2010 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit 2-12-2010 

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S o c i a l S e c u r i ty( th e “ Co mmi s s i o n e r ” ) . W e wi l l a f f i r m. I. B e c a u se w e w rite s o lelyf o r th e b e n e f

it o f th e p a rties , w e w ill o n lyb rie f ly su m m a riz e th e e ss e n tial f a c ts. O n Ju n e 3 , 2 0 0 3 , K n o x f iled a n a p p lica tio n f

o r D isa b ili ty In su ra n c e B e n e f

its a n d S u p p lem e n tal S e c u rityIn c o m e u n d e r th e S o c ial S e c u rityA c t, al l egi ng di s abi l i tys i nce M ar ch 16, 2002 due t o H I V and pul m onaryhypert ens i on. T he C om m i s s i onerdeni ed hi s cl ai m s , both i ni t i al l yand upon r econs i der at i on. K nox r eques t ed a hea r i ng befor e an a dm i ni s tr at i ve l aw j udge ( “A L J ”) , w hi ch w as hel d on D ece m ber7, 2006. I n a dec i s i on i s s ued February9, 2007, the A L J found thatK nox w as notdi s abl ed f o rp u rp o s e s o f

r e c e i v i n g S o c i a l S e c u r i tyb e n e f i t s . T h e Ap p e a l s Co u n c i l d e n i e d r e v i e w, ma k i n g th e AL J ’ s F e b ru a r y9 , 2 0 0 7 d e c i s i o n th e f i n a l d e c i s i o n o f

th e Co mm i s s i o n e r . On D ece m ber21, 2007, K nox fi l ed a c om pl ai nti n D i s tr i ctC our tchal l engi ng the deni al . T he D i s tr i ctC our tfound thatthe C om m i s s i oner ’ s deci s i on w as s uppor t ed bys ubs t ant i al e v id e n c e . B yo rd e r e n te re d D e c e m b e r 9 , 2 0 0 8 , th e D is tr ic t C o u rt d is m is s e d th e a c tio n . K nox t i m el yappea l ed. II. T h e D is tr ic t C o u rt h a d s u b je c t m a tte r j u ri s d ic tio n p u rs u a n t to 4 2 U .S .C . § 4 0 5 (g ). W e have j ur i s di ct i on t o r evi ew the D i s tr i ctC our t ' s deci s i on under28 U . S. C . § 1291. O ur r evi ew i s l i m i t ed t o det erm i ni ng w hethers ubs t ant i al evi dence s uppor t s the A L J ' s fi ndi ng thatK nox w as notdi s abl ed. 42 U . S. C . §§ 405( g) , 1383( c) ; R uther for d v. B arnhart , 3993

F. 3d 546, 552 ( 3d C i r . 2005) . “‘ Subst ant i al evi dence ’ has been de fi ned as ‘ m or e than a m er e s ci nt i l l a. I tm eans s uch r el evantevi dence as a r eas onabl e mi nd m i ghtacc eptas adequa t e t o s uppor ta conc l us i on. ’ ” Sm i th v. C al i fano, 637 F. 2d 968, 970 ( 3d C i r . 1981) (qu o ti n g R icha rdso n v . P era les, 4 0 2 U . S . 3 8 9 , 4 0 1 (19 7 1 )). III . T h e S o c ial S e c u rityA c t au th o riz e s th e C o m m iss io n e r to p a yso c ial s e c u rity benef i t s t o di s abl ed per s ons . 42 U . S. C . §§ 423( d) , 1382. D i s abi l i tyi s defi ned as the

“ in a b ili tyto e n g a g e in a n ysu b sta n tial g a in f u l ac tiv ityb yre a so n o f

a n ym e d ica lly det erm i nabl e phy s i cal orm ent al i m pai r m entw hi ch ca n be expe ct ed t o r es ul ti n death or w hi ch has l as t ed orcan be expec t ed t o l as tfora cont i nuous per i od of notl es s than 12 m onths . ” 42 U . S. C . § 423( d) ( 1) ( A ) . A n i ndi vi dual i s notdi s abl ed unl es s “hi s phy s i cal or m e n tal im p a irm e n t o r im p a irm e n ts a re o f su c h se v e rityth a t h e is n o t o n lyu n a b le to d o h is p re v io u s w o rk b u t ca n n o t, co n sid e rin g h is a g e , ed u c a tio n , an d w o rk e x p e rie n c e , en g a g e in anyotherki nd of s ubs t ant i al gai nful w or k w hi ch exi s t s i n the nat i onal economy . ” 42 U . S . C . § 4 2 3 (d)(2 )(A ). T h e C o m m iss io n e r a p p lies a f iv e -ste p tes t to d e ter m in e w h e th e r a c laim a n t is di s abl ed. 20 C . F. R . §§ 404. 1520( a) ( 4) , 416. 920( a) ( 4) . T he fi r s ttw o s t eps r equi r e the c l a i m a n tt o d e m o n s tr a t e th a th e i s n o tc u rr e n t l y e n g a g i n g i n s u b s t a n t i a l g a i n f u l a c t i v i ty, and thathe i s s uffe r i ng fr om a s ever e i m pai r m ent . I d. I f the cl ai m antpr ogr es s es t o s t ep thr ee, then the ques t i on becomes “‘ w hetherthe i m pai r m enti s equi val entt o one of a4

num berof Li s t ed I m pai r m ent s [art i cul at ed i n 20 C . F. R . Pt . 404, Subpt . P, A pp. 1] thatt he C om m i s s i oneracknow l edges ar e s o s ever e as t o pr ecl ude s ubs t ant i al gai nful act i vi ty . ’ ” K nepp v. A pfel , 204 F. 3d 78, 84 ( 3d C i r . 2000) ( quot i ng B ow en v. Y uckert , 482 U . S. 137, 1 4 1 (1 9 8 7 )); se e a lso 2 0 C .F .R . § 4 0 4 .1 5 2 0 (a )(4 )(iii). If th e c laim a n t' s s p e c if ic i m p a i rm e n ti s n o ta L i s t e d I m p a i r m e n t , th e A L J m u s tc o n s i d e rw h e th e rth e c l a i m a n t 's i m pai rm entorcombi nat i on of i m pai r m ent s i s “medi cal l yequi val ent ” t o a Li s t ed I m pai r m ent . See 20 C . F. R . § 404. 1526( a) . A n i m pai r m entorcombi nat i on of im p a irm e n ts is “ m e d ica llye q u iv a len t” to a L iste d Im p a irm e n t if it is “ a t lea st e q u a l in s ever i tyand dur at i on t o t he cr i t er i a of a ny[L]i s t ed [I ] m pai r m ent . ” I d. I n otherw or ds , t he cl ai m ant ' s i m pai r m ent“‘ m us tm eetal l of the s peci fi ed medi cal cr i t er i a. A n i m pai r m ent thatm ani fes t s onl ys om e of thos e cr i t er i a, no m att erhow s ever el y , does notqual i fy . ’ ” W i l l i ams v. Sul l i van, 970 F. 2d 1178, 1186 ( 3d C i r . 1992) ( quot i ng Sul l i van v. Z ebl ey , 493 U .S . 5 2 1 , 5 3 0 (1 9 9 0 )). A c laim a n t w h o sa tisf ies ste p th re e “ is c o n c lu siv e lyp re su m e d to be di s abl ed. ” K nepp, 204 F. 3d at84 ( ci t at i on and quot at i on m arks om i t t ed) . A cl ai m ant w ho fai l s ats t ep thr ee mustcont i nue t o s t eps fourand fi ve. A ts t ep four , the ques t i on i s “w hetherthe cl ai m antr et ai ns the r es i dual funct i onal capa ci tyt o per form [hi s ] pas tr el evantw or k. ” Pl um m er , 186 F. 3d at428. I ti s the claim an t' s b u rde n to es tablish a n inab il ityto return to h is pa st r elev an t w o rk. S ee id. I f the cl ai m ants at i s fi es thi s bur den, then the bur den of pr oduct i on s hi ft s t o the C om m i s s i onert o s how , ats t ep fi ve, that“ther e ar e otherj obs exi s t i ng i n s i gni fi cant5

num ber s i n the nat i onal economyw hi ch the cl ai m antcan pe r form , cons i s t entw i th her m edi cal i m pai r m ent s , age, educa t i on, pas tw or k exper i ence , and r es i dual funct i onal capa ci ty . ” Pl um m er , 186 F. 3d at428. T hi s s t ep r equi r es the A L J t o cons i derthe c laim a n t' s re sid u a l f

u n c tio n a l ca p a c ity , ag e , ed u c a tio n , an d p a st w o rk e x p e rie n c e to d e ter m in e w h e th e r th e c u m u lativ e e f f e c t o f a ll o f th e c laim a n t' s im p a irm e n ts re n d e rs h im ca p ab le of

w o rkin g . S ee 2 0 C . F . R . § 4 0 4 . 1 5 2 0 (g). I V. O n appea l , K nox ar gues thatthe A L J ’ s deci s i on i s nots uppor t ed bys ubs t ant i al evi dence . K nox ar gues s peci fi cal l ythatthe A L J err ed: ats t ep thr ee byfai l i ng t o fi nd t hat hi s condi t i ons m etthe Li s t ed I m pai r m ent s ; ats t ep fourbyi m pr oper l yeval uat i ng the m edi cal evi dence ; and ats t ep fi ve bypos i ng an i nadequa t e hypothet i cal t o the voca t i onal e x p e rt. W e a g re e w ith th e D istric t C o u rt th a t n o n e o f th e se a rg u m e n ts h a s m e rit. A. K n o x arg u es th at th e A L J erred at st ep three b yfa il ing to f ind that K n o x ’s con dit i on s m et , i nd i vidual l yor i n co m binat i on , on e of the L i st ed Im pairm ents , s peci fi cal l y1. 04 for“D i s or der s of the Spi ne” a nd 12. 06 for“A nxi etyr el at ed di s or der s . ” F or both of these L i st ed Im pairm ents , the A L J r ecog nized that aggravat i ng fact ors m ust be pr es entforthe condi t i on t o m eetthe r equi r ement s of the Li s t i ngs . ForL i s t i ng 12. 06, th e A L J c o n c lu d e d th a t K n o x ’s “ a lleg e d a n x ietyre late d d iso rd e r (p a n ic d iso rd e r w ith p a rtial a g o ra p h o b ia) is n o t ac c o m p a n ied b ya ‘m a rk e d ’ re stric tio n o f th e a c tiv iti e s o f

d a ily6

l i vi ng, or‘ m arked’ di ffi cul t i es i n m ai nt ai ni ng s oci al funct i oni ng, or‘ m arked’ di ffi cul t i es in m a in tain in g c o n c e n tra tio n , o r ‘re p e a ted ’ e p iso d e s o f d e c o m p e n sa tio n , o r th e c o m p lete i nabi l i tyt o funct i on i ndepende nt l yout s i de the ar ea of hi s hom e. ” A ppendi x ( “A pp. ”) 16- 1 7 (c itatio n s o m itt e d ). K n o x a rg u e s th a t h e su f f e rs f ro m a p a n ic d iso rd e r w ith agor aphobi a and phobi as of el evat or s , K nox B r . 50, butthe A L J concl uded thatthe m e d ica l ev id e n c e d id n o t su p p o rt K n o x ’s a ss e rtio n th a t h is c o n d iti o n w a s s u f f icie n tly debi l i t at i ng w i thi n t he meani ng of the Li s t i ngs . T he A L J ’ s det erm i nat i on i s s uppor t ed by s ubs t ant i al evi dence . W i th r es pectt o L i s t i ng 4. 04, the A L J found thatK nox’ s “muscul os kel et al di s or der s of the ce r vi cal and l um bars pi ne have notr es ul t ed i n compromi s e of a nerve ro o t w ith e v id e n c e o f

n e rv e ro o t co m p re ss io n c h a ra c ter ize d [ b y ] n e u ro -a n a to m ic di s tr i but i on of pai n, m arked l i m i t at i on of m ot i on of the s pi ne, m ot orl os s , [or ] s ens oryor ref lex lo ss.” A p p . 1 7 . K n o x ca n n o t dem o n str ate h is cl aim ed sp ine d isord ers w ere s uffi ci ent l yaggr avat ed t o m eetthe def i ni t i on s uppl i ed bythe r egul at i ons . T he evi dence of “mi l d bi l at er al m edi an nerve entr apmentneruopathy[s i c] ( carpal tunnel s yndr om e) aff ect i ng s ens orycomponent s , ” C ert i fi ed A dm i ni s tr at i ve R ecor d ( “Tr. ”) 422, r educe d ra n g e o f m o tio n in th e n e c k a n d lo w e r b a c k , T r. 2 5 1 , an d “ lim itatio n s d u e to o ste o a rth ritis a n d n e u ro p a th y ,” T r. 2 7 1 , d o e s n o t co m p e l a c o n c lu sio n th a t K n o x m e e ts th e re q u ire m e n ts of the Li s t i ngs . T he A L J ’ s eval uat i on of thi s L i s t ed I m pai r m enti s s uppor t ed by s ubs t ant i al evi dence .7 B. K nox r ai s es tw o chal l enges t o the A L J ’ s det erm i nat i on ats t ep four . Fi r s t , K nox a r g u e s th a tth e ALJ i mpr o p e r l ye v a l u a t e d th e me d i c a l e v i d e n c e , c o n t e n d i n g th a tth e ALJ “fa i l ed t o gi ve pr opercr edenc e t o the compl ai nt s of M r . K nox conce rni ng hi s pai n, l i m i t at i on of m ot i on and func t i on, w eakne s s , . . . num bnes s , s hor tnes s of br eath, head aches, dizzi ness and fat i gu e, m ental i m pairm ents i ncludi ng anx i et y , pan i c at t acks, phobi as and depr es s i on, and ca r di ac c ondi t i on and che s tpai ns . ” K nox B r . 31- 32 ( ci t at i ons om i t t ed) . I f the medi cal evi dence s ugges t s a cl ai m ant“has an i m pai r m ent w hi ch i s r eas onabl yexpec t ed t o pr oduce s om e pai n, [the A L J ] m us tcons i deral l of the ev iden ce relev an t t o the in d ividu al’s all eg ati o n s o f p ain, ev en if th e a ll eg ed p ain is m o re s ever e orper s i s t entthan w oul d be expe ct ed. ” Sykes v. A pfel , 228 F. 3d 259, 266 n. 9 ( 3d C ir. 2 0 0 0 ) (c itatio n s o m itt e d ). T h e A L J “ m u st e x p licitlyw e ig h th e e v id e n c e a n d e x p lain a re jecti o n o f th e e v iden ce . ” Id . (cit ati o n s o m itted). I n thi s cas e, the A L J expl ai ned i n det ai l the r eas ons forpart i al l ydi s cr edi t i ng K nox’ s t es t i m onyr egar di ng hi s cl ai m ed che s tpai n, di arrhea, w eakne s s , fat i gue, neck, l ow back a nd bi l at er al knee pa i n. See A pp. 18- 19. Speci fi cal l y , the A L J found the s cope of K nox’ s cl ai m ed i m pai r m ent s t o be i ncons i s t entw i th hi s choi ce of pai n m edi cat i on, the l ack of fr equenti npat i entadmi s s i ons , emer gencyr oom vi s i t s , orpr otr act ed phy s i cal th e r a p y , a n d th e c l i n i c a l f i n d i n g s r e g a r d i n g h i s c l a i me d i mpa i r me n t s . App . 1 8 . Th e ALJ a lso e x p lain e d th e in c o n sis ten c ies in K n o x ’s te stim o n yre g a rd in g h is c laim e d p sy c h iatric8

condi t i ons thatl ed hi m t o di s countthi s t es t i m ony . See A pp. 19- 20. W e agr ee w i th the D i s tr i ctC our tthatthe A L J ’ s eval uat i on of the medi cal evi dence i n arr i vi ng atthe r es i dual fun ct i on al capac i tyasses sm ent, i ncludi ng the ev al uati on of K no x’s s ubj ect i ve co m plai nts , w as s uppor t ed bys ubs t ant i al evi dence . K nox fur therar gues thatthe A L J err ed i n i m pr oper l yr el y i ng “on an uns uppor t ed opi ni on of a non e xami ni ng doct or , D r . Fechner , bas ed on a mi s i nt erpr et at i on of the r ecor d” t o “s uppl antthe medi cal opi ni on of a tr eat i ng phy s i ci an. ” K nox B r . 56- 57. K nox corr ect l ypoi nt s outthatthe r eport s of tr eat i ng phy s i ci ans ar e t o be af for ded “gr eat w ei ght , ” i d. 57 ( quot i ng M or al es v. A pfel , 225 F. 3d 310, 317 ( 3d C i r . 2000) ) , butK nox m i s char act er i zes the A L J ’ s as s es s m ent . T he A L J ci t ed D r . Fechner ’ s t es t i m onythatK nox c o u ld p e rf

o rm lig h t w o rk , se e A p p . 2 0 , b u t th e re sid u a l f u n c tio n a l ca p a c itya ss e ss m e n t d id noti gnor e the otherm edi cal evi dence ci t ed i n K nox’ s br i ef. T he A L J di s cus s ed the r eport s fr om eac h of K nox’ s tr eat i ng phy s i ci ans , D r . M angi a, D r . D ungo, and D r . H r i s o, s ee A pp. 17, and di s cus s ed thei ropi ni ons – al ong w i th the obj ect i ve medi cal evi dence – in d e tail. S e e A p p . 1 7 -1 8 . H e c o n c lu d e d th a t K n o x ’s H IV in f e c tio n h a s b e e n lar g e ly as ym pt om at i c, bas ed on D r . M angi a’ s ques t i onnai r e. A pp. 17. H e furthernot ed that K nox’ s C D - 4 counthas been hi gh, hi s vi r al l oad r el at i vel yl ow , and thatK nox has not e x h ib ite d s e c o n d a ry c o m p lic a tio n s th a t o f te n a ri s e f

ro m m o re d e b ilita tin g H IV in f e c tio n s . A pp. 18. T he A L J concl uded thatK nox’ s pul m onaryhypert ens i on w as notaggr avat ed by any“s i gni fi cants econda r ycompl i cat i ons ort ar getend- or gan damage, ” bas ed on the9

num er ous di agnos t i c i m agi ng r es ul t s i n the r ecor d. A pp. 17- 18. T he A L J found that K n o x ’s o rth o p e d ic im p a irm e n ts d id n o t re su lt i n d e b ili tatin g p a in o r lim itatio n in funct i on, bas ed on s ever al i m agi ng s tudi es . A pp. 18. T he A L J eval uat ed the evi dence r egar di ng K nox’ s m ent al i m pai r m ent s and conc l uded thattheyw oul d i m pos e onl yl i m i t ed r es tr i ct i ons on hi s pos s i bl e w or ki ng envi r onm ent s . A pp. 19. T he A L J di s count ed the “chec k-l i st ” qu est i on nair e prepared byD r. H ri so, see T r. 48 2-84, because t hese concl us i ons “ar e nots uppor t ed byobj ect i ve narr at i ve ment al s t atus fi ndi ngs of any speci fi ci ty . ” A pp . 19 ; accord A pp . 20 (di scoun t i ng this check -l i stform becau se D r. H ri so “e ssen ti all ych ec k ed o ff ev eryn o n -ex erti o n al l im it ati o n o n the f o rm , ev en so m e tha t w ere n o t alle g e d ” ). T h e A L J’s re sid u a l f u n c tio n a l ca p a c itya ss e ss m e n t is e x p lain e d in d e tail and s uppor t ed bys ubs t ant i al evi dence . C. K nox’ s fi nal ar gum enti s thatthe A L J err ed ats t ep fi ve byr el y i ng on a h yp o th e tica l p o se d to th e v o c a tio n a l ex p e rt th a t f a iled to a c c o u n t f

o r h is “ lim itatio n s a s to the nee d t o avoi d w etnes s , fum es , gas es , t emper atur e extr emes, hei ght s , i nabi l i tyt o pus h, pul l , kneel , bend ors t oop” bas ed on K nox’ s “pul m onaryand bi l at er al knee i m pai r m ent s . ” K nox B r . 59- 60 ( ci t i ng T r . 489- 96) . H ow ever , an A L J i s notr equi r ed “t o s ubm i tt o the v o c a tio n a l ex p e rt e v e ryim p a irm e n t al l eged bya cl ai m ai nt . ” R uther for d, 399 F. 3d at554 ( emphasi s i n or i gi nal ) . R ather , “the hypothet i cal s pos ed mustacc ur at el ypor tr aythe cl ai m ant’ s i m pairm ents and . . . the ex pertm ustbe g i ven an o pp ortun i tyt o ev al uate tho se10

i m pairm ents as contai ned i n the r ecord. ” Id. (quotat i on m arks om i t t ed). In ot her w ords, “t he A L J m ustaccurat el ycon veyt o the voc at i on al exp ertal l of a c l ai m ant’ s c re d ib ly es tabl is hed l i m i tat i ons . ” I d . ( e mph a s i s i n o r i g i n a l ) ( c i t a t i o n o mi t t e d ) . Her e , th e ALJ pos ed a hypothet i cal thatm i r r or ed K nox’ s funct i onal l i m i t at i ons thatthe A L J det erm i ned had bee n es t abl i s hed bythe medi cal evi dence . C om par e Tr. 593- 94 ( hypothet i cal pos ed to v o ca ti o n al ex p ert) w ith A p p . 1 9 (A L J’s residu al fu n cti o n al ca p ac ityasse ssm en t) ; acc or d A pp. 21 ( expl ai ni ng thatK nox’ s otherpr opos ed l i m i t at i ons “w er e t ot al l yl acki ng in c re d ib ili ty ” ). W e a g re e w ith th e D istric t C o u rt th a t th e A L J in c o rp o ra ted th e c re d ib ly e sta b lish e d lim itatio n s in th e h yp o th e tica l, l e a d in g th e A L J to c o n c lu d e th a t K n o x c o u ld p erf o rm w o rk e x ist ing in sign ifi ca n t nu m b ers in the n ati o n al ec o n o m y . T h e A L J’s det erm i nat i on thatK nox w as notdi s abl ed forpurpos es of r ece i vi ng D i s abi l i tyI ns ur ance B enef i t s and Suppl ement al Secur i tyI ncome underthe Soci al Secur i tyA cti s s uppor t ed by s ubs t ant i al evi dence . V. F o r th e f o re g o in g re a so n s, w e w ill a f f irm th e ju d g m e n t o f

th e D istric t C o u rt.