Woodson v. Berryhill

          REPORT AND RECOMMENDATION

          David J. Novak, United States Magistrate Judge.

         On July 15, 2013, William Woodson ("Plaintiff) applied for Social Security Disability Benefits ("DIB") and, on July 31, 2013, for Supplemental Security Income ("SSI") under the Social Security Act ("Act"), alleging disability from lumbar disc problems, with an alleged onset date of August 20, 2012 - later amended to August 8, 2013. The Social Security Administration ("SSA") denied Plaintiffs claims both initially and upon reconsideration. Thereafter, an Administrative Law Judge ("ALJ") denied Plaintiffs claims in a written decision and the Appeals Council denied Plaintiffs request for review, rendering the ALJ's decision as the final decision of the Commissioner.

         Plaintiff now seeks judicial review of the ALJ's decision pursuant to 42 U.S.C. § 405(g), arguing that the ALJ erred in failing to (1) consider all of Plaintiff s cervical impairments at step two; (2) find that Plaintiff satisfied all of the criteria for Listing 1.04A at step three; (3) conduct a function-by-function analysis before formulating the residual functional capacity ("RFC"); and, (4) properly assess Plaintiffs credibility. Plaintiff further argues that the Appeals Council erred in failing to remand in light of new evidence submitted to the Appeals Council. (Mem. in Supp. of Pl.'s Mot. For Summ. J. ("Pl.'s Mem.") (ECF No. 18) at 2-29.) Lastly, Plaintiff requests that the Court accept the after-acquired report of Arthur Lorber, M.D. (Pl.'s Mot. for the Ct. to Receive the After-Acquired Rep. of Dr. Lorber and Suppl. Br. ("Pl.'s Suppl. Mot.") (ECF No. 25).) This matter now comes before the Court for a Report and Recommendation pursuant to 28 U.S.C. § 636(b)(1)(B) on the parties' cross-motions for summary judgment, rendering the matter ripe for review.^[1] For the reasons that follow, the Court recommends that Plaintiffs Motion for Summary Judgment (ECF No. 15) be DENIED, that Plaintiffs Motion for the Court to Accept the After-Acquired Report of Dr. Lorber (ECF No. 25) be DENIED, and Defendant's Motion for Summary Judgment (ECF No. 28) be GRANTED and that the final decision of the Commissioner be AFFIRMED.

         I. PROCEDURAL HISTORY

         On July 15, 2013, Plaintiff filed an application for DIB and, on July 31, 2013, Plaintiff filed an application for SSI with an alleged onset date of August 20, 2012. (R. at 74, 256, 266.) The SSA denied these claims initially on December 11 and December 12, 2013, and again upon reconsideration on August 11, 2014. (R. at 138-39, 156-57.) At Plaintiffs written request, the ALJ held a hearing on February 4, 2016. (R. at 92-137, 211-12.) During the hearing, Plaintiff amended his alleged onset date to August 8, 2013. (R. at 97.) On March 2, 2016, the ALJ issued a written opinion, denying Plaintiffs claims and concluding that Plaintiff did not qualify as disabled under the Act, because he could perform jobs existing in significant numbers in the national economy. (R. at 74-86.) On March 16, 2017, the Appeals Council denied Plaintiffs request for review, rendering the ALJ's decision as the final decision of the Commissioner subject to review by this Court. (R. at 1-7.)

         On August 10, 2017, Plaintiff filed a motion requesting oral argument. (ECF No. 16.) On October 10, 2017 - the day before the deadline expired for Defendant to file her motion for summary judgment - Plaintiff filed a motion to suspend the current briefing schedule, so that Plaintiff could submit Dr. Lorber's report and a supplemental brief in support of Plaintiffs Motion for Summary Judgment. (ECF No. 23.) On October 12, 2017, the Court granted Plaintiffs motion to suspend the current briefing schedule, so that Plaintiff could submit the additional records and a supplemental brief. (ECF No. 24.) Finding that the issues Plaintiff raised in his Brief in Support of Oral Argument (ECF No. 19) could be sufficiently addressed in a supplemental brief, the Court also denied Plaintiffs request for oral argument. (ECF No. 24.)

         II. STANDARD OF REVIEW

         In reviewing the Commissioners decision to deny benefits, a court "will affirm the Social Security Administration's disability determination 'when an ALJ has applied correct legal standards and the ALJ's factual findings are supported by substantial evidence.'" Mascio v. Colvin, 780 F.3d 632, 634 (4th Cir. 2015) (quoting Bird v. Comm 'r of Soc. Sec. Admin., 699 F.3d 337, 340 (4th Cir. 2012)). Substantial evidence requires more than a scintilla but less than a preponderance, and includes the kind of relevant evidence that a reasonable mind could accept as adequate to support a conclusion. Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012); Craig v. Chater, 76 F.3d 585, 589 (4th Cir. 1996). Indeed, "the substantial evidence standard 'presupposes ... a zone of choice within which the decision makers can go either way, without interference by the courts. An administrative decision is not subject to reversal merely because substantial evidence would have supported an opposite decision.'" Dunn v. Colvin, 607 Fed.Appx. 264, 274 (4th Cir. 2015) (quoting Clarke v. Bowen, 843 F.2d 271, 272-73 (8th Cir. 1988)). To determine whether substantial evidence exists, the court must examine the record as a whole, but may not "undertake to re-weigh conflicting evidence, make credibility determinations, or substitute [its] judgment for that of the [ALJ]." Hancock, 667 F.3d at 472 (quoting Johnson v. Barnhart, 434 F.3d 650, 653 (4th Cir. 2005)). In considering the decision of the Commissioner based on the record as a whole, the court must "take into account whatever in the record fairly detracts from its weight." Breeden v. Weinberger, 493 F.2d 1002, 1007 (4th Cir. 1974) (quoting Universal Camera Corp. v. N.L.R.B., 340 U.S. 474, 488 (1951)). The Commissioner's findings as to any fact, if substantial evidence in the record supports the findings, bind the reviewing court to affirm regardless of whether the court disagrees with such findings. Hancock, 667 F.3d at 477. If substantial evidence in the record does not support the ALJ's determination or if the ALJ has made an error of law, the court must reverse the decision. Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987).

         The Social Security Administration regulations set forth a five-step process that the agency employs to determine whether disability exists. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4); see Mascio, 780 F.3d at 634-35 (describing the ALJ's five-step sequential evaluation). To summarize, at step one, the ALJ looks at the claimant's current work activity. §§ 404.1520(a)(4)(i), 416.920(a)(4)(i). At step two, the ALJ asks whether the claimant's medical impairments meet the regulations' severity and duration requirements. §§ 404.1520(a)(4)(ii). 416.920(a)(4)(H). Step three requires the ALJ to determine whether the medical impairments meet or equal an impairment listed in the regulations. §§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii). Between steps three and four, the ALJ must assess the claimant's RFC, accounting for the most that the claimant can do despite his physical and mental limitations. §§ 404.1545(a), 416.945(a). At step four, the ALJ assesses whether the claimant can perform his past work given his RFC. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv). Finally, at step five, the ALJ determines whether the claimant can perform any work existing in the national economy. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v).

         III. THE ALJ'S DECISION

         On February 4, 2016, the ALJ held a hearing during which Plaintiff (represented by counsel) and a vocational expert testified. (R. at 92-137.) On March 2, 2016, the ALJ issued a written opinion, finding that Plaintiff did not qualify as disabled under the Act. (R. at 74-86.)

         The ALJ followed the five-step evaluation process established by the Social Security Act in analyzing Plaintiffs disability claims. (R. at 75-85.) At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity since August 8, 2013, the amended alleged onset date. (R. at 76.) At step two, the ALJ found that Plaintiff suffered from a single severe impairment - degenerative disc disease. (R. at 76.) At step three, the ALJ held that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments. (R. at 77.)

         In assessing Plaintiffs RFC, the ALJ determined that Plaintiff could perform a range of light work with additional limitations. (R. at 77.) Specifically, Plaintiff could frequently climb ramps and stairs, occasionally climb ladders, ropes and scaffolds, and frequently balance, stoop, kneel, crouch and crawl. (R. at 77.) At step four, the ALJ found that Plaintiff could not perform any past relevant work. (R. at 84.) At step five, the ALJ determined that Plaintiff could perform jobs existing in significant numbers in the national economy. (R. at 84-85.) Therefore, Plaintiff did not qualify as disabled under the Act. (R. at 84-85.)

         IV. ANALYSIS

         Plaintiff, forty-nine years old at the time of this Report and Recommendation, previously worked as chicken catcher, laborer and a machine operator. (R. at 292, 298.) He applied for Social Security Benefits, alleging disability from lumbar disc problems, with an alleged onset date of August 20, 2013 - later amended to August 8, 2013. (R. at 97, 292.) Plaintiffs appeal to this Court alleges that the ALJ erred in (1) failing to consider all of Plaintiff s cervical impairments at step two; (2) failing to find that Plaintiff satisfied all of the criteria for Listing 1.04A at step three; (3) failing to conduct a function-by-function analysis before formulating the RFC; and, (4) in assessing Plaintiff s credibility. (Pl.'s Mem. at 2-13, 19-29.) Plaintiff further argues that the Appeals Council erred in failing to remand Plaintiffs claims to the ALJ in light of new evidence. (Pl.'s Mem. at 12-19.) Finally, Plaintiff requests that this Court accept the after-acquired report of Dr. Lorber. (Pl.'s Suppl. Mot.) For the reasons set forth below, the ALJ did not err in his decision, the Appeals Council did not err in rejecting Plaintiffs request for review and the Court rejects Dr. Lorber's after-acquired report.

         1. The ALJ Satisfied Step Two by Finding that Plaintiff Suffered from a Single Severe Impairment.

         Plaintiff argues that the ALJ erred at step two by failing to classify his cervical spinal stenosis, cervical myelomalcia and cervical myelopathy as severe impairments. (Pl.'s Mem. at 2-7.) Defendant responds that the ALJ sufficiently discussed Plaintiffs cervical impairments throughout his opinion and properly explained why the medical evidence supported the ALJ's finding that Plaintiff could perform light work. (Def.'s Mot. for Summ. J. and Br. in Supp. Thereof ("Def.'s Mem.") (ECF No. 29) at 18-21.).

         At step two, the ALJ must consider the claimant's medically determinable impairments. 20 C.F.R. §§ 404.1521, 416.921 ("a physical or mental impairment must be established by objective medical evidence from an acceptable medical source" - a claimant's statements of symptoms alone are insufficient). "The Supreme Court has held that this step of the disability evaluation is a de minimis threshold." Williams v. Astrue, 2010 WL 395631, at * 14 (E.D. Va. Feb. 2, 2010) (citing Bowen v. Yuckert, 482 U.S. 137, 146-47 (1987)). In Yuckert, the Supreme Court explained that step two of the sequential analysis "increases the efficiency and reliability of the evaluation process by identifying at an early stage those claimants whose medical impairments are so slight that it is unlikely they would be found to be disabled even if their age, education, and experience were taken into account." 482 U.S. at 153.

         An ALJ satisfies step two by finding a severe impairment and proceeding through the rest of the sequential analysis. McCormick v. Soc. Sec. Admin., Comm 'r, 619 Fed.Appx. 855, 858 (11th Cir. 2015); Jamison v. Bowen, 814 F.2d 585, 588 (11th Cir. 1987) ("The finding of any severe impairment, whether or not it qualifies as a disability and whether or not it results from a single severe impairment or a combination of impairments that together qualify as severe, is enough to satisfy the requirement of step two.").

         Here, the ALJ satisfied step two, because he found that Plaintiff suffered from a severe impairment - degenerative disc disease - and proceeded to the next step of the sequential analysis. (R. at 76.) Plaintiff argues that "this is not a scenario where the ALJ found at least one, severe impairment, but then considered all of the claimant's impairments and related functional limitations in assessing how much work the plaintiff could still do." (Pl.'s Mem. at 4 (citing Kirkland v. Comm' r of Soc. Sec, 528 Fed.Appx. 425, 427 (6th Cir. 2013)).) Defendant asserts that the ALJ's failure to address Plaintiffs cervical spinal stenosis, myelomalacia and myelopathy at step two constitutes harmless error, because the ALJ appropriately considered and discussed Plaintiffs cervical impairments throughout his opinion. (Def.'s Mem. at 18-19.)

         An ALJ's incorrect characterization of a severe impairment as "non-severe" or failure to address a medically determinable impairment at step two does not automatically require remand. Rather, courts will find no reversible error - or treat the error as harmless - provided that the ALJ considered all of the claimant's impairments in the sequential analysis. Compare Maziarz v. Sec'y of Health & Human Servs., 837 F.2d 240, 244 (6th Cir. 1987) (finding no reversible error where the ALJ labeled an impairment non-severe, but properly considered the impairment in the RFC assessment), with McCormick, 619 Fed.Appx. at 858 ("[S]tep two is merely a filter, and any error in considering an additional impairment is harmless since it does not factor into the determination of disability."), and Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007) (omission of the plaintiffs bursitis at step two constituted harmless error, because the ALJ "extensively discussed" the plaintiffs bursitis at step four of the analysis).

         While the Fourth Circuit has not addressed the precise issue, district courts in this Circuit have adopted the view that an ALJ does not commit reversible error by omitting an impairment at step two, so long as the ALJ considers the impairment in subsequent steps. Clark v. Comm' r of Soc. Sec, 2010 WL 2730622, at *11 (E.D. Va. June 3, 2010), report and recommendation adopted, 2010 WL 2731380 (E.D. Va. July 9, 2010) (quoting Jones v. Astrue, 2009 WL 455414, at *2 (E.D. N.C. Feb. 23, 2009) ("[I]t is not reversible error where an ALJ does not consider whether an impairment is severe at step two of the sequential evaluation provided the ALJ considers that impairment in subsequent steps.")); see also Jones v. Comm 'r of Soc. Sec, 2011 WL 3273129, at *14 (E.D. Va. June 9, 2011), report and recommendation adopted, 2011 WL 3268120 (E.D. Va. July 28, 2011) (citing Clark, 2010 WL 2730622, at * 11) (finding no error where the ALJ considered omitted impairment in subsequent steps); Nuckles v. Astrue, 2009 WL 3208685, at *9 n.4 (E.D. N.C. Oct. 5, 2009) (same).^[2]

         For example, in Clark, the court found no reversible where the ALJ failed to discuss whether Clark's cervical herniated discs qualified as a severe impairment at step two. 2010 WL 2730622, at * 11. Rather, the ALJ sufficiently considered Clark's cervical herniated discs in the RFC assessment, noting that Clark's doctors endorsed chronic back pain in their treatment records, but conservative treatment, such as medication, reasonably controlled Clark's pain. Id. Similarly, the court in Jones found no reversible error where the ALJ failed to discuss Jones' back pain at step two, but sufficiently considered his lower back pain in later steps, "though not necessarily in the most straightforward manner." 2009 WL 455414, at *2-3.

         Like the ALJs in Clark and Jones, the ALJ here omitted discussion of Plaintiffs cervical spinal stenosis, cervical myelomalcia and cervical myelopathy at step two, but gave appropriate consideration to those impairments later in the RFC assessment. (R. at 78-84); Clark, 2010 WL 2730622, at * 11; Jones, 2009 WL 455414 at, *2-*3. First, the ALJ noted that Plaintiff cited, inter alia, "cervical stenosis with cord compression" as one of the impairments that rendered him disabled. (R. at 78.) Second, in the ALJ's discussion of the medical evidence, he noted that "[a] February 27, 2014 MRI of the cervical spine ... revealed disc osteophyte complex at C3-C4 causing stenosis and increased ... signal and cord volume loss consistent with myelomalacia[.]" (R. at 80 (emphasis added).) Third, the ALJ noted that in April 2014, Plaintiff presented to University of Virginia Health Systems ("UVA Health Systems") with cervical stenosis and cervical cord signal change; he underwent an anterior cervical discectomy and fusion ("ACDF") and tolerated the procedure "well and without complication;" and, UVA Health Systems discharged Plaintiff the day after the procedure "with the diagnosis of cervical stenosis[.]" (R. at 80.) Fourth, the ALJ stated that a May 2014 x-ray of Plaintiff s cervical spine revealed normal findings. (R. at 80-81.)

         Next, the ALJ discussed the results of a September 2014 physical examination conducted by Gregory Helm, M.D., in which Plaintiff experienced "some numbness in his right leg," but showed no signs of myelopathy. (R. at 81.) Finally, the ALJ discussed Plaintiffs December 2015 emergency room visit to Centra Southside Community Hospital ("CSC Hospital"), in which Plaintiff displayed cervical tenderness upon physical examination, "but he was neurologically intact, and the remainder of the exam was unremarkable[.]" (R. at 81.) The ALJ further discussed the results of an x-ray and MRI taken of Plaintiff s cervical spine during that visit. (R. at 81.) The x-ray revealed "surgical and degenerative changes," while the MRI showed "some mild compression of the cervical spine." (R. at 81.) The ALJ noted that the hospital discharged Plaintiff "in stable condition with the diagnosis of cervical spine pain." (R. at 81.)

         Plaintiff argues that mere recitation of the medical evidence does not satisfy the ALJ's duty to "build an accurate and logical bridge from the evidence to his conclusion." (Pl.'s Mem. at 5 (quoting Monroe v. Colvin, 826 F.3d 176, 189 (4th Cir. 2016) (additional citation omitted)).) But the ALJ did more than merely regurgitate Plaintiffs medical records. In discounting the alleged severity of Plaintiff s limitations and in formulating the RFC, the ALJ explained (i) inconsistencies between Plaintiffs stated capabilities and those reported by his spouse in a third-party function report, (ii) the conservative nature of Plaintiffs treatment and (iii) Plaintiffs failure to remain compliant with his prescribed course of treatment. (R. at 81-82.) Finally, the ALJ stated that Plaintiffs "reasonably good health... and relatively benign physical examinations belie[d] [his] allegations of disabling symptoms or functional limitations." (R. at 82.) Although the ALJ failed to classify Plaintiffs cervical stenosis, myelomalacia and myelopathy as severe or non-severe impairments at step two, the ALJ adequately discussed those impairments in the RFC assessment. While, "collapsing of the analysis of the evidence by an ALJ is not the preferred form of opinion writing for an ALJ because it makes review of his opinions more difficult, ... it is not necessarily reversible error." Jones, 2009 WL 455414, at *3 (citation omitted). Here, the ALJ sufficiently discussed Plaintiffs conditions throughout his decision such that he did not commit reversible error at step two.

         2. The ALJ Did Not Err at Step Three.

         Next, Plaintiff argues that the ALJ erred in concluding that Plaintiff did not satisfy the requirements of Listing 1.04A. (Pl.'s Mem. at 7-13.) First, Plaintiff asserts that the ALJ failed to "correlate the medical evidence of record with the criteria set forth in [the listing]." (Pl.'s Mem. at 7-8.) Second, Plaintiff argues that the ALJ failed to properly apply the medical evidence to the listing criteria. (Pl.'s Mem. at 8-13.) Defendant responds that substantial evidence supports the ALJ's step three finding and that the ALJ's discussion of the medical evidence in the RFC analysis satisfied the ALJ's duty to correlate the evidence with the listing criteria. (Def.'s Mem. at 21-26.)

         When issuing a decision, an ALJ "is not required to use particular language or adhere to a particular format in conducting his analysis;" the decision must only show that "there is sufficient development of the record and explanation of findings to permit meaningful review." Moore v. Astrue, 2010 WL 3394657, at *6 n.12 (E.D. Va. July 27, 2010). But an ALJ only needs to review medical evidence once in his opinion. McCartney v. Apfel, 28 Fed.Appx. 277, 279-80 (4th Cir. 2002). Therefore, the reviewing court will determine if the ALJ's decision as a whole provides substantial evidence supporting the step three evaluation.

         To meet Listing 1.04A, Plaintiff must have a disorder of the spine that results in compromise of a nerve root or the spinal cord, with:

Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine).

20 C.F.R. Pt. 404, Subpt. P, App'x 1, § 1.04A. To satisfy Listing 1.04A, the impairment must also last or be expected to last for at least twelve months. §§ 404.1509; 416.909.

         At step three, the ALJ held that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of Listing 1.04. (R. at 77.) The ALJ acknowledged that Plaintiffs representative testified at the hearing that Plaintiff satisfied the Listing 1.04 criteria. (R. at 77.) After reviewing the evidence, the ALJ found otherwise. (R. at 77.) In support of his finding, the ALJ explained that "the evidence of record does not establish evidence resulting in" the criteria set forth in Listing 1.04. (R. at 77.) Further, the ALJ noted that state agency physicians reviewed Plaintiffs medical records and likewise concluded that Plaintiff did not meet or medically equal the listing criteria. (R. at 77.) Nor did any evidence submitted after the state agency physicians completed their review "warrant a different determination." (R. at 77.) Finally, the ALJ explained that no treating or examining physician opined that Plaintiff met the listing criteria. (R. at 77.)

         Contrary to Plaintiffs argument, the ALJ correlated the medical evidence to his opinion. (R. at 77-84; Pl.'s Mem. at 7-8.) In Radford v. Colvin, the Fourth Circuit held that the district court abused its discretion by awarding benefits, rather than remanding the case for further explanation from the ALJ as to why the plaintiff did not satisfy the criteria for Listing 1.04A. 734 F.3d 288, 295-96 (4th Cir. 2013). The ALJ in that case "summarily concluded that Radford's impairment did not meet or equal a listed impairment, but he provided no explanation other than writing that he 'considered, in particular,' a variety of listings, including Listing 1.04A, and noting that state medical examiners had also concluded 'that no listing [was] met or equaled.'" Id. at 295 (describing the ALJ's decision as "devoid of reasoning"). The court also took issue with the fact that the ALJ "reject[ed] the opinions of Radford's treating physicians in favor of the state medical examiners" without sufficient explanation. Id. at 295-96.

         Arguing that the ALJ in this case provided similar conclusory reasoning at step three, Plaintiff urges the Court to remand his case. (R. at 77; Pl.'s Mem. at 7-8.) Indeed, the Fourth Circuit made clear that an ALJ's citation to state agency physicians' opinions alone did not constitute substantial evidence in support of the ALJ's step three finding. 734 F.3d at 295-96. But unlike the ALJ in Radford, the ALJ here additionally cited the fact that no treating or examining physician found that Plaintiff satisfied the criteria for Listing 1.04A. (R. at 77.) The ALJ also properly explained the weight that he afforded to the opinions of the state agency physicians and Plaintiffs treating physician in the RFC assessment. (R. at 77, 83.)

         In August 2013, Plaintiffs treating physician, Cynthia Sessums, D.O., instructed Plaintiff not to work for two days and to avoid heavy lifting until his follow-up appointment three to four days later. (R. at 448.) The ALJ afforded Dr. Sessums' opinion that Plaintiff could not work no weight, because she imposed the work restriction for only a limited time period. (R. at 83.) With respect to the state agency physicians' opinions, the ALJ afforded partial weight to the opinion of Michael Cole, D.O., who conducted the initial disability determination. (R. at 83, 150-53.) Dr. Cole opined that Plaintiff could occasionally climb ladders, ropes and scaffolds, frequently stoop, kneel, crouch and crawl, and had no limitation with respect to climbing ramps and stairs. (R. at 153.) The ALJ afforded great weight to the more restrictive opinion of Catherine Howard, M.D., who reviewed Plaintiffs claim on reconsideration. (R. at 83, 168.) Dr. Howard opined that Plaintiff could frequently climb ramps and stairs, occasionally climb ladders, ropes and scaffolds, and frequently balance, stoop, kneel, crouch and crawl. (R. at 168.) The ALJ described these opinions as "balanced and objective, consistent with the overall evidence of record" and supportive of the RFC. (R. at 83.)

         As Defendant points out, the ALJ also gave sufficient consideration to the medical evidence showing that Plaintiff did not satisfy the Listing 1.04 A criteria in the RFC assessment. (R. at 79-81; Def.'s Mem. at 22-23.) For example, at step three the ALJ stated that the record did not show evidence of limited motion of the spine or motor loss accompanied by sensory or reflex loss associated with Listing 1.04A. (R. at 77.) In the RFC assessment, the ALJ correlated the medical evidence to his step three finding by discussing the following: in December 2013, Plaintiffs physical examination showed that Plaintiff produced positive straight leg test results and felt some numbness in his feet, but he experienced no tenderness in his lumbar spine and had normal reflexes in his lower extremities. (R. at 79.) Plaintiff complained of numbness, weakness and loss of sensation in January and April 2014, but he displayed "normal 5/5 strength" during his April 2014 physical examination. (R. at 80.) That same month, Plaintiff underwent a cervical discectomy and fusion and subsequently reported "no arm pain, sensory changes, or weakness." (R. at 80.) In May 2014, Plaintiff displayed good strength and sensation in both the upper and lower extremities, and an x-ray of Plaintiff's cervical spine looked normal. (R. at 81.) Although Plaintiff reported experiencing numbness and pain in September 2014, he displayed normal strength during a physical examination. (R. at 81.) In December 2015, Plaintiff again complained of "numbness, tingling and pain in his right side[, ]" but physical examination revealed tenderness in the cervical spine at C4 only, with otherwise unremarkable results. (R. at 81 (noting that Plaintiff "was neurologically intact").) Although the ALJ discussed the medical evidence in the RFC assessment - rather than at step three - the ALJ only needed to discuss the medical evidence once. McCartney, 28 Fed.Appx. at 279-80. Thus, the ALJ satisfied his duty to explain his step three findings. Moreover, substantial evidence - including Plaintiffs medical records and the opinions of the state agency physicians - supports the ALJ's step three finding.

         a. Plaintiffs medical records show that Plaintiff did not satisfy all of the requirements of Listing 1.04A.

         Plaintiff relies on instances in the record showing that he experienced pain, weakness, tenderness and loss of sensation to establish that he satisfies the criteria for Listing 1.04A, but complete review of the medical records considered by the ALJ and Appeals Council reveal that Plaintiff did not suffer from the requisite motor, sensory or reflex loss under Listing 1.04A. (Pl.'s Mem. at 9-13.)

         On August 8, 2013, Plaintiff presented to CSC Hospital, complaining of back pain. (R. at 442.) Plaintiff experienced tenderness in his lower back, displayed a decreased range of motion of the back secondary to pain and had positive straight leg raise test results bilaterally. (R. at 445.) But Plaintiff displayed a normal range of motion in his other extremities and full range of motion in his neck. (R. at 445.) He also experienced normal sensation in his lower extremities bilaterally and moved all extremities "with good strength and coordination." (R. at 445.) An x- ray of Plaintiff s lumbar spine revealed no fracture, subluxation or destructive lesion; and, the disc spaces appeared "essentially normal." (R. at 446-47.) Dr. Sessums diagnosed Plaintiff with lumbar spine strain and lumbosacral radiculopathy. (R. at 447.) Dr. Sessums described Plaintiffs condition as "stable" and "good" upon discharge. (R. at 447-48.) She instructed Plaintiff to follow-up with John Andrew Kona, M.D., in three to four days. (R. at 448.) Dr. Sessums also instructed Plaintiff to avoid heavy lifting until his follow-up examination. (R. at 448.) The record contains no evidence that Plaintiff followed up with Dr. Kona.

         On December 17, 2013, Plaintiff presented to Adam C. Godsey, M.D., at UVA Health Systems, complaining of low back pain, radiating to his thigh and down his leg. (R. at 461.) Plaintiff stated that his pain had worsened in the past two to three months. (R. at 461.) Plaintiff denied experiencing relief from medication, but also said that he "tries to avoid medications as much as possible." (R. at 461.) Although Plaintiff had positive straight leg raise test results due to pain and experienced numbness on the right side, Dr. Godsey observed no tenderness to palpitation over the lumbar spine. (R. at 463.) On physical examination, Plaintiff displayed normal reflexes in his lower extremities. (R. at 463.) Dr. Godsey diagnosed Plaintiff with lumbar disc disease, but noted "no red flag symptoms," and he prescribed Naproxen and Gabapentin for Plaintiffs low back pain. (R. at 463.)

         On January 29, 2014, Plaintiff presented to Kimberly Skinner, PA-C, at UVA Health Systems, complaining of pain in his lower back, numbness in his right side, weakness and gait instability. (R. at 465-69.) In her progress notes, Skinner described Plaintiffs history of low back pain and the results from a 2010 MRI showing that Plaintiff had "a small disc bulge at L4-5." (R. at 469.) Plaintiffs treatment providers had prescribed "conservative treatment with physical therapy and epidural steroid injections," but Plaintiff told Skinner that he had not sought such treatment since 2010. (R. at 469.) On physical examination, Plaintiff demonstrated "good strength in his upper extremities" and, despite some "mild hip flexor weakness on the right side," Plaintiff displayed 5/5 strength in his lower extremities. (R. at 469.) He experienced decreased sensation on the right side, but had good sensation on the left side in both his upper and lower extremities. (R. at 469.) Plaintiff walked with an antalgic gait and ambulated with a cane. (R. at 469.) Skinner ordered a follow-up MRI. (R. at 469.)

         Plaintiff returned to UVA Health Systems on February 4, 2014, for an MRI of the thoracic and lumbar spine. (R. at 477-78.) David Joyner, M.D., and David. A. Oman, M.D., observed degenerative changes on the lumbar spinal canal, including mild spinal canal stenosis at L3-4 and foraminal stenoses most prominent at L4-5 and L5-S1. (R. at 478.) Drs. Joyner and Oman also observed "moderate to severe spinal canal stenosis at C6-C7 secondary to disc protrusion/disc osteophyte complex and questionable abnormal signal in the cervical spinal cord." (R. at 478.) Finally, Drs. Joyner and Oman observed no disc herniation, spinal canal or foraminal stenosis in the thoracic spine. (R. at 478.) Plaintiff had a follow-up MRI of the cervical spine on February 27, 2014. (R. at 520.) Erin McCrum, M.D., and David Abdullah, M.D., observed the following: disc bulges at C3-C4 and C6-C7 showing cord volume loss consistent with myelomalacia; increased central cord T2W1 signal extending from C7 to Tl; and, central canal and neural foraminal stenosis. (R. at 520.)

         On April 14, 2014, Plaintiff presented to Dr. Helm, whom Plaintiff had previously seen in 2010, at UVA Health Systems. (R. at 542.) Dr. Helm performed an anterior cervical discectomy and fusion procedure to treat Plaintiffs cervical stenosis with cord compression and cord edema. (R. at 542, 562.) During the procedure, Dr. Helm found that Plaintiff suffered from a herniated disc causing pathology compression of the cervical spine. (R. at 543.) Sze Chun Winson Ho, M.D., described Plaintiffs spinal cord as "thoroughly decompressed" after the discectomy. (R. at 563.) Post-operative notes also describe Plaintiffs condition as stable, although he experienced some residual numbness in his right leg. (R. at 543.) The day after his surgery, Chad Aldridge, P.T., visited Plaintiff to determine whether he required further inpatient services. (R. at 543, 549.) Aldridge noted improvement in Plaintiffs condition since the previous day and observed Plaintiff ambulate and climb stairs using a cane. (R. at 550.) Pain did not interfere with Plaintiffs physical therapy session. (R. at 550.) Plaintiff reported that he felt better and that the sensation in his right leg continued to improve. (R. at 550.) Plaintiff also reported improved sensation in his right leg to the on-call occupational therapist. (R. at 552.) Aldridge assessed that Plaintiff would benefit from outpatient physical therapy, but noted that Plaintiff "ha[d] no acute [physical therapy] needs" and could return home. (R. at 550.) Plaintiffs discharge instructions called for activity "as tolerated." (R. at 662.)

         Plaintiff had several postoperative phone calls with treating staff at UVA Health Systems. About a week after his surgery, Plaintiff called Natalie B. Krovetz, R.N., complaining that he had not had a bowel movement since his surgery. (R. at 700.) Nurse Krovetz discussed laxative options with Plaintiff but noted that Plaintiff was "[o]therwise doing fairly well." (R. at 700.) On April 23, 2014, Plaintiff called Nurse Krovetz again, requesting a refill of his pain medication and complaining of neck pain when changing position. (R. at 700.) Plaintiff reported no arm pain, sensory changes or weakness. (R. at 700.) On April 29, 2014, Plaintiff called again, inquiring as to whether he should continue taking Gabapentin. (R. at 699.) Plaintiff told a nurse that he felt tingling in his right knee cap, which ran down his leg to his foot. (R. at 699.) He requested a higher dosage of Gabapentin. (R. at 699.) The next day, Dr. Godsey faxed Plaintiff a prescription for Gabapentin to treat his pain. (R. at 698.) On May 14, 2014, Plaintiff called Nurse Krovetz complaining of upper arm pain. (R. at 697.) Plaintiff stated that he could not afford physical therapy or the $6 copay for his Gabapentin. (R. at 697.) Nurse Krovetz advised Plaintiff to use his collar as needed and to "take it easy" until his next appointment. (R. at 697.)

         On May 28, 2014, Plaintiff returned to Skinner for a follow-up appointment. (R. at 668.) Although Plaintiff experienced some numbness and tingling in his right lower extremity, he reported that the numbness on his right side had improved post-surgery. (R. at 668-69.) He also reported experiencing significant pain in his left tricep. (R. at 669.) On physical examination, Plaintiff appeared in no acute distress and displayed good strength and sensation in both his upper and lower extremities. (R. at 669.) Skinner described Plaintiffs anterior cervical incision as "well healed without evidence of infection or complication." (R. at 669.) Skinner had additional radiographs taken of Plaintiff s cervical spine. (R. at 673.) Manal Nicolas-Jilwan, M.D., observed "postoperative changes C3-C4 and C6-C7 ACDF, without interval complications," and he described Plaintiffs vertebral body heights and degenerative changes as stable. (R. at 673.) Skinner diagnosed Plaintiff with cervical stenosis of the spine, prescribed Gabapentin for his pain and instructed Plaintiff to contact Skinner's office if he had persistent left upper extremity pain. (R. at 669, 672.)

         On September 16, 2014, Plaintiff returned to Dr. Helm, complaining of increasing numbness in his right flank and right leg and pain in his low back, leg and in the triceps region of his left arm. (R. at 692.) On physical examination, Plaintiff experienced some numbness in his right leg, but Dr. Helm noted that Plaintiff "[was] not myelopathic." (R. at 692.) Plaintiff also displayed normal strength. (R. at 692.) Dr. Helm increased Plaintiffs Neurontin dosage and instructed Plaintiff to schedule a cervical and lumbar CT scan/myelogram. (R. at 692.) Treating staff also advised Plaintiff that treatment for his spine could prove more effective if he quit smoking. (R. at 693.) On October 20, 2014, Plaintiffs wife informed Nurse Krovetz that Plaintiff could not afford to have the cervical and lumbar CT/myelogram, because he had no insurance and could not make payments while he "await[ed] disability." (R. at 692.) Nurse Krovetz asked Plaintiffs wife to contact UVA Health Systems if anything changed, so that they could schedule Plaintiffs study. (R. at 692.)

         Plaintiff did not seek treatment again until June 2, 2015, when he returned to Dr. Helm, complaining of continued neck pain and significant numbness and weakness in his right leg. (R. at 738.) Plaintiff displayed "some weakness of dorsiflexion on the right side, as well as some numbness in the L5 distribution on the right side." (R. at 738.) Dr. Helm again recommended a cervical and lumbar CT scan/myelogram and decided to "keep [Plaintiff] off work for two months[, ]" while Plaintiff obtained a functional capacity evaluation. (R. at 738.) On June 9, 2015, treating staff at UVA Health Systems took additional scans of Plaintiff s cervical and lumbar spine, which revealed the following: Plaintiffs cervical spine showed postsurgical changes of C3-C4 and C6-C7 ACDF with partial fusion of the disc spaces, but no evidence of hardware complication; multilevel central canal stenosis (mild to moderate with cord atrophy at C3-C4 and C6-C7); and, multilevel neuroforaminal stenosis (severe at C3-C4 on the right). (R. at 740-43.) Plaintiffs lumbar spine showed no significant central canal stenosis; multilevel neuroforaminal stenosis (moderate at C4-L5); and, mild disc degeneration from T9-T10 to T11-T12. (R. at 743.) The record lacks evidence that Plaintiff sought follow-up treatment during the months following those scans.

         On December 28, 2015, Plaintiff presented to the emergency department at CSC Hospital, complaining of weakness, as well as numbness and tingling in his right side that began to bother him two days before his visit. (R. at 723.) Plaintiff described his neck pain as ongoing, and he told treating staff that he had not felt better since his cervical spine surgery in August 2014. (R. at 723, 725.) Benjamin D. Wallace, D.O., conducted Plaintiffs physical examination and noted no tenderness in Plaintiffs neck or back. (R. at 725.) Although Plaintiff displayed 4/5 strength in his right upper and lower extremities, reduced (1/4) patellar reflexes and tenderness in the cervical spine, he had grossly intact sensory functioning. (R. at 725.) James Hall, Jr., M.D., reviewed an MRI of Plaintiff s cervical spine and described Plaintiffs spinal cord as having an abnormal appearance, including flattening of the spinal cord at C2-C3. (R. at 732-33.) Dr. Wallace's treatment notes showed "some mild compression." (R. at 728.) Dr. Wallace sought further consultation from the neurosurgery department regarding Plaintiffs MRI, and they found that ...