WALKER v. MALLEY (2024)

MEMORANDUM OPINION AND ORDER

Plaintiff Lisa Walker alleges that she is disabled—due to due to human immunodeficiency virus (“HIV”), osteoarthritis of her left hip and knee, liver disease, hernia, headaches, asthma, gastrointestinal dysfunction, chronic obstructive pulmonary disease (“COPD”), and seizures—and therefore entitled to disability benefits and supplemental security income. See Pl.’s Statement P. & A. (“Pl.’s Mem.”) 2, 11, ECF No. 8-1. The Social Security Administration (“SSA”) denied Ms. Walker's application for disability benefits and supplemental security income. See Administrative R. (“AR”) 1, 15, ECF No. 5. Ms. Walker appealed to this Court and moved for a judgment of reversal. See Pl.’s Mot. J. Reversal 1, ECF No. 8. The SSA moved for a judgment of affirmance. See Def.’s Mot. J Affirmance & Opp. Pl.’s Mot. J. Reversal 1–2, ECF No. 10. For the reasons set forth herein, the Court will GRANT Defendant's motion for a judgment of affirmance and DENY Plaintiff's motion for a judgment of reversal.

I. BACKGROUND

A. Factual Background

Ms. Walker is a 60-year-old adult female with a GED. See AR 43–44. Between 2002 and 2019, she worked intermittently as a cashier at a grocery store, a cashier at a liquor store, and as a restaurant server. See AR 48, 492–95.

In June 2014, Dr. Towana Spriggs examined Ms. Walker. See AR 986, 989. Dr. Spriggs’ tests indicated that Ms. Walker was HIV positive with many copies of HIV RNA in her blood (a high “viral load”). See AR 986, 1001, 1006, 1016. In August 2014, Ms. Walker presented to Dr. Momodu A. Jack with complaints of abdominal pain and weight loss. See AR 619. An endoscopy revealed Ms. Walker had chronic active gastritis. See AR 620. In November 2014, Ms. Walker was hospitalized for chest pain, wheezing, and blood while coughing. See AR 625. She was diagnosed with multiple aliments including “[c]ommunity acquired pneumonia ․ [and] HIV.” AR 625, 627.

Between November 2014 and May 2015, various practitioners treated Ms. Walker for HIV and pneumonia. See AR 974, 978, 1455. Lab results in this period indicated that after starting HIV medication, Ms. Walker's viral load decreased, but her white blood cell count also decreased. See AR 832, 1226–28. In May 2015, doctors noted that Ms. Walker's HIV condition was “currently asymptomatic” with a “declining” viral load. AR 1455. However, the doctors also observed that Ms. Walker had abnormal airflow because of her wheezing. See AR 1459.

Between May 20 and June 9, 2015, Ms. Walker was again hospitalized, with multiple ailments including an AIDS diagnosis. See AR 706. Doctors noted that Ms. Walker had “an unsteady” gait and recommended physical therapy. AR 1480.

In summer and fall 2015, various practitioners examined Ms. Walker for her HIV and knee pain. See AR 1224, 1230, 1236, 1242. In June, Ms. Walker reported having fallen on her left knee and that she had been “given a walker.” AR 1224. Dr. Saumil Doshi examined Ms. Walker and observed an abnormal gait and joint pain in her left knee, “but no joint swelling, no [muscle pain] ․ no joint stiffness and no limb swelling.” AR 1224. By July, Ms. Walker reported that her knee pain was resolved and that she was no longer using a walker, and doctors observed a normal gait. See AR 1230, 1233. Ms. Walker reported during this period that she was compliant with her HIV medication and had no adverse side effects. See AR 1230, 1236, 1242.

Between January 2016 and January 2017, Ms. Walker continued reporting that she was compliant with her HIV medication and had no adverse side effects. See AR 1262, 1273, 1277. In January 2017, Dr. Doshi noted that Ms. Walker had had an undetectable HIV viral load “for ~2 years.” AR 1281.

Between March 2017 and July 2017, various practitioners examined Ms. Walker for left knee pain. See AR 1051–52, 1054, 1069, 1070–78, 1085, 1089, 1093, 1286, 1295. Doctors observed that Ms. Walker had a normal gait but limited and painful range of movement of the knee, and Ms. Walker reported “intermittent, throbbing pain that [wa]s exacerbated by walking” and was “better with rest.” AR 1091, 1093. Doctors diagnosed Ms. Walker with osteoarthritis of the left knee, classified her knee as “[f]ull weight bearing,” and referred her to physical therapy. AR 1052, 1092.

In May and June 2017, practitioners continued to examine Ms. Walker, and she attended physical therapy six times. See AR 1071–77, 1085, 1286. Ms. Walker reported continued adherence to her HIV medication, and Dr. Wilcox noted that while she had “poor rise in [white blood cell] count,” she had a low viral load. AR 1289. Other practitioners during this period noted that Ms. Walker's knee was swollen and had limited, painful range of movement. See AR 1071, 1087. By mid-June, Ms. Walker had completed physical therapy, and she reported “improved tolerance to walking and stairs,” but “swelling and pain in [her left] knee.” AR 1075–76. Doctors noted that Ms. Walker's range of motion had improved and that the swelling had decreased. See AR 1085. However, they noted that steroid injections had not helped with the pain, which Ms. Walker continued to report as “10/10, worse with walking, [and] better with rest.” AR 1085.

In July 2017, Dr. Hasan Nabhani reviewed an MRI of Ms. Walker's left knee and noted symptoms “likely consistent with [a] meniscal tear.” AR 1078. After observing knee tenderness and painful restricted range of movement, doctors gave Ms. Walker a steroid injection into her left knee. See AR 1295, 1297–98.

In August 2017, Dr. Wilcox examined Ms. Walker. See AR 1133–34. Ms. Walker reported mostly continued compliance with her HIV medication and minimal side effects. See AR 1133. Lab tests indicated that Ms. Walker had undetectable levels of HIV RNA. See AR 1160, 1163. Dr. Wilcox noted that Ms. Walker had a history of seizures, but none in the past few years. AR 1137. Dr. Wilcox prescribed Ms. Walker medication for seizures, because “[w]hen an HIV+ patient has seizures, usually they stay on anticonvulsants.” AR 1137. Dr. Wilcox also noted that Ms. Walker had an abnormal gait, with an “unsteady tandem walk,” along with “joint swelling and joint stiffness.” AR 1133, 1136.

In September 2017, Dr. Bonnie Davis reviewed sonography of Plaintiff's abdomen and diagnosed her with chronic hepatitis B (“HBV”). See AR 1560. In October 2017, practitioners observed “limited ambulation” with a “slight limp,” but no change in gait due to pain. AR 1141, 1629. Ms. Walker reported that she was taking medication which “help[ed] [with] swelling but d[id] not help pain,” that she had felt relief with medication, and that the left knee injection she received in July had provided “significant relief,” but that the pain had since returned. AR 1139, 1629. Doctors thus administered another corticosteroid injection and prescribed additional medication. See AR 1141–42, 1629.

In January 2018, Ms. Walker reported that the left knee injection she previously received had provided “significant relief,” but that the pain had since returned. AR 1317. Noting that Ms. Walker's knee condition was “mild, unchanged, and responding to treatment,” the doctors administered another corticosteroid injection into her left knee. AR 1319–20.

In February 2018, Dr. Wilcox examined Ms. Walker. See AR 1119–24. Ms. Walker reported 100% adherence to her HIV/HBV medication, and Dr. Wilcox observed that Ms. Walker's gait and station were “normal.” AR 1119, 1123. Tests ordered in May 2018 indicated that Ms. Walker had undetectable levels of HIV RNA in her blood but that she was still positive for HBV. See AR 1145, 1147, 1153.

In June 2018, Ms. Walker was admitted to emergency care and discharged the same day with a diagnosis of pneumonia, influenza, and chronic obstructive pulmonary disease (“COPD”), and a prescribed an inhaler for the COPD. See AR 1430. During a follow-up visit in July 2018, Ms. Walker's respiration had “no wheezing, rales/crackles, or rhonchi,” and her “breath sound[ed] normal, [with] good air movement.” AR 1627.

In September 2018, Dr. Wilcox again examined Ms. Walker. See AR 1327–32. Ms. Walker reported that she was “feeling poorly” and had recently lost 16 pounds, and Dr. Wilcox observed that she was suffering from “shortness of breath and cough.” AR 1327. Later that month, doctors admitted Ms. Walker to emergency care and discharged her later the same day with a diagnosis of COPD with acute exacerbation. See AR 1386. Prior to discharge, doctors noted that “[p]atient feels improved” and that the “mild COPD exacerbation ․ has improved after [ ] treatment.” AR 1401.

In April 2019 Dr. Wilcox examined Ms. Walker. See AR 1333–43. Ms. Walker reported that although she had been adhering to her medication with no side effects, she was having “night sweats, decreased appetite, cough and shortness of breath, but no fever, no lethargy, no depression, no weight loss, no skin lesions, no mouth sores, no thrush, no nausea, no vomiting, no diarrhea, no headache and no visual changes.” AR 1333. She also reported “no difficulty concentrating and no decreased memory.” AR 1333. Dr. Wilcox described Ms. Walker's HIV as “controlled on new regimen,” and her HBV as needing “[n]o acute intervention at this time.” AR 1340. Dr. Wilcox also observed that Ms. Walker had “shortness of breath and wheezing,” and noted “[p]ossible underlying undiagnosed asthma.” AR 1333, 1341.

In January 2020, Ms. Walker was admitted to emergency care and discharged the next day with a diagnosis of exacerbation of COPD. See AR 1349. She reported shortness of breath starting two days prior and pain when she took deep breaths. See AR 1354. Doctors observed Ms. Walker breathing “close to baseline,” with her lungs sounding clear under a stethoscope. AR 1355.

In June and July 2020, Dr. Afsoon Roberts examined Ms. Walker. See AR 1168, 1170. Ms. Walker reported continued compliance with her HIV medication. See AR 1168, 1170. Lab tests indicated a lower white blood cell count than in April, detectable levels of HIV RNA, and a positive test for HBV. See AR 1173, 1179, 1181. In June, Dr. Roberts prescribed new HIV medication and discontinued prior ones. See AR 1171–72.

In September 2020, Ms. Walker presented to Dr. Andrew Becker to evaluate the need for seizure medication. See AR 1582. Dr. Becker recommended against restarting medication and recommended further evaluation for possible risk for recurrence of seizures by performing additional testing. See AR 1585–87. Dr. Becker observed Ms. Walker had “normal base and stride” for her gait. AR 1585.

Between December 2020 and November 2021, Dr. Roberts examined Ms. Walker in routine follow-ups for her HIV. See AR 1580, 1662, 1666, 1669. Lab tests during this period indicated declining white blood cell counts and viral loads. See AR 1663–65. Ms. Walker reported compliance with her medication and had no side effects but reported a chronic cough and off-and-on headaches accompanied occasionally by nausea. See AR 1662, 1666, 1670. Dr. Roberts noted Ms. Walker's history of seizures and reminded her to follow up with neurology, which she confirmed having done by November. See AR 1666, 1670. By November 2021, Dr. Roberts assessed Ms. Walker's HIV as “asymptomatic.” AR 1670.

In December 2021, Erin Palmer, NP observed that Ms. Walker had tenderness and pain upon touching the posterior of her left knee, that she had no issues in her respiration, and that her “breath sound[ed] normal, [with] good air movement.” AR 1609–10. NP Palmer referred Ms. Walker to an orthopedic surgeon for left knee pain. See AR 1610. Ms. Walker was prescribed a new inhaler. AR 1607.

In March and July of 2022, Dr. Roberts examined Ms. Walker twice. See AR 1682, 1690. Ms. Walker reported that her left knee was continuing to swell “on and off,” that she was seeing an orthopedist for her knee, and that her chronic headaches were “on and off.” AR 1683, 1691. In March, Dr. Roberts noted that Ms. Walker's white blood cell count “continue[d] to improve ․ and her viral load [was] undetectable.” AR 1685. As of July 29, 2022, Ms. Walker remained asymptomatic for her HIV infection. See AR 1691–92.

B. Statutory Framework

The Social Security Act (the “Act”) provides disability insurance benefits (“DIB”) and supplemental security income benefits (“SSI”) for “disabled” individuals. See 42 U.S.C. §§ 423(a)(1), 1381, 1382(a). The Act defines “disability” as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment,” which for DIB must have “lasted or can be expected to last for a continuous period of not less than 12 months,” and for SSI “can be expected to result in death” or “has lasted or can be expected to last for a continuous period of not less than twelve months.” Id. §§ 423(d)(1)(A), 1382c(a)(3)(A). The impairment must be severe and must render the individual unable to perform both “previous work” and “any other kind of substantial gainful work which exists in the national economy.” Id. §§ 423(d)(2)(A), 1382c(a)(3)(B); see 20 C.F.R. §§ 404.1505, 416.905 (2024).

Whether a claimant is disabled is determined through a five-step process. See 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). The claimant bears the burden of proof at each of the first four steps and the SSA bears the burden at step five. See Butler v. Barnhart, 353 F.3d 992, 997 (D.C. Cir. 2004) (citing 20 C.F.R. §§ 404.1520, 416.920).

At step one, the claimant must demonstrate she is not presently engaged in “substantial gainful activity.” § 404.1520(a)(4)(i); § 416.920(a)(4)(i). If she is, then she is not disabled. See id. At step two, the claimant must show that she has a “severe medically determinable” impairment that “significantly limits [her] physical or mental ability to do basic work activities.” § 404.1520(a)(4)(ii), (c); § 416.920(a)(4)(ii), (c). If the claimant does not have a severe impairment, then she is not disabled. See id. At step three, the claimant must show that her impairment—or combination of impairments—“meets or equals” the criteria of an impairment listed in the SSA's regulations. § 404.1520(a)(4)(iii), (d); § 416.920(a)(4)(iii), (d). If the claimant's impairment meets or equals a listed impairment, then she is disabled. See id. Otherwise, between steps three and four the ALJ proceeds to determine the claimant's residual functional capacity (“RFC”). See § 404.1520(a)(4), (e); § 416.920(a)(4), (e). An RFC is “the most [a claimant] can still do despite [her] limitations,” and considers a claimant's “ability to meet the physical, mental, sensory, and other requirements of work.” See § 404.1545(a)(1), (a)(4); § 416.945(a)(1), (a)(4). At step four, the ALJ must determine whether, considering the RFC, the claimant can still perform any relevant past work. See § 404.1520(a)(4)(iv), (f); § 416.920(a)(4)(iv), (f). If she can, then she is not disabled under the Act. See id. If the RFC indicates that the claimant cannot engage in past work, then at step five, the ALJ looks to the claimant's RFC, age, education, and work experience to determine if she can perform “other work” in the national economy. § 404.1520(a)(4)(v), (g); § 416.920(a)(4)(v), (g). If there is no other work that the claimant can adjust to, then she is disabled under the Act. See id.

II. PROCEDURAL HISTORY

On June 23, 2017, Ms. Walker applied for DIB and SSI, alleging disability due to HIV and osteoarthritis of the left knee. See AR 18, 130.

On October 11, 2017, Dr. Ann L. Williams, a state agency medical consultant, offered a medical opinion. See AR 135–36. Dr. Williams opined that Ms. Walker could only lift 20 pounds occasionally and 10 pounds frequently. See AR 135. She found that Ms. Walker could stand and walk for four hours and could sit for about six hours in an eight-hour workday. See AR 135. Dr. Williams further opined that Ms. Walker's osteoarthritis of her left knee, her pain, and her range of movement limited her to: occasionally climbing ramps, stairs, ladders, ropes, and scaffolds; occasionally kneeling, crouching, and crawling; and frequently balancing and stooping. See AR 135–36. Finally, she found that Ms. Walker had no manipulative, visual, communicative, nor environmental limitations. See AR 136.

On October 27, 2017, the SSA denied Ms. Walker's claim. See AR 148. Ms. Walker subsequently filed for reconsideration. See AR 152.

On June 20, 2018, Dr. Lisa Venkataraman, a state agency medical consultant, concluded that the same limitations as previously found by Dr. Williams applied. See AR 157–58. On June 20, 2018, the SSA denied Ms. Walker's request for reconsideration. See AR 159. On July 2, 2018, Ms. Walker requested a hearing before an ALJ. See AR 215.

A. Administrative Review

On October 4, 2022, the ALJ held a hearing on Ms. Walker's appeal. See AR 43–67.¹ At Ms. Walker's request, the ALJ amended her alleged onset to December 1, 2019. See AR 47.

Ms. Walker testified about her job history. See AR 47–54. She stated that she was currently unemployed. See AR 47–48. Previously, she had worked as a server at IHOP and as a cashier at a liquor store. See AR 52. While working at the liquor store, she would not lift more than 10 pounds. See AR 53. Ms. Walker reported sitting for approximately half of her shift and walking and standing for the other half. See AR 61. Her most recent job had been in 2019 as a cashier working approximately 25 hours per week. See AR 47–50. She reported that she had issues while there with standing for too long and that her left knee would lock up. See AR 48–49. Ms. Walker testified that she would not lift more than 10 pounds at this job. See AR 50.

Ms. Walker further testified that she was not able to return to work because of her knee. See AR 55. She stated that it would “lock[ ] up and give[ ] out on [her] sometimes.” AR 55. She reported that she sometimes wore a knee brace. See AR 55. Ms. Walker stated that her knee experienced swelling and inflammation. See AR 55. As such, she was taking Ibuprofen and elevating her knee. See id. Ms. Walker reported having to take a break after walking “[a]bout a good block and a half.” AR 56. She said that she had received an injection into the knee for swelling and had used a cane, but she did not use one at the time of the hearing. See AR 56–57.

Ms. Walker testified that she used two inhalers and a nebulizer to treat her asthma, and that she experienced symptoms when exerting herself. See AR 57. She stated that she was HIV positive, and experienced weakness in her body and bones, poor balance, and poor sleep. See AR 58.

A Vocational Expert (“VE”), Asheley Wells, testified regarding Ms. Walker's past relevant work. See AR 63–64. VE Wells noted that while being a server is normally light exertional work, Ms. Walker had reported serving a medium level of exertion. See AR 63. Furthermore, VE Wells noted that while being a liquor store cashier and warehouse worker are normally heavy and medium in exertion respectively, that Ms. Walker had reported performing them at a light level of exertion. See AR 64.

The ALJ asked VE Wells hypotheticals about an individual with Ms. Walker's age, education, and work experience who was limited to: light exertional work; able to stand and walk for four hours and sit for six hours; occasionally able to climb ramps, stairs, ladders, ropes, or scaffolds; frequently able to balance and stoop; occasionally able to kneel, crouch, and crawl; and frequently ² able to adapt to changes in the workplace. See AR 64. VE Wells testified that such an individual would be able to perform Ms. Walker's past relevant work as a liquor store cashier as she had actually performed it, but not as generally performed in the national economy. See AR 65. VE Wells testified that such an individual would not be able to transfer skills to other jobs in the national economy. See AR 65. VE Wells also testified that if this individual were further limited to only standing and walking two hours and sitting for four, that they would not be able to perform Ms. Walker's past work as a liquor store cashier. See AR 65.

B. ALJ's Findings and Conclusions

On November 14, 2022, the ALJ denied Ms. Walker's claim. See AR 15. At step one, the ALJ determined that Ms. Walker had not engaged in substantial gainful activity since December 1, 2019. See AR 20. At step two, the ALJ determined that Ms. Walker had “the following severe impairments: HIV; osteoarthritis of the left hip and knee; pneumonia; liver disease; hernia; headaches; asthma; and gastrointestinal dysfunction.” AR 21.

At step three, the ALJ determined that Ms. Walker's knee condition, respiratory conditions, HIV infection, and headaches did not meet or were not medically equivalent to their comparable listings.³ See AR 21–23. The ALJ determined that Ms. Walker did not “have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments.” AR 21.

Between steps three and four, the ALJ determined that Ms. Walker had the RFC to “perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) with additional limitations.” AR 23. Specifically, the ALJ found that Ms. Walker could “stand and walk four hours in an eight-hour workday, sit for seven hours in an eight-hour workday, occasionally climb ramps and stairs, occasionally climb ladders, ropes, or scaffolds, frequently balance, and stoop, and occasionally kneel, crouch, and crawl.” AR 23. Additionally, the ALJ found that “[d]ue to ‘off and on’ headaches and side effects from medications, [Ms. Walker] c[ould] only frequently adapt to changes.” AR 23. In formulating the RFC, the ALJ considered the objective medical evidence, Ms. Walker's testimony, Drs. Williams's and Venkataraman's medical opinions, and Ms. Walker's alleged symptoms and the extent to which they were consistent with the other evidence. See AR 23–26, 28–31.

The ALJ determined that while the “medically determinable impairments could reasonably be expected to cause the alleged symptoms ․ the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms [we]re not entirely consistent with the medical evidence and other evidence in the record.” AR 26. The ALJ also found Drs. Williams's and Venkataraman's opinions to be “persuasive,” because Ms. Walker's “HIV [wa]s controlled with better [white blood cell] counts, an undetectable viral load, and no side effects from the medication regimen,” and because Ms. Walker “consistently describe[d] herself as doing well with no concerns.” AR 26. The ALJ further found that the postural limitations recommended by Drs. Williams and Venkataraman “would adequately accommodate the level of knee pain supported in the objective medical record.” AR 26. Specifically, the ALJ adopted their recommendation to limit Ms. Walker to “light work consisting of lifting/carrying 20 pounds occasionally and 10 pounds frequently, sitting for six hours in an eight-hour workday, standing/walking for four hours in an eight-hour workday, occasionally climbing ladders, ropes, scaffolds, ramps, and stairs, frequently balancing and stooping, and occasionally kneeling, crouching, and crawling.” AR 26.

The ALJ “also limited the claimant to frequently being able to adapt to changes in the work setting,” out of an “abundance of caution” due to Ms. Walker's reports of headaches and possible medication side effects. AR 26. The ALJ also reviewed Ms. Walker's HIV, knee, breathing, and gastrointestinal issues, and discussed how the impairments caused by each condition were addressed by the limitations in the RFC. See AR 24–26. Furthermore, the ALJ noted that the RFC was consistent with the fact that Ms. Walker had previously collected unemployment in 2020 and 2021, because “[w]hen collecting unemployment, one is agreeing that they are ready, willing, and able to work.” AR 26.

The ALJ determined at step four that Ms. Walker was “capable of performing her past relevant work as a liquor store cashier as actually performed.” AR 27. In making this determination, the ALJ compared Ms. Walker's RFC to the physical and mental demands of her past work, and considered evidence such as VE Wells’ testimony, Ms. Walker's testimony, and Ms. Walker's work history report. See AR 27. The ALJ thus concluded that Ms. Walker was not disabled. See AR 32.

On January 4, 2023, Ms. Walker requested review of the ALJ's decision. See AR 398–99. On November 17, 2023, the SSA Appeals Council denied Ms. Walker's request for review. See AR 1–4. On January 9, 2024, Ms. Walker filed the complaint in this matter. See generally Compl., ECF No. 1. In April 2024, the parties consented to proceed before a magistrate judge for all purposes. See Notice, Consent, & Reference Civil Action Magistrate Judge 1, ECF No. 7. In June 2024, this case was referred to the undersigned. See Min. Order (June 5, 2024).

III. LEGAL STANDARD

A district court sits in what is essentially an appellate role when it reviews the [SSA's] disability determination, which must be upheld “if it is supported by substantial evidence and is not tainted by an error of law.” Smith v. Bowen, 826 F.2d 1120, 1121 (D.C. Cir. 1987). Substantial evidence is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Butler, 353 F.3d at 999 (quoting Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971)). This standard “requires more than a scintilla, but can be satisfied by something less than a preponderance of the evidence.” Fla. Mun. Power Agency v. FERC, 315 F.3d 362, 365–66 (D.C. Cir. 2003) (quoting FPL Energy Me. Hydro LLC v. FERC, 287 F.3d 1151, 1160 (D.C. Cir. 2002)).

“Substantial-evidence review is highly deferential to the agency fact-finder.” Rossello ex rel. Rossello v. Astrue, 529 F.3d 1181, 1185 (D.C. Cir. 2008). “An ALJ's credibility determinations, in particular, are entitled to great deference.” Harrison Cnty. Coal Co. v. Fed. Mine Safety & Health Rev. Comm'n, 790 F. App'x 210, 212 (D.C. Cir. 2019) (internal quotation marks omitted). “The reviewing court may neither reweigh the evidence presented to it nor replace the [ALJ's] judgment concerning the credibility of the evidence with its own.” Goodman v. Colvin, 233 F. Supp. 3d 88, 104 (D.D.C. 2017) (internal quotation marks omitted). But the ALJ must have built a “logical bridge” between the evidence and his conclusions so that this Court may “assess the validity of the agency's ultimate findings and afford a claimant meaningful judicial review.” Lane-Rauth v. Barnhart, 437 F. Supp. 2d 63, 67 (D.D.C. 2006) (quoting Scott v. Barnhart, 297 F.3d 589, 595 (7th Cir. 2002)).

On review, the “plaintiff bears the burden of demonstrating that the [ALJ's] decision [was] not based on substantial evidence or that the incorrect legal standards were applied.” Settles v. Colvin, 121 F. Supp. 3d 163, 169 (D.D.C. 2015) (quoting Muldrow v. Astrue, No. 11-cv-1385, 2012 WL 2877697, at *6 (D.D.C. July 11, 2012)). If the ALJ is found to have applied the correct legal standards and met the substantial evidence threshold, then the court may grant the Commissioner's motion for affirmance of the disability determination. See, e.g., Hicks v. Astrue, 718 F. Supp. 2d 1, 17 (D.D.C. 2010). If a reviewing court finds that an ALJ erred in his determination that a claimant was not disabled, it may reverse and remand, requiring the SSA to conduct further proceedings consistent with the law. See, e.g., Jackson v. Barnhart, 271 F. Supp. 2d 30, 38 (D.D.C. 2002).

IV. DISCUSSION

Substantial evidence supports the ALJ's conclusion that Ms. Walker is not disabled.

A. Medical Opinions

An ALJ must “not defer or give any specific evidentiary weight, including controlling weight, to any medical opinion(s).” 20 C.F.R. §§ 404.1520c(a), 416.920c(a). “Instead, the ALJ must decide how persuasive [he] finds all medical opinions according to five factors: (1) supportability; (2) consistency; (3) the medical source's relationship with the claimant; (4) specialization; and (5) other factors that tend to support or contradict a medical opinion.” Tiana O. v. Kijakazi, No. 20-cv-2051, 2023 WL 5348747, at *6 (D.D.C. Aug. 21, 2023) (internal quotation marks omitted).

Ms. Walker does not challenge the ALJ's evaluation of Drs. Williams's and Venkataraman's medical opinions. See generally Pl.’s Mem. Instead, Ms. Walker argues that the ALJ erred in relying upon the doctors’ opinions in crafting the RFC 1) because they were “stale findings,” and 2) because the doctors were “non-examining, non-treating State Agency consultants.” Pl.’s Mem. at 5.

1. Stale Findings

“New medical evidence introduced into the record after a State agency consultant's assessment does not automatically render that assessment invalid. After all, there is almost always additional evidence submitted after the state agency physician issues his or her opinion and before the ALJ's decision is rendered.” Goodman, 233 F. Supp. 3d at 105 (internal quotation marks and brackets omitted).

In June 2018, Dr. Venkataraman provided a medical opinion. See, e.g., AR 1327. Ms. Walker continued medical treatment through July 2022. See, e.g., AR 1690. Accordingly, Ms. Walker argues that Drs. Williams's Venkataraman's opinions were stale because “significant treatment occurred following their assessments.” Pl.’s Mem. at 10. However, “[t]o rectify the issue, the ALJ has simply to consider the new medical evidence in addition to the State agency physicians’ assessments.” Goodman, 233 F. Supp. 3d at 105 (citing Wilson v. Astrue, 331 F. App'x. 917, 919 (3d Cir. 2009)).

Here, the ALJ did so by considering the post-June 2018 medical evidence of Ms. Walker's HIV, headaches, knee pain, and COPD when constructing the RFC. See AR 24–26. First, the ALJ recounted the history of Ms. Walker's HIV condition and headaches. See AR 24–25. Then, the ALJ stated that “during the periods during which her HIV was still slightly uncontrolled, the claimant was working and continued to work through 2019.” AR 25–26. And finally, that Ms. Walker had an “asymptomatic HIV infection” since November 2021. Id.; see also AR 1670. The ALJ's RFC determination was based on “documented signs, symptoms, and laboratory results” up to the time of the October 2022 hearing. AR 25. Thus, the ALJ reviewed the “entire medical history ․ and came to a rational conclusion regarding [Ms. Walker's] limitations.” Sportsman v. Colvin, 637 F. App'x 992, 995 (9th Cir. 2016); see AR 25.

Similarly, the ALJ discussed the evidence of Ms. Walker's knee condition as of October 2022. See AR 25. The ALJ noted that “[t]here does not appear to be any on-going treatment for knee pain currently.” Id. (emphasis added). And the claimant stated she was only taking ibuprofen, a mild over the counter drug, for pain in October 2022. See AR 24. Thus, the ALJ considered the entire record—including contemporaneous evidence—when fashioning the related limitations. See AR 25.

Finally, the ALJ discussed Ms. Walker's history of COPD. See id. The ALJ found that the “medical evidence shows that this condition appears controlled with inhalers and no recent exacerbations despite the claimant continuing to smoke.” Id. (emphasis added). “It is evident that the ALJ reviewed the entire record and concluded ․ that the later records are consistent with the medical evidence as a whole.” Sportsman, 637 F. App'x at 995; see AR 25.

Ms. Walker “only point[s] to a generalized concern that the medical experts did not have a complete evidentiary record,” Wilson v. Astrue, 331 F. App'x 917, 919 (3d Cir. 2009) (internal quotation marks omitted); see Pl.’s Mem. at 10. And then the heart of her argument is merely a laundry list of her treatments post-August 1, 2019. See Pl.’s Mem. at 11. But she offers no analysis of how subsequent test results or medical assessments rebut Drs. Williams's and Venkataraman's prior findings. See id. Without this, there is no teeth to her argument. See Wilson, 331 F. App'x at 919. Indeed, “[t]he fact that additional medical evidence was added to the record after [Drs. Williams's and Venkataraman's] opinions renders them no less valid as of the dates they were written.” Goodman, 233 F. Supp. 3d at 106 (quoting Etheridge v. Comm'r of Soc. Sec., 15-cv-697, 2015 WL 6769116, at *2 (D. Md. Oct. 30, 2015)). Ultimately, “[t]he regulations simply require the ALJ to make decisions supported by substantial evidence, and which consider the entire record including both the State agency assessments, and [ ] additional [ ] test results. It is clear from the ALJ's decision that he did just that.” Goodman, 233 F. Supp. 3d at 106 (cleaned up); see AR 25. Therefore, the ALJ's decision was proper. See Goodman, 233 F. Supp. 3d at 106.

2. Non-Examining Physicians

Ms. Walker “cites no authority as support for the proposition that an ALJ may not rely on the opinion of a non-examining physician, and the regulations expressly contemplate the ALJ's reliance on opinions provided by nonexamining state agency medical consultants.” Higgins v. Saul, No. 16-cv-27, 2019 WL 4418681, at *14 (D.D.C. Sept. 16, 2019) (citing 20 C.F.R. §§ 404.1513(c), 1527(c)(3)); see Pl.’s Mem. at 5. “Thus, the Court must reject the plaintiff's argument that the state agency consultants’ opinions were invalid simply because the consultants did not examine the plaintiff,” and declines to disturb the ALJ's decision on this basis. Higgins, 2019 WL 4418681, at *14.

B. Lay Interpretation of Medical Data

“The SSA's regulations expressly require ALJs to evaluate all the relevant medical and other evidence in making their [RFC] assessment, including a claimant's medical history and the medical signs and laboratory findings.” Higgins, 2019 WL 4418681, at *8 (cleaned up). Ms. Walker argues that “the ALJ on his own interpreted the [post-June 2018] raw medical evidence ․ to arrive at RFC limitations that exceeds those assessed by the state Agency consultants.” Pl.’s Mem. at 8. Specifically, Ms. Walker points to instances where the ALJ described Ms. Walker's HIV as “still slightly uncontrolled” and noted “no treatment for what the claimant described at the hearing as severe knee pain.” Id. (quoting AR 26).

“The Court must reject the plaintiff's argument that the ALJ improperly considered the post-June [2018] medical evidence by evaluating it [himself].” Higgins, 2019 WL 4418681, at *8. Ms. Walker cites various cases to support her argument that the ALJ inappropriately engaged in lay interpretation of raw medical evidence. See Pl.’s Mem. at 9–10 (collecting cases); Pl.’s Reply 3, ECF No. 12 (collecting cases). However, these cases merely support the proposition that an ALJ is not qualified to interpret technical medical data and test results. See, e.g., Caitlin O. v. Kijakazi, No. 17-cv-1939, 2022 WL 17370231, at *16 (D.D.C. Oct. 27, 2022) (it “would have been error for the ALJ to himself interpret ․ ‘monitor strips’ ․ [from] ECG monitoring”), report and recommendation adopted, 2023 WL 4744068 (D.D.C. July 25, 2023); Brandon K. v. O'Malley, No. 22-cv-1041, 2024 WL 1331969, at *7–8 (M.D.N.C. Mar. 28, 2024) (it was error for the ALJ to interpret cervical and lumbar MRIs); Burke v. Berryhill, No. 16-cv-485, 2018 WL 1000006, at *6 (S.D. Ohio Feb. 21, 2018) (ALJ was “not qualified to interpret spirometry results”). The ALJ here did not engage in lay interpretation of technical medical data or test results.

First, regarding Ms. Walker's knee pain, the ALJ's stated that there was “no other treatment in record and no consistent complaints of knee pain during her numerous exams for HIV management.” AR 26. This was not “lay interpretation” of medical data, but rather a summary of the post-June 2018 treatment plan and symptoms. See, e.g., AR 1168, 1170, 1327, 1333, 1580, 1662, 1666, 1669, 1682, 1690. Indeed, Ms. Walker's gait returned to normal after her final steroid injection in January 2018, and subsequent appointments indicated that her gait remained free of limping from pain. See AR 1123, 1585. Second, the ALJ's description of Ms. Walker's HIV as “slightly uncontrolled” in 2019 is an accurate summary of Ms. Walker's condition at the time, given that Ms. Walker reported “night sweats, decreased appetite, cough, and shortness of breath” and was still testing positive for HBV. AR 26, 1333, 1336–37. Such summaries are not lay interpretation of medical data.

Furthermore, the singular limitation the ALJ added in the RFC above the opinions the state agency consultant was not due to medical evidence, but because of Ms. Walker's statements. See AR 28, 30–31. There is no bar to an ALJ interpreting a plaintiff's statements about her condition. Ms. Walker fails to substantiate her contrary argument that the added RFC limitation was a result of the ALJ's lay interpretation of medical evidence. See Pl.’s Mem. at 8–10. Without this, her argument fails. Thus, the ALJ appropriately handled the post-June 2018 medical evidence.

C. Development of the Record

The “decision to order a consultative examination is discretionary.” John W. v. Kijakazi, No. 18-cv-2453, 2022 WL 4245519, at *10 (D.D.C. Sept. 15, 2022) (citing Sims v. Apfel, 224 F.3d 380, 381–82 (5th Cir. 2000)). The ALJ “should only require a consultative examination if the evidence as a whole, both medical and nonmedical, is not sufficient to support a decision.” John W., 2022 WL 4245519, at *10 (quoting 20 C.F.R. § 404.1519a(b)). That is, when there is “obvious gap or defect in the administrative record.” Richmond-Howard v. Saul, No. 19-cv-2014, 2022 WL 17370228, at *8 (D.D.C. July 25, 2022) (citing Gurrola v. Astrue, 706 F. Supp. 2d 78, 85 (D.D.C. 2010)), report and recommendation adopted sub nom. Richmond-Howard v. Kijakazi, 2022 WL 17370162 (D.D.C. Aug. 12, 2022).

Ms. Walker argues that the ALJ's decision lacks substantial evidence because the ALJ did not obtain an agency consultative examination or medical expert testimony regarding the new post-June 2018 medical evidence. See Pl.’s Mem. at 10. However, Ms. Walker has not pointed to any obvious gap in the record and again “only point[s] to a generalized concern.” Wilson, 331 F. App'x at 919; see Pl.’s Mem. at 10. “In this situation, the ALJ was not required to seek an updated report from the State consultants.” Wilson, 331 F. App'x at 919. Indeed, as discussed above: neither did the new evidence invalidate the previous medical opinions; nor did the new evidence require an expert to interpret it. The record was adequate—without further supplementation—because it included Ms. Walker's “treatment notes, test results, related prescriptions, and evaluation charts.” Johnson v. Colvin, 197 F. Supp. 3d 60, 77 (D.D.C. 2016) (citing Rothe v. Astrue, 766 F. Supp. 2d 5, 13–14 (D.D.C. 2011)); see generally AR 598–1719. “Plaintiff has failed to show a basis for ordering an examination and had not shown how additional evidence would help to properly determine plaintiff's RFC. The ALJ was able to make an informed decision without ordering another consultative examination. Again, substantial evidence supports the ALJ's decision.” Pinkney v. Astrue, 675 F. Supp. 2d 9, 21 (D.D.C. 2009); see generally AR 598–1719.

D. Narrative Discussion

Ms. Walker finally argues that because the ALJ did not “order a consultative examination or procure medical expert testimony” and “relied upon his own lay interpretation of the evidence,” he “fail[ed] to sufficiently offer a narrative discussion describing how the evidence supports the ALJ's ultimate conclusion.” Pl.’s Mem. at 10. Ms. Walker misunderstands the nature of the narrative discussion requirement.

This requirement necessitates that “the ALJ buil[d] an accurate and logical bridge from the evidence to his conclusion.” Bullock v. Kijakazi, No. 20-cv-1764, 2023 WL 5023380, at *7 (D.D.C. Aug. 8, 2023) (internal quotation marks and brackets omitted). “To provide the requisite logical bridge, [the] narrative discussion ․ must enable the Court to understand the ALJ's route to his conclusion to permit meaningful review.” Johnson v. Kijakazi, No. 18-cv-2749, 2022 WL 2452610, at *2 (D.D.C. July 6, 2022) (internal quotation marks omitted). “[T]he narrative discussion generally is adequate if the ALJ does not merely list the evidence but also discusses what the evidence shows about the claimant's RFC and explains which evidence he found credible and why.” Id. (internal quotation marks omitted).

Here, the ALJ satisfied the narrative discussion requirement. The ALJ comprehensively described how he utilized the consultants’ medical opinions and evaluated the medical evidence in formulating the RFC. See supra; AR 24–26. “[T]he ALJ did more than merely list the evidence. The ALJ explained which evidence he found credible and why.” Pinkney, 675 F. Supp. 2d at 17–18 (D.D.C. 2009); see AR 24–26. Specifically, the ALJ relied on the consultative examiners’ opinions and explained why their reports along with subsequent medical evidence supported his conclusion. See AR 24–26. By doing so, the ALJ allowed the Court to assess the validity of the ALJ's findings and afford Ms. Walker meaningful judicial review. See id. at 17.

Even if Ms. Walker's argument was germane to the narrative discussion requirement, her argument would fail, again. As discussed above, the ALJ did not need to further develop the record, nor did he engage in lay interpretation. See supra. The ALJ's RFC assessment was supported by substantial evidence and provided a sufficient narrative discussion. See supra; AR 24–26.

V. CONCLUSION

For the foregoing reasons, the Court will DENY Plaintiff's Motion for Judgment of Reversal and GRANT Defendant's Motion for Judgment of Affirmance.

ORDER

Upon consideration of Plaintiff's Motion for Judgment of Reversal and Defendant's Motion for Judgment of Affirmance, it is hereby ORDERED that Defendant's Motion for Judgment of Affirmance is GRANTED and Plaintiff's Motion for Judgment of Reversal is DENIED.

FOOTNOTES

1.   Additional hearings were previously held by another ALJ on August 24, 2020, November 24, 2020, March 1, 2021, and September 10, 2021, but all were postponed to give Ms. Walker time to find representation. See AR 76, 97–98, 104, 107, 125.

2.   ALJs use “frequently” to indicate that claimant is limited in some fashion, but less limited than if the term “occasionally” was used. See, e.g., Garza v. Comm'r Soc. Sec., No. 21-cv-403, 2022 WL 2974691, at *5 (E.D. Cal. July 27, 2022).

3.   The ALJ compared Ms. Walker's conditions to listing 1.18 (abnormality of a major joint in an extremity), 3.02 (chronic respiratory disorders), 3.03 (asthma), 11.02 (epilepsy), 14.11 (disorders associated with HIV infection). See AR 21–23; 20 C.F.R. Part 404, Subpart P, App. 1, 1.18, 3.02, 3.03, 11.02, 14.11.

ZIA M. FARUQUI, UNITED STATES MAGISTRATE JUDGE