28 format in conducting his analysis” of a claimant’s obesity.131 Rather, so long as the ALJ “meaningfully consider[s] the effect of a claimant’s
obesity, individually and in combination with her impairments, on her workplace function at step three and at every subsequent step[,]” a remand is not required.132 In the instant case, the ALJ recognized that
the plaintiff’s BMI during the relevant period was indicative of obesity but found this impairment to be nonsevere.133 While he acknowledged
the findings and the claimant’s testimony as to her obesity, he reasoned that there was no evidence in the record to demonstrate that her obesity had more than a minimal effect on her abilities or on her severe physical
impairments.134 The plaintiff fails to point to evidence showing that her obesity had more than a minimal effect on her abilities, and instead generally refers to her physical impairments and her complaints that her
pain was worse with prolonged sitting, standing and walking. But as we
131 , 577 F.3d 500, 504 (3d Cir. 2009) (citations omitted). 132 at 504; , 661 F. App’x 762, 765 (3d Cir. 2016); , 563 F. App’x 904, 911 (3d Cir. 2014). 133 Tr. 21-22. 134 29 have noted, the ALJ explained why he found White’s testimony not entirely consistent with the medical evidence. Ultimately, we conclude
that the ALJ’s assessment of White’s obesity is supported by substantial evidence. Finally, White asserts that the ALJ failed to adequately develop the
record because there was no opinion from a consultative or examining physician regarding White’s physical capabilities. Thus, she argues that
the ALJ’s RFC determination was improperly based on his lay opinion. “ALJs have a duty to develop a full and fair record in social security cases[.]”135 But this duty “does not require a consultative examination
unless the claimant establishes that such an examination is necessary to enable the ALJ to make the disability decision.”136 “The decision to order a consultative examination is within the sound discretion of the ALJ.”137
Here, the ALJ concluded, based on the opinions of the state agency consultants, as well as the medical records and White’s testimony, that she could perform a range of light work with additional postural
135 Ventura v. Shalala, 55 F.3d 900, 902 (3d Cir. 1995). 136 , 45 F. App’x 146, 149 (3d Cir. 2002). 137 30 limitations. Although the state agency opinions found that White could perform a range of sedentary work, the ALJ explicitly reasoned that he
increased White’s standing and walking capabilities based on White’s own testimony that her pain was well-managed with medication. This finding was supported by the medical records in 2023 that demonstrated
White’s pain was adequately managed with her medications. While the plaintiff contends that a consultative examination was necessary, she
fails to demonstrate that there was an unexplained conflict or inconsistency in the evidence that would have required the ALJ to order a consultative examination.138 Therefore, a remand is not required.
Given that the ALJ considered all the evidence and adequately explained the decision for including or discounting certain limitations as established by the evidence, we find no error with the decision.
Therefore, under the deferential standard of review that applies to appeals of Social Security disability determinations, we conclude that substantial evidence supported the ALJ’s evaluation of this case, and this
decision will be affirmed.
138 20 C.F.R. 416.920b. 31 IV. Conclusion For the foregoing reasons, the decision of the Commissioner in this
case will be affirmed, and the plaintiff’s appeal denied. An appropriate order follows. Submitted this 23rd day of February 2026.
Daryl F. Bloom Chief United States Magistrate Judge