Shiva V. Hodges United States Magistrate Judge

REPORT AND RECOMMENDATION

This appeal from a denial of social security benefits is before the court for a Report and Recommendation ("Report") pursuant to Local Civ. Rule 73.02(B)(2)(a) (D.S.C.). Plaintiff brought this action pursuant to 42 U.S.C. § 405(g) and § 1383(c)(3) to obtain judicial review of the final decision of the Commissioner of Social Security ("Commissioner") denying her claim for Disability Insurance Benefits ("DIB"). The two issues before the court are whether the Commissioner's findings of fact are supported by substantial evidence and whether he applied the proper legal standards. For the reasons that follow, the undersigned recommends that the Commissioner's decision be reversed and remanded for further proceedings as set forth herein. I. Relevant Background

A. Procedural History

On September 10, 2014, Plaintiff filed an application for DIB in which she alleged her disability began on August 11, 2014. Tr. at 188. Her application was denied initially and upon reconsideration. Tr. at 114-17, 118-22. On May 22, 2017, Plaintiff had a hearing before Administrative Law Judge ("ALJ") Mary Ryerse. Tr. at 48-76 (Hr'g Tr.). The ALJ issued an unfavorable decision on September 29, 2017, finding Plaintiff was not disabled within the meaning of the Act. Tr. at 21-47. Subsequently, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner for purposes of judicial review. Tr. at 1-6. Thereafter, Plaintiff brought this action seeking judicial review of the Commissioner's decision in a complaint filed on December 21, 2018. [ECF No. 1]. On October 4, 2019, the undersigned issued an order permitting the Commissioner until October 18, 2019, to file a supplemental brief and advising the parties the court intended to schedule the case for hearing. [ECF No. 18]. Upon reviewing the Commissioner's supplemental brief and notice of supplemental authority (ECF Nos. 19, 20), the undersigned determined a hearing would not aid the court in its decision.

B. Plaintiff's Background and Medical History

1. Background

Plaintiff was 58 years old at the time of the hearing. Tr. at 52. She completed college. Tr. at 189. Her past relevant work ("PRW") was as a caregiver, a life enrichment coordinator, an office assistant, an outreach specialist, and a staff assistant. Tr. at 189. She alleges she has been unable to work since August 11, 2014. Tr. at 188.

2. Medical History

Plaintiff presented to Michelle B. Nobles, PA-C ("PA Nobles"), for recurrent episodes of vertigo on August 26, 2014. Tr. at 310-11. PA Nobles indicated she had referred Plaintiff to a neurologist when she initially presented with vertigo one year prior. Tr. at 310. She noted blood work, an electrocardiogram ("EKG"), a computed tomography ("CT") scan, magnetic resonance imaging ("MRI"), and an electroencephalogram ("EEG") had all been normal. Id. She stated Plaintiff's providers ultimately concluded Plaintiff's anxiety likely caused the vertigo. Id. She indicated Plaintiff's psychiatrist had adjusted her medications, and her symptoms had improved until Plaintiff developed more frequent vertigo over the prior month. Id. Plaintiff stated she felt dizzy if she looked up or down or moved her head too quickly. Id. She endorsed tinnitus and tiredness, but denied syncope and pre-syncopal episodes. Id. She also reported decreased cognition. Id. PA Nobles noted some fluid in Plaintiff's ears and a severely deviated septum, but indicated no other abnormalities. Id. She assessed recurrent episodes of vertigo, fatigue, bipolar disorder, tinnitus, and hearing loss. Id. She referred Plaintiff to an ear, nose, and throat specialist for evaluation. Id.

Plaintiff also followed up with psychiatrist Hayne McMeekin, M.D. ("Dr. McMeekin"), on August 26, 2014. Tr. at 322. She reported continued decline and difficulty coping. Id. She endorsed difficulty counting and working with numbers. Id. Dr. McMeekin indicated Plaintiff's work ability had declined. Id. He noted Plaintiff wanted to "go out on disability." Id.

On October 21, 2014, Plaintiff reported she had stopped working. Tr. at 321. She indicated she had been very suspicious of others, had scattered thoughts, and was unable to think through problems. Id. Dr. McMeekin indicated a mental status exam was abnormal, as Plaintiff demonstrated racing thoughts and fair attention, concentration, and comprehension. Id. He noted Plaintiff reported work-related stressors and an abusive boss. Id. He assessed a global assessment of functioning ("GAF") score of 65. Id. He prescribed Lorazepam 0.5 mg and increased Plaintiff's dose of Lamotrigine to 1.5 pills twice a day. Id.

On December 9, 2014, Plaintiff followed up with PA Nobles for Vitamin B12 deficiency. Tr. at 331. She reported increased energy, but indicated the injections became less effective one week prior to the next scheduled injection. Id. PA Nobles described Plaintiff's affect as normal and noted no abnormalities. Id. She provided Plaintiff with a vial of B12 and syringes for at-home administration. Id. She instructed Plaintiff to continue to take oral Vitamin D and B12 supplements. Id.

Plaintiff also followed up with Dr. McMeekin on December 9, 2014. Tr. at 351. She reported she was doing a "lot better." Id. She continued to endorse paranoia, but indicated she was not as obsessive. Id. She reported she had previously reached a psychotic level. Id. She stated she had felt like everyone was against her, but her symptoms had improved since she stopped working. Id. Dr. McMeekin noted the following on mental status exam: neat appearance; cooperative behavior; motor function and speech within normal limits; full affect; anxious mood; scattered thought form; and linear thought process. Id. He assessed a GAF score of 75. Id.

On December 23, 2014, state agency medical consultant Seham El-Ibiary, M.D. ("Dr. El-Ibiary"), reviewed the record and completed a physical residual functional capacity ("RFC") assessment. Tr. at 88-90. He provided the following limitations: occasionally lift and/or carry 50 pounds; frequently lift and/or carry 25 pounds; stand and/or walk for a total of about six hours in an eight-hour workday; sit for a total of about six hours in an eight-hour workday; never climbing ladders/ropes/scaffolds; occasionally balancing; frequently climbing ramps/stairs, stooping, kneeling, crouching, and crawling; and avoiding even moderate exposure to hazards. Id. A second state agency medical consultant, George Walker, M.D. ("Dr. Walker"), assessed the same physical RFC on June 3, 2015. Tr. at 105-07.

On February 2, 2015, Plaintiff presented to Chad Ritterspach, Psy. D. ("Dr. Ritterspach"), for a psychological consultative evaluation. Tr. at 352-54. Dr. Ritterspach noted Plaintiff was cooperative, informative, demonstrated a positive attitude, answered questions freely, spoke articulately, showed normal psychomotor activity, and "appeared to be an accurate source of information about her difficulties." Tr. at 352. Plaintiff reported her mind raced and she had difficulty remaining "on track." Id. She stated she was "almost always manic." Id. She endorsed infrequent depressed mood characterized by self-deprecation. Id. Dr. Ritterspach noted Plaintiff "ha[d] the ability to conform to social standards, comply with rules and regulations, cooperate with authority, and interact with peers" and could "engage in social activity." Id.

Plaintiff reported a history of termination from employment for attendance problems related to depression. Id. She endorsed mild difficulty remembering instructions and stated she was unable to maintain concentration throughout the workday or perform tasks independently. Id. She denied a history of conflict with coworkers and supervisors and stated she was able to accept constructive feedback from supervisors. Id. She reported average daily activities that included reading, writing, cooking, a little walking, and watching the news. Tr. at 353. She stated mania affected her ability to drive without getting lost. Id.

Dr. Ritterspach noted Plaintiff could read, write, follow directions, engage in self-care, prepare simple meals, and engage in social activities. Id. He stated, "[d]ue to mood impairment," Plaintiff was "easily distressed and fe[lt] overwhelmed and "d]ue to possible cognitive limitations," she required "help with managing money, driving, managing finances, and remembering appointments." Id.

Dr. Ritterspach observed the following on mental status exam: appropriate eye contact; articulate speech at normal volume; euthymic mood and affect; logical thought processes; appropriate thought content; ability to follow simple directions; denial of suicidal and homicidal ideation and hallucinations; oriented to time, date, place, and situation; average intellectual functioning; impaired memory for short-term auditory recall; concentration within normal limits; and intact judgment and insight. Id. Plaintiff performed digits correctly up to five digits, remembered recent and remote events, spelled "world" backward, completed serial threes, performed simple math, and interpreted proverbs correctly, but had difficulty recalling three words she had repeated earlier without prompts. Id.

Dr. Ritterspach diagnosed unspecified mood disorder and indicated "there may be another underlying problem, such as ADHD." Id. He noted Plaintiff reported mania interfered with her activities of daily living ("ADLs"), causing forgetfulness and disorientation while driving. Id. He stated Plaintiff "would have the ability to interact appropriately with co-workers, supervisors, and the public" in the workplace. Id. He indicated Plaintiff "may have trouble retaining new information as she performs work tasks," "may have some problems tolerating work-related stressors," and "may be somewhat easily distracted from work tasks, particularly if they are detailed and complex." Id. He added "[t]he extent of limitations based on racing thoughts and distractibility suggests she would have difficulty in most work settings." Id. However, he noted Plaintiff's medication was "not helpful at [that] time," and stated "she ha[d] the general cognitive/psychological capacity for employment" if she obtained appropriate treatment. Id. He indicated Plaintiff needed assistance to manage her finances in her own best interest. Tr. at 354.

On February 6, 2015, state agency consultant Craig Horn, Ph.D. ("Dr. Horn"), reviewed the record and completed a psychiatric review technique ("PRT"). Tr. at 85-87. He considered Listing 12.04 for affective disorders and assessed the following degree of functional limitation: mild restriction of ADLs; moderate difficulties in maintaining social functioning; moderate difficulties in maintaining concentration, persistence, or pace; and no repeated episodes of decompensation, each of extended duration. Tr. at 85. He determined Plaintiff had the ability to perform "simple routine tasks away from public." Id. Dr. Horn also completed a mental RFC assessment. Tr. at 90-91. He found Plaintiff was moderately limited in the following abilities: to carry out detailed instructions; to maintain attention and concentration for extended periods; to work in coordination with or proximity to others without being distracted by them; and to interact appropriately with the general public. Id.

On April 20, 2015, Plaintiff indicated she had become delusional and paranoid within five days of applying for jobs. Tr. at 359. She indicated she would attempt to work as a telemarketer. Id. Dr. McMeekin described Plaintiff's mental status as "fragile." Id. He noted the following observations on mental status exam: neat appearance; appropriately oriented; positive eye contact; cooperative behavior; normal motor activity; normal speech; labile affect; anxious mood; scattered thought form; racing thoughts; delusional thought content; startled; and good attention, concentration, recent and past memory, language, insight, and judgment. Id. He indicated Plaintiff was having a delusional episode, as she had become paranoid and delusional while working in a cleaning job and felt like her coworkers did not like her and were stealing her supplies. Id. He prescribed two additional medications and assessed a GAF score of 70. Id.

On June 3, 2015, a second state agency consultant, Douglas Robbins, Ph.D. ("Dr. Robbins"), completed a PRT and mental RFC assessment. Tr. at 102-04, 107-09. He considered Listing 12.04 and assessed no episodes of decompensation, mild restriction of ADLs, and moderate difficulties in maintaining social functioning and concentration, persistence, or pace. Tr. at 102. He concluded the additional evidence supported a severe, but not listing- level impairment "with moderate functional limitations." Tr. at 104. In the RFC assessment, he indicated Plaintiff had moderate limitations with respect to the following abilities: to carry out detailed instructions; to maintain attention and concentration for extended periods; to work in coordination with or in proximity to others without being distracted by them; and to interact appropriately with the general public. Tr. at 107-09. He concluded Plaintiff was able to perform "simple routine tasks away from public." Tr. at 109.

On June 22, 2015, Dr. McMeekin noted the following on mental status exam: neat appearance; cooperative behavior; motor activity within normal limits; speech within normal limits; full affect; euthymic mood; linear thought process and form; thought content within normal limits; and no perceptual disturbances. Tr. at 372. He indicated Plaintiff's inability to work increased her stressors. Id. He changed Plaintiff medications. Id.

On July 23, 2015, Plaintiff presented to a Marsha D. Jackson, LMSW, LPCS ("Counselor Jackson"), for counseling. Tr. at 367. She complained of increased depressive symptoms, including hopelessness, isolation, and paranoia of being avoided by others. Id. Counselor Jackson indicated Plaintiff's symptoms were precipitated by a diagnosis of bipolar disorder, loss of her job, foreclosure of her home, and a recent visit to the neurologist. Id. Plaintiff requested intensive treatment for increased negative thoughts. Tr. at 368. She reported a history of suicide attempt years prior and endorsed fleeting thoughts that others would be better off without her, but denied suicidal ideation and plan. Id. Counselor Jackson noted Plaintiff was accompanied to the visit by her husband, who was concerned about her isolation and tearfulness. Id. She assessed a GAF score of 50 and indicated Plaintiff was willing to attend a day treatment program. Id.

Plaintiff followed up with Dr. McMeekin on July 28, 2015. Tr. at 371. Dr. McMeekin noted the following on mental status exam: cooperative behavior; tense and agitated motor activity; depressed, anxious, and angry mood; and scattered thought form characterized by racing thoughts and flight of ideas. Id. He adjusted Plaintiff's medications. Id.

Plaintiff presented to Carolinas Medical Center Randolph Adult Partial Hospitalization Program ("Partial Hospitalization Program") for intake on August 3, 2015. Tr. at 390. Lisa Winn, RN ("Nurse Winn"), observed Plaintiff to have appropriate grooming and hygiene and anxious and depressed affect. Id. Plaintiff endorsed depression with increased sleep, binge eating, decreased motivation and interest, lack of energy, poor concentration and focus, and short-term memory loss. Id. She stated she had visited a neurologist, who had diagnosed her with depression-induced dementia, and was scheduled for an upcoming evaluation for possible sleep apnea. Id. Plaintiff endorsed thoughts that "people would be better off without [her]" and a history of two suicide attempts years prior, but denied suicidal intent or plan. Tr. at 390-91. She reported constant paranoia that "people [were] out to get [her]" and were following her. Tr. at 391. She feared being chastised by others. Id. Plaintiff indicated she had been diagnosed with bipolar disorder and had a history of manic behavior characterized by constant movement and talking and impulsive spending. Id.

On August 5, 2015, Plaintiff presented to the Partial Hospitalization Program for intake with Rodney A. Villanueva, M.D. ("Dr. Villanueva"). Tr. at 391. She reported financial difficulty and hopelessness and expressed "not wanting to be [there]" for the appointment. Id. She endorsed ruminating thoughts prior to falling asleep, decreased interest in activities, feelings of guilt, poor energy level, binge eating, and poor concentration. Id. She reported being followed by others, having her patients' family members accuse her of stealing things, and feeling as if others were annoyed by and jealous of her. Tr. at 392. Dr. Villanueva stated he was not sure if Plaintiff had bipolar disorder. Id. He noted Plaintiff's medications and indicated use of "an antidepressant in the possible setting of bipolar disorder [was] somewhat problematic as it could switch her over into a manic episode." Id. He indicated "an antipsychotic might be a better choice if she is having mania" and "may be helpful for what may be paranoid delusions." Id.

Relying on Plaintiff's report that she sometimes lacked money for medication because of irresponsible spending, Dr. Villaneuva stated "[o]f note, is that the patient can sometimes go 1-2 weeks without medicines because of financial reasons." Tr. at 393. He acknowledged "[t]he patient may not be consistent with her medications." Id. He observed the following on mental status exam: neatly dressed; calm and cooperative behavior; good eye contact; no abnormal movements; normal rate and volume of speech; euthymic mood; no suicidal or homicidal ideation; no auditory or visual hallucinations; questionable paranoid delusions; fair insight and judgment; and linear and goal-directed thought process without evidence of loosening of associations or flight of ideas. Tr. at 394. Dr. Villanueva assessed (1) unspecified bipolar and related disorder, by history and (2) unspecified psychotic disorder, consider delusional disorder. Id. He also indicated "[t]here may be some narcissism on the patient's part." Id. He discontinued Prozac, decreased Lorazepam, prescribed Abilify 10 mg, and continued Lamictal. Id.

Plaintiff reported she was "much better" on August 13, 2015. Tr. at 364. She endorsed decreased paranoia and stated she had recently reached out to friends. Id. She continued to report racing thoughts that occurred at night, but stated she was able to stop them. Id. Dr. Villaneuva probed Plaintiff's history of paranoid beliefs. Id. He questioned the diagnosis of bipolar disorder because he did not believe Plaintiff had described any true manic episodes. Tr. at 365. He noted the following observations on mental status exam: neatly dressed and well-groomed; cooperative and pleasant; good eye contact; no evidence of psychomotor agitation; speech at normal rate and volume; euthymic mood; affect marked by appropriate smiling; no suicidal or homicidal ideation or auditory or visual hallucinations; paranoid delusions present; linear and goal-directed thought process; no evidence of flight of ideas or loosening of associations; fair insight; and adequate judgment. Id. He continued Plaintiff's medications. Tr. at 366.

Plaintiff reported "doing really well" during a visit with Dr. Villanueva on August 20, 2015. Tr. at 361. She reported she had declined a job with an afterschool program because she shared a car with her husband and would not have transportation. Id. She indicated she had applied for jobs within walking distance of her home. Id. She reported "a lot less" paranoia. Id. Dr. Villanueva assessed delusional disorder and explained to Plaintiff that people with her diagnosis were often capable of normal functioning. Tr. at 361-62. He noted the following on mental status exam: neatly dressed; calm, cooperative, and pleasant; no evidence of psychomotor agitation; good eye contact; normal rate and volume of speech; euthymic mood; appropriate and smiling affect; no suicidal or homicidal ideation; paranoid delusions present, but occurring "a lot less" often; thought process linear and goal-directed without evidence of flight of ideas or loosening of associations; and adequate insight and judgment. Tr. at 362. Dr. Villanueva continued Abilify and Lamictal, discontinued Ativan, and instructed Plaintiff to use Melatonin for sleep.

On September 21, 2015, Dr. McMeekin noted the following on mental status exam: neat appearance; cooperative behavior; motor function within normal limits; speech within normal limits; full affect; anxious mood; and scattered thought form characterized by flight of ideas. Tr. at 370. He assessed a GAF score of 65, continued Plaintiff's prescriptions for Ativan and Fluoxetine, and increased Abilify. Id.

On January 4, 2016, Dr. McMeekin indicated Plaintiff was doing well. Tr. at 369. A mental status exam was within normal limits. Id.

On February 15, 2016, Plaintiff reported she was no longer delusional. Tr. at 376. She indicated she recently worked in an office, as a cleaner, and as a caretaker. Id. She stated she initially did well in the jobs, but subsequently began to worry about her job performance and others' thoughts of her to the point she became suspicious of her coworkers. Id. She reported she remained at home most of the time, but sometimes left her home to engage in activities like shopping. Id. Plaintiff indicated she was unable to read well because of her short attention span. Id. She reported a sense of dread, anxiety, and failure, but denied being delusional and indicated she could recognize her abnormal thoughts. Id. She stated her medications were working. Id. Dr. McMeekin noted it had been difficult to find medications that were consistently effective and recommended Plaintiff continue her medications. Id.

On April 25, 2016, Plaintiff indicated she desired to become involved in her mother's church. Tr. at 377. Dr. McMeekin observed Plaintiff to be calm and not as suspicious or overwhelmed as she was when she was working. Id. He noted Plaintiff's symptoms were stable and continued her medications. Id.

Plaintiff presented to Anthony W. Bracken, M.D. ("Dr. Bracken"), for a cardiology consultation on March 29, 2017. Tr. at 379. She reported recent low diastolic blood pressure readings, but Dr. Bracken indicated a review of her chart failed to yield any abnormal recordings. Tr. at 379-80. Plaintiff also complained of falling asleep during the day and upper right-sided chest discomfort that occurred at rest and upon exertion. Tr. at 380. Dr. Bracken noted no abnormalities on physical exam, but indicated an EKG showed poor R-wave progression, nonspecific T-wave changes, and low voltage in the precordial leads. Tr at 382. He recommended a stress echocardiogram based on Plaintiff's risk factors and advised her to follow up with her primary care physician for daytime somnolence and a possible sleep apnea evaluation. Tr. at 379, 382.

On April 26, 2017, Counselor Jackson provided a letter specifying she had begun counseling Plaintiff in 2007. Tr. at 388. She stated Plaintiff was a "model client," who was "motivated and cooperative concerning recommendations" for treatment. Id. She noted Plaintiff had worked successfully for many years in a hospital, but had accepted a new position in 2011 that had led to increased work stress. Id. She indicated "[b]y 2014, her psychiatric s[ymptoms] became full-blown" and included reduced cognitive functioning. Id. She stated after Plaintiff left the hospital, she "counseled her through countless other attempts at employment." Id. She noted Plaintiff had attempted and failed many types of jobs. Id. She stated Plaintiff's "severe paranoid ideation . . . took its toll socially and in the workplace." Id. She indicated Plaintiff "would rather be gainfully employed, but each attempt t[ook] her further into a depressed state." Id.

C. The Administrative Proceedings

1. The Administrative Hearing

a. Plaintiff's Testimony

At the hearing, Plaintiff testified she was married and lived with her husband. Tr. at 52. She stated she was 5' 1½" tall and weighed 185 pounds. Tr. at 52-53. She said she earned a master's degree. Tr. at 53. She indicated that since August 2016, she had worked three hours a day, three days a week for Boomerang Transport, transporting Workers' Compensation patients to their appointments and earning a minimum of $22 per ride. Tr. at 53-54. She said she had previously worked for Care Partners. Tr. at 54. She stated she initially worked as a caregiver, but subsequently worked in the office, handling billing and payroll matters. Id. She testified she stopped working as a caregiver because the rushed pace of the job exacerbated her symptoms. Id. She indicated she left the office job because she made mistakes with numbers, causing her to become upset and depressed and to miss work. Id. She said she worked for Eaeic for one week as a scanner for $200. Tr. at 55.

Plaintiff testified she previously worked for Charlotte Mecklenburg Hospital as an outreach specialist and a staff assistant. Id. She testified she previously worked for Liberty Mutual Insurance as an office assistant. Tr. at 55-56. She stated she also previously worked for wholesale distributor Natural Organics and for chemical distributor Aceto Corporation as a customer service representative. Tr. at 56-57.

Plaintiff testified that her medications caused dizziness, vertigo, drowsiness, and blurred vision. Tr. at 57. She said she occasionally had problems with high blood pressure and continually had problems with irritable bowel syndrome ("IBS") and gastroesophageal reflux disease ("GERD") that were not relieved by medication. Tr. at 58. She denied having recently followed up with Dr. Gaspari for digestive issues. Id. She indicated she received primary treatment from PA Nobles and was last seen in November 2016. Id.

Plaintiff described periods of mania in which she stayed up all night, as well as periods of depression in which she remained in bed for extended periods. Tr. at 58-59. During periods of depression, she stated she felt paranoid, could not get out of bed, felt dizzy, and lost her balance. Tr. at 59. She indicated she felt like she was being watched at grocery stores and followed while working. Tr. at 59-60. She described crying episodes that caused her to call out from work, hide, or leave. Tr. at 60. She said during manic episodes, she would sometimes feel "at the top of the world" and able to do anything, would talk all the time, and sometimes offended people by saying "really stupid things." Tr. at 60-61. She described having anxiety and paranoia and being bothered by loud sounds. Tr. at 61. She said she was able to function in her current job of transporting people because she worked alone and only had to listen to very sad and lonely people. Id. She said she worked mostly on the south side of Rock Hill, where there was not much traffic. Tr. at 62. She described blurred vision when she worked on the computer and stated she sometimes confused letters and numbers when she wrote or typed. Id. She mentioned problems with short-term memory and difficulty keeping track of her medications, and said she sometimes brought up topics to her husband only to learn they had already discussed the issues. Tr. at 62-63. She testified she had difficulty concentrating, could not read a book, and would need to get up many times to walk around or wash dishes if watching a movie. Tr. at 64. She said she was unable to complete tasks like washing dishes. Id. She stated she shied away from people because she feared offending them. Id. She indicated she attended church every once in a while because it was so far away. Tr. at 65. She said she would take a walk with a friend once a month and sometimes kept a journal. Id. She testified she was able to shower, dress, brush her teeth, shop for groceries, and prepare meals. Tr. at 65-66. She described feeling worried while grocery shopping, especially when cameras were present, and sometimes being distracted when cashiers made change or asked if she wanted paper or plastic bags. Tr. at 66. She said she did not often do housework like dishes and laundry. Id. She stated she handled the household finances, but indicated her difficulty with that task led to bankruptcy and the foreclosure of her home. Id.

Plaintiff described a good day as getting up, watching the news, eating breakfast, walking the dog, and sitting at the computer all day waiting for emails and looking at Facebook. Tr. at 66-67. She described a bad day as going back to sleep after walking the dog. Tr. at 67. She said she sometimes took too much medicine, accidentally taking two Lorazepam tablets in the morning instead of at night, and being unable to stay awake. Id. She estimated half her days were good and the other half were bad. Tr. at 68. She indicated she experienced headaches. Id.

Plaintiff testified she and her husband went to a theater to see a movie every two or three months and watched movies at home and listened to music more frequently. Id. She said she enjoyed being outside, walking her dog, and listening to the birds. Id. She indicated she maintained a driver's license and drove three times a week. Tr. at 68-69. Aside from her job, she said she drove to the supermarket, to two friends' homes, and occasionally to her mother's apartment if she needed her. Tr. at 69. Plaintiff said she "snapped" and had a nervous breakdown in 2014 and believed she could no longer work fulltime. Tr. at 70.

b. Vocational Expert Testimony

Vocational Expert ("VE") G. Roy Sumpter, Ph.D., reviewed the record and testified at the hearing. Tr. at 71-75. The VE categorized Plaintiff's PRW as a customer service representative, Dictionary of Occupational Titles ("DOT") No. 299.367-010, as light, with a specific vocational preparation ("SVP") of 4, and as an administrative clerk, DOT No. 219.362-010, as light with an SVP of 4. Tr. at 71-72. The ALJ described a hypothetical individual of Plaintiff's vocational profile who could lift and carry 50 pounds occasionally and 25 pounds frequently; could stand and walk up to six hours in an eight-hour day; could sit up to six hours in an eight-hour day; could frequently climb ramps and stairs; could stoop, kneel, crouch, and crawl; could occasionally balance when walking; could never climb ladders, ropes, or scaffolds; should avoid working at unprotected heights and around moving mechanical machinery; was limited to performing simple routine tasks and maintaining concentration, persistence, and pace for two hour periods during the day; was limited to no contact with the public and no team-type work with coworkers; and could engage in infrequent changes to the work routine. Tr. at 73, 75. The VE testified the hypothetical individual could not perform claimant's PRW. Tr. at 72-73. The ALJ asked whether there were any other jobs in the regional or national economy that the hypothetical person could perform. Id. The VE identified the following medium positions with an SVP of 2: (1) assembler of metal furniture, DOT No. 709.684-014; (2) marker, DOT No. 369.687-026; and (3) hand packer, DOT No. 920.587-018, with 206,000, 472,000, 220,000 positions available nationally, respectively. Tr. at 73-74.

The ALJ provided a second hypothetical that modified the first hypothetical to lift and carry up to 20 pounds occasionally and ten pounds frequently. Tr. at 74. The VE testified the hypothetical individual could not perform claimant's PRW, but could perform light jobs. Id. The VE testified if the individual would be off task more than 20% of the work day due to breaks or distraction, there would be no work available. Id. Similarly, the VE testified if the individual had more than one unscheduled absence a month, there would be no work available. Tr. at 74-75.

2. The ALJ's Findings

In her decision, the ALJ made the following findings of fact and conclusions of law:

1. The claimant meets the insured status requirements of the Social Security Act through December 31, 2018.
2. The claimant has not engaged in substantial gainful activity since August 11, 2014, the alleged onset date (20 CFR 404.1571 et seq.).
3. The claimant has the following severe impairments: delusional disorder, mood disorder, bipolar disorder, irritable bowel syndrome/gastroesophageal reflux disease ("GERD"), vertigo, and hypotension (20 CFR 404.1520(c)).
4. The claimant does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525 and 404.1526).
5. After careful consideration of the entire record, I find that the claimant has the residual functional capacity to perform medium work as defined in 20 CFR 404.1567(c), in that she can lift and carry 50 pounds occasionally and 25 pounds frequently; stand and walk up to six hours in an eight-hour day; sit up to six hours in an eight-hour day; frequently climb ramps and stairs, stoop, kneel, crouch, and crawl; occasionally balance; no climbing of ladders, ropes, or scaffolds; and must avoid working at unprotected heights and around moving mechanical machinery. She is limited to performing simple, routine tasks; and maintaining concentration, persistence and pace for two-hour periods during the workday. She is limited to no contact with the public; no team-type work with co-workers; and a work environment where there are infrequent changes to the work routine.
6. The claimant is unable to perform any past relevant work (20 CFR 404.1565).

7. The claimant was born on December 21, 1958 and was 55 years old, which is defined as an individual of advanced age, on the alleged disability onset date (20 CFR 404.1563).
8. The claimant has at least a high school education and is able to communicate in English (20 CFR 404.1564).
9. Transferability of job skills is not material to the determination of disability because using the Medical-Vocational Rules as a framework supports a finding that the claimant is "not disabled," whether or not the claimant has transferable job skills (See SSR 82-41 and 20 CFR Part 404, Subpart P, Appendix 2).
10. Considering the claimant's age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform (20 CFR 404.1569, 404.1569(a)).
11. The claimant has not been under a disability, as defined in the Social Security Act, from August 11, 2014, through the date of this decision (20 CFR 404.1520(g)).

Plaintiff alleges the Commissioner erred for the following reasons:

1) the ALJ failed to resolve an apparent conflict between an RFC assessment for simple, routine work and the VE's identification of jobs described by the DOT as having a GED reasoning level of two;

2) the ALJ did not address evidence of additional mental limitations in assessing Plaintiff's RFC; and

3) the ALJ failed to properly evaluate Plaintiff's treating psychiatrist's opinion.

The Commissioner counters that substantial evidence supports the ALJ's findings and that the ALJ committed no legal error in her decision.

A. Legal Framework

1. The Commissioner's Determination-of-Disability Process

The Act provides that disability benefits shall be available to those persons insured for benefits, who are not of retirement age, who properly apply, and who are under a "disability." 42 U.S.C. § 423(a). Section 423(d)(1)(A) defines disability as:

the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for at least 12 consecutive months.

To facilitate a uniform and efficient processing of disability claims, regulations promulgated under the Act have reduced the statutory definition of disability to a series of five sequential questions. See, e.g., Heckler v. Campbell, 461 U.S. 458, 460 (1983) (discussing considerations and noting "need for efficiency" in considering disability claims). An examiner must consider the following: (1) whether the claimant is engaged in substantial gainful activity; (2) whether she has a severe impairment; (3) whether that impairment meets or equals an impairment included in the Listings; (4) whether such impairment prevents claimant from performing PRW; and (5) whether the impairment prevents her from doing substantial gainful employment. See 20 C.F.R. § 404.1520. These considerations are sometimes referred to as the "five steps" of the Commissioner's disability analysis. If a decision regarding disability may be made at any step, no further inquiry is necessary. 20 C.F.R. § 404.1520(a)(4) (providing that if Commissioner can find claimant disabled or not disabled at a step, Commissioner makes determination and does not go on to the next step).

A claimant is not disabled within the meaning of the Act if she can return to PRW as it is customarily performed in the economy or as the claimant actually performed the work. See 20 C.F.R. Subpart P, § 404.1520(a), (b); Social Security Ruling ("SSR") 82-62 (1982). The claimant bears the burden of establishing her inability to work within the meaning of the Act. 42 U.S.C. § 423(d)(5).

Once an individual has made a prima facie showing of disability by establishing the inability to return to PRW, the burden shifts to the Commissioner to come forward with evidence that claimant can perform alternative work and that such work exists in the regional economy. To satisfy that burden, the Commissioner may obtain testimony from a VE demonstrating the existence of jobs available in the national economy that claimant can perform despite the existence of impairments that prevent the return to PRW. Walls v. Barnhart, 296 F.3d 287, 290 (4th Cir. 2002). If the Commissioner satisfies that burden, the claimant must then establish that she is unable to perform other work. Hall v. Harris, 658 F.2d 260, 264-65 (4th Cir. 1981); see generally Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987) (regarding burdens of proof).

2. The Court's Standard of Review

The Act permits a claimant to obtain judicial review of "any final decision of the Commissioner [] made after a hearing to which he was a party." 42 U.S.C. § 405(g). The scope of that federal court review is narrowly-tailored to determine whether the findings of the Commissioner are supported by substantial evidence and whether the Commissioner applied the proper legal standard in evaluating the claimant's case. See Richardson v. Perales, 402 U.S. 389, 390 (1971); Walls, 296 F.3d at 290 (citing Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990)).

The court's function is not to "try these cases de novo or resolve mere conflicts in the evidence." Vitek v. Finch, 438 F.2d 1157, 1157-58 (4th Cir. 1971); see Pyles v. Bowen, 849 F.2d 846, 848 (4th Cir. 1988) (citing Smith v. Schweiker, 795 F.2d 343, 345 (4th Cir. 1986)). Rather, the court must uphold the Commissioner's decision if it is supported by substantial evidence. "Substantial evidence" is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson, 402 U.S. at 390, 401; Johnson v. Barnhart, 434 F.3d 650, 653 (4th Cir. 2005). Thus, the court must carefully scrutinize the entire record to assure there is a sound foundation for the Commissioner's findings and that her conclusion is rational. See Vitek, 438 F.2d at 1157-58; see also Thomas v. Celebrezze, 331 F.2d 541, 543 (4th Cir. 1964). If there is substantial evidence to support the decision of the Commissioner, that decision must be affirmed "even should the court disagree with such decision." Blalock v. Richardson, 483 F.2d 773, 775 (4th Cir. 1972).

B. Analysis

1. Alleged Conflict Between DOT and VE Testimony

Plaintiff argues there is an apparent conflict between an RFC that limits her to simple, routine work and the VE's testimony that she could perform jobs with a GED reasoning level of two. [ECF No. 14 at 13]. She maintains substantial evidence does not support the ALJ's finding that she could perform jobs that existed in significant numbers in the economy. Id.

The Commissioner argues there is no apparent conflict between simple, routine tasks and occupations with a GED reasoning level of two. [ECF No. 16 at 13]. He distinguishes apparent conflicts between VE testimony and the DOT as to "instructions" from "tasks" and argues "Plaintiff's RFC includes no limitation regarding her ability to handle instructions." Id. at 14-16. He cites Lawrence v. Saul, 941 F.3d 140 (4th Cir. 2019), in which the Fourth Circuit recently held there was no apparent conflict between the "simple, routine, repetitive tasks of unskilled work" and the DOT's description of GED reasoning level two. [ECF No. 20].

"[T]he Commissioner bears the burden to prove that the claimant is able to perform alternative work." Pearson v. Colvin, 810 F.3d 204, 207 (4th Cir. 2015), citing Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987). The Social Security Administration ("SSA") relies primarily on the DOT for information about the requirements of work in the national economy, and ALJs should take administrative notice of information contained therein and consider it in assessing claimants' abilities to perform specific jobs. 20 C.F.R. § 404.1566(d). ALJs obtain testimony from VEs to address more complex vocational issues, such as whether claimants' work skills can be used in other work and specific occupations that allow for use of particular skills. 20 C.F.R. § 404.1566(e).

In recognizing that opinions from VEs sometimes conflict with the information contained in the DOT, the SSA promulgated SSR 00-4p to explain how these conflicts should be resolved. The "purpose" of SSR 00-4p "is to require the ALJ (not the vocational expert) to '[i]dentify and obtain a reasonable explanation' for conflicts between the vocational expert's testimony and the Dictionary, and to '[e]xplain in the determination or decision how any conflict that has been identified was resolved.'" Pearson, 810 F.3d at 208, citing SSR 00-4p (emphasis in original). Pursuant to SSR 00-4p, "[f]irst, the ALJ must '[a]sk the [vocational expert] . . . if the evidence he or she has provided conflicts with the information provided in the [Dictionary]'; and second, '[i]f the [vocational expert]'s . . . evidence appears to conflict with the [Dictionary],' the ALJ must 'obtain a reasonable explanation for the apparent conflict.'" Id. at 208, citing SSR 00-4p.

In Thomas v. Berryhill, 916 F.3d 307, 313-14 (4th Cir. 2019), the court found an apparent conflict between a claimant's RFC limiting her to jobs involving "short, simple instructions" and the "detailed but uninvolved instructions" required in jobs having a GED reasoning level of two. Because the ALJ failed to identify and resolve the apparent conflict, the court ordered the case be remanded. Id. However, recently in Lawrence v. Saul, 941 F.3d at 143, the Fourth Circuit drew a distinction between "short, simple instructions" and "simple, routine, repetitive tasks." The court explained "short" was inconsistent with the "detailed" instructions required at GED reasoning level two because "detail and length are highly correlated," but found "no comparable inconsistency between [the plaintiff's] residual functional capacity [for 'simple, routine repetitive tasks of unskilled work'] and Level 2's notions of 'detailed but uninvolved . . . instructions' and tasks with 'a few [ ] variables.'" Id. (citing DOT, App. C, 1991 WL 688702). Thus, the Fourth Circuit recognizes an RFC for short, simple instructions as apparently conflicting with jobs at GED reasoning level two, but finds no apparent conflict between an RFC for simple, routine, repetitive tasks and GED reasoning level two.

The ALJ included in the RFC assessment a provision for "simple, routine tasks." Tr. at 31. She relied on the VE's testimony to meet her burden at step five through the identification of jobs as an assembler of metal furniture, a marker, and a hand packer. Tr. at 42. She concluded the VE's testimony was consistent with the information contained in the DOT. Id.

A review of the DOT reveals the three jobs the ALJ cited are generally performed at GED reasoning level two. See 709.684-014, ASSEMBLER, METAL FURNITURE. DOT (4th Ed., revised 1991), 1991 WL 679107; 369.687-026, MARKER. DOT (4th Ed., revised 1991), 1991 WL 673074; 920.587-018, PACKAGER, HAND. DOT (4th Ed., revised 1991), 1991 WL 687916. Although the jobs the ALJ relied on to meet her burden at step five all have a GED reasoning level of two, the undersigned finds no apparent conflict between the VE's identification of the jobs and the information contained in the DOT. The assessed RFC is more similar to the RFC found to create no apparent conflict in Lawrence, as both involved simple and routine tasks. Because the ALJ limited Plaintiff to "simple, routine tasks," as opposed to "short instructions" or "short, simple instructions," there appears to be no conflict. Given the foregoing, the ALJ did not err in failing to resolve an apparent conflict between the VE's testimony and the DOT.

2. RFC Assessment

Plaintiff argues the ALJ failed to explain her RFC assessment as required pursuant to SSR 96-8p. [ECF No. 14 at 14]. The Commissioner maintains the ALJ's RFC assessment is supported by substantial evidence, including Plaintiff's providers' observations and her ADLs. [ECF Nos. 16 at 19-21, 19 at 2-4].

The regulations require SSA to use a special technique for evaluating the severity of mental impairments at each level of the administrative review process. 20 C.F.R. 404.1520a(a). If the ALJ determines the claimant has a medically-determinable mental impairment, she "must specify the symptoms, signs, and laboratory findings that substantiate the presence of the impairment(s) and document [her] findings." 20 C.F.R. § 404.1520a(b)(1). She "must then rate the degree of functional limitation resulting from the impairment(s)" in the areas of understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; and adapting or managing oneself. 20 C.F.R. § 404.1520a(b)(2).

If the ALJ assesses a degree of limitation that is consistent with severe mental impairment, but that neither meets or is equivalent in severity to a listing, she must account for the mental impairment in determining the claimant's RFC. 20 C.F.R. § 404.1520a(d). The ALJ's decision should "show the significant history, including examination and laboratory findings, and the functional limitations that were considered in reaching a conclusion about the severity of the mental impairment(s)" and "must include a specific finding as to the degree of functional limitation in each of the functional areas." 20 C.F.R. § 404.1520a(e)(4).

A claimant's RFC must be based on all the relevant evidence in the case record and should account for all her medically-determinable impairments. 20 C.F.R. § 404.1545(a). The RFC assessment must include a narrative discussion describing how all the relevant evidence in the case record supports each conclusion and must cite "specific medical facts (e.g., laboratory findings) and non-medical evidence (e.g., daily activities, observations)." SSR 96-8p, 1996 WL 374184, at *7 (1996); see also 20 C.F.R. § 404.1520a(c)(1) (providing the ALJ must specifically "consider all relevant and available clinical signs and laboratory findings, the effects of [a claimant's] symptoms, and how [the claimant's] functioning may be affected by factors including, but not limited to, chronic mental disorders, structured settings, medication, and other treatment"). The ALJ must determine the claimant's ability to perform work-related physical and mental abilities on a regular and continuing basis. Id., at *2; see also 20 C.F.R. § 404.1520a(c)(1) (requiring ALJs "to consider multiple issues and all relevant evidence to obtain a longitudinal picture of [a claimant's] overall degree of functional limitation").

The ALJ is further instructed to "rate the degree of [the claimant's] functional limitation based on the extent to which [her] impairment(s) interfere with [her] ability to function independently, appropriately, effectively, and on a sustained basis," which may involve consideration of "the quality and level of [her] overall functional performance, any episodic limitations, the amount of supervision or assistance [she] require[s], and the settings in which [she is] able to function." 20 C.F.R. § 404.1520a(c)(2). She must explain how any material inconsistencies or ambiguities in the record were resolved. Id., at *7. "[R]emand may be appropriate . . . where an ALJ fails to assess a claimant's capacity to perform relevant functions, despite contradictory evidence in the record, or where other inadequacies in the ALJ's analysis frustrate meaningful review." Mascio v. Colvin, 780 F.3d 632, 636 (4th Cir. 2015) (citing Cichocki v. Astrue, 729 F.3d 172, 177 (2d Cir. 2013)).

The ALJ assessed Plaintiff as having moderate limitation in interacting with others and concentrating, persisting, or maintaining pace. Tr. at 28. In the RFC assessment, she limited Plaintiff "to performing simple, routine tasks; and maintaining concentration, persistence, and pace for two-hour periods during the workday." Tr. at 31. She further limited Plaintiff to "no contact with the public; no team-type work with co-workers; and a work environment where there are infrequent changes to the work routine." Id.

a. Moderate Limitation in Concentration, Persistence, or Pace

Plaintiff claims the ALJ's RFC assessment for simple, routine, repetitive tasks does not account for her moderate difficulties in concentration, persistence, and pace. [ECF No. 14 at 15]. She maintains the ALJ did not explain the finding that she could maintain concentration, persistence, or pace for two-hour segments. Id. at 17-18. She contends the ALJ also failed to address evidence that suggested she would be unable to sustain work on a regular and continuing basis. Id. at 19.

The Commissioner argues the ALJ's RFC finding adequately accounted for Plaintiff's moderate difficulties in concentration, persistence, or pace. [ECF No. 16 at 18]. He maintains the ALJ extensively explained how Plaintiff's moderate limitations in concentrating, persisting, and maintaining pace affected her RFC. Id. at 18-19.

In Mascio, 780 F.3d at 638, the court found the ALJ erred in assessing the plaintiff's RFC. Id. It stated "we agree with other circuits that an ALJ does not account 'for a claimant's limitations in concentration, persistence, and pace by restricting the hypothetical question to simple, routine tasks or unskilled work.'" Id. The court explained that it was possible for the ALJ to find that the moderate concentration, persistence, or pace limitation did not affect the plaintiff's ability to work, but that remand was required "because the ALJ here gave no explanation." Id. This court has interpreted the Fourth Circuit's holding in Mascio to emphasize that an ALJ must explain how she considered the claimant's limitation in concentration, persistence, or pace in assessing her RFC. See Sipple v. Colvin, No. 8:15-1961-MBS-JDA, 2016 WL 4414841, at *9 (D.S.C. Jul. 29, 2016), adopted by 2016 WL 4379555 (D.S.C. Aug. 17, 2016) ("After Mascio, further explanation and/or consideration is necessary regarding how Plaintiff's moderate limitation in concentration, persistence, or pace does or does not translate into a limitation in his RFC.").

Pursuant to Listing 12.00(E)(3), evaluation of a claimant's ability to maintain concentration, persistence, or pace requires examination of her "abilities to focus attention on work activities and stay on task at a sustained rate." 20 C.F.R. Pt. 404, Subpt. P, App'x 1 § 12.00(E)(3). "[T]he nature of this area of mental functioning" includes: "initiating and performing a task that you understand and know how to do; working at an appropriate and consistent pace; completing tasks in a timely manner; ignoring or avoiding distractions while working; changing activities or work settings without being disruptive; working close to or with others without interrupting or distracting them; sustaining an ordinary routine and regular attendance at work; and working a full day without needing more than the allotted number or length of rest periods during the day." Id.

The ALJ applied the special technique for evaluating the severity of mental impairments and assessed Plaintiff as having moderate limitation in concentration, persistence, or pace. Tr. at 28. She summarized Plaintiff's testimony as to her limitations and ADLs, the information her husband provided to the state agency, the medical source statement from Dr. McMeekin, assessments from treatment visits, and Dr. Ritterspach's observations. See Tr. at 28-31. However, the ALJ failed to explain how the summarized evidence supported the assessed degree of functional limitation in each functional area. See id.

The ALJ cited subjective allegations and objective evidence that could arguably support the RFC assessment or a finding that Plaintiff was more or less limited than indicated in the RFC assessment. See generally Tr. at 34-36. She then concluded "[t]he medical evidence of record d[id] not support the persuasiveness of the claimant's allegations regarding her physical and mental impairments." Tr. at 36. She acknowledged Plaintiff "had problems with delusions and paranoia," but cited the absence of hospitalizations and emergency room visits and normal mental status findings during some treatment visits as supporting the RFC assessment, as opposed to Plaintiff's subjective allegations. See generally Tr. at 36-38. "[T]he ALJ must both identify evidence that supports [her] conclusion and 'build an accurate and logical bridge from [that] evidence to [her] conclusion.'" Woods v. Berryhill, 888 F.3d 686, 694 (4th Cir. 2018) (citing Monroe v. Colvin, 826 F.3d 176, 189) (4th Cir. 2016)). Here, the ALJ acknowledged evidence of greater restrictions, but chose to credit the evidence of lesser restrictions without explaining why she was crediting one over the other. Her decision is devoid of the required "accurate and logical bridge" between the evidence and the conclusion. See id.

The ALJ included in the RFC assessment provisions for "simple, routine tasks," "maintaining concentration, persistence, or pace for two-hour periods during the workday," and "a work environment where there are infrequent changes to the work routine." Tr. at 31. She included more specific restrictions in the RFC assessment than did the ALJ in Mascio, but she did not explain how the restrictions accommodated Plaintiff's limitations. A review of her decision shows no specific support for a finding that Plaintiff could maintain pace for two-hour periods, despite recognized evidence of significant distractibility. It also fails to address Plaintiff's ability to engage in work activity on a regular and continuing basis, despite evidence that her psychiatric symptoms interfered with her ability to maintain employment. The undersigned takes no position on the merit of those arguments, but recognizes "the dispute here arises from a problem that has become all too common among administrative decisions challenged in this court—a problem decision makers could avoid by following the admonition they have no doubt heard since their grade-school math classes: Show your work." Patterson v. Comm'r of Soc. Sec. Admin., 846 F.3d 656, 663 (4th Cir. 2017). Because "we are left to guess how the ALJ arrived at [her] conclusions," the court cannot meaningfully review them. See Mascio, 780 F.3d at 637.

b. Moderate Limitation in Interacting With Others

Plaintiff argues the ALJ neglected to account for evidence suggesting she had difficulty interacting appropriately with supervisors. [ECF No. 14 at 20-21]. The Commissioner claims the evidence did not support additional restrictions as to Plaintiff's interaction with supervisors if she was taking her medications as prescribed. [ECF No. 16 at 21-23].

To assess a claimant's ability to interact with others, the ALJ must consider a claimant's "abilities to relate to and work with supervisors, co-workers, and the public." 20 C.F.R. Pt. 404, Subpt. P, App'x 1, § 12.00(E)(2). Examples of this area of functioning include, but are not limited to, the following:

cooperating with others; asking for help when needed; handling conflicts with others; stating own point of view; initiating or sustaining conversation; understanding and responding to social cues (physical, verbal, emotional); responding to requests, suggestions, criticism, correction, and challenges; and keeping social interactions free of excessive irritability, sensitivity, argumentativeness, or suspiciousness.

The ALJ included in the RFC assessment provisions for "no contact with the public" and "no team-type work with co-workers." Tr. at 28. She acknowledged evidence of Plaintiff's difficulty interacting with supervisors. Tr. at 29 (noting her husband reported she resigned from two jobs because human resources failed to resolve issues between her and her supervisors), 33 (acknowledging Plaintiff testified she left her job in 2014 because "she was being singled out by her boss . . . for wanting her job"). She also cited evidence suggesting Plaintiff had no difficulty interacting with supervisors. Tr. at 30 (indicating Plaintiff had "denied any history of conflict with co-workers and supervisors"). However, the ALJ neither provided an explanation for the provisions she included in the RFC assessment to address Plaintiff's moderate limitation in interacting with others nor explained her reasons for declining to include any provision as to her interaction with supervisors. Thus, the ALJ cited evidence that would support the RFC she assessed, as well as evidence that supported greater restrictions, but failed to reconcile that evidence in her decision. The court is again "left to guess how the ALJ arrived at [her] conclusions" as to the effect of Plaintiff's moderate limitation in interacting with others, and cannot provide meaningful judicial review. See Mascio, 780 F.3d at 637.

3. Dr. McMeekin's Opinion

Dr. McMeekin completed a questionnaire concerning Plaintiff's mental condition on November 4, 2014. Tr. at 328-29. He indicated he had initially treated Plaintiff on May 8, 2006, and had most recently treated her on October 21, 2014. Tr. at 328. He stated he saw Plaintiff monthly for medication management and some counseling. Id. He indicated Plaintiff had not been hospitalized for psychiatric conditions within the prior year, but noted she had lost several jobs and required time off through the Family and Medical Leave Act ("FMLA"). Id. Dr. McMeekin described Plaintiff's compliance as good. Id. He indicated Plaintiff was at her baseline, but continued to be symptomatic. Id. He stated Plaintiff's condition was chronic and full remission was not expected. Id. He provided a diagnosis of bipolar I disorder. Id. He stated Plaintiff's medications included Lorazepam, Lamotrigine, Fluoxetine, Risperidone, and Adderall. Id. He described Plaintiff's mental status as follows: appropriate grooming and hygiene; oriented to time, person, place, and situation; labile affect; depressed and hypomanic mood that was fragile when stressed; obsessive thought process characterized by loose associations; paranoid perceptual distortions; average cognitive ability; moderately-to-severely distractible attention/concentration dependent on stress; and mild-to-severe memory deficit depending on stress. Tr. at 329. He indicated Plaintiff had good ability to complete basic ADLs and variable abilities to relate to others and complete simple, routine and complex tasks. Id. He noted Plaintiff had lost multiple jobs within the prior year. Id. He considered Plaintiff capable of managing her own funds. Id.

Plaintiff argues the ALJ erred in assigning greater weight to opinions of non-examining, non-treating state agency consultants than to her treating psychiatrist. [ECF No. 14 at 24]. She maintains the ALJ found Dr. McMeekin's opinion to be vague, but failed to explain how it was vague. Id. She contends Dr. McMeekin's opinion is consistent with his observations, Dr. Ritterspach's opinion, Counselor Jackson's statement, and the other evidence of record. Id. at 24-25. She claims the ALJ did not comply with the provisions of 20 C.F.R. § 404.1527(c) in evaluating Dr. McMeekin's opinion. Id. at 25-26.

The Commissioner argues the ALJ was not required to explain why she considered Dr. McMeekin's opinion to be vague because its vagueness was apparent on its face. [ECF No. 16 at 24-25]. He notes Dr. McMeekin indicated Plaintiff had "good" ability to complete basic ADLs; her attention, concentration, and memory were "dependent on stress"; and her abilities to relate to others and complete simple, routine, and complex tasks "varie[d]." Id. He contends the lack of specificity in Dr. McMeekin's opinion made it difficult for the ALJ to assign it greater weight, but that the ALJ accounted for the opinion in the RFC assessment. Id. at 25; ECF No. 19 at 5, 8. He claims the ALJ did not err in assigning great weight to the state agency consultants' opinions because they were "consistent with the longitudinal medical evidence." Id. at 25-26. He argues the ALJ appropriately accorded "some weight" to Dr. Ritterspach's opinion, finding it only partially consistent with the evidence. Id. at 26; ECF No. 19 at 5-6.

Pursuant to the regulations, ALJs are required to give controlling weight to treating physicians' medical opinions that are well supported by medically-acceptable clinical and laboratory diagnostic techniques and that are not inconsistent with the other substantial evidence of record. 20 C.F.R. § 404.1527(c)(2). Medical opinions from "treating physicians are given 'more weight . . . since these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of [the claimant's] medical impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone[.]'" Lewis, 858 F.3d at 867 (quoting 20 C.F.R. § 404.1527(c)(2)).

An ALJ may decline to allocate controlling weight to a treating physician's opinion that is not well supported by medically-acceptable clinical and laboratory diagnostic techniques or that is inconsistent with the other substantial evidence of record. SSR 96-2p, 1996 WL 374188, at *2 (1996). However, the ALJ's assessment of the treating physician's opinion does not end with the finding that it is not entitled to controlling weight. Johnson, 434 F.3d at 654; SSR 96-2p, 1996 WL 374188, at *4 (1996). The ALJ must weigh the treating physician's opinion, in addition to all other medical opinions of record, based on the factors in 20 C.F.R. § 404.1527(c), which include "(1) whether the physician has examined the applicant, (2) the treatment relationship between the physician and the applicant, (3) the supportability of the physician's opinion, (4) the consistency of the opinion with the record, and (5) whether the physician is a specialist." Johnson, 434 F.3d at 654.

The court should not disturb an ALJ's weighing of the medical opinions of record "absent some indication that the ALJ has dredged up 'specious inconsistencies,' Scivally v. Sullivan, 966 F.2d 1070, 1077 (7th Cir. 1992), or has not given good reason for the weight afforded a particular opinion." Craft v. Apfel, 164 F.3d 624 (Table), 1998 WL 702296, at *2 (4th Cir. 1998) (per curiam). "[T]he ALJ holds the discretion to give less weight to the testimony of a treating physician in the face of persuasive contrary evidence." Mastro v. Apfel, 270 F.3d 171, 178 (4th Cir. 2011) (citing Hunter v. Sullivan, 993 F.2d 31, 35 (4th Cir. 1992)). However, if the ALJ issues a decision that is not fully favorable, his decision "must contain specific reasons for the weight given to the treating source's medical opinion, supported by the evidence in the case record, and must be sufficiently specific to make clear to any subsequent reviewers the weight the adjudicator gave to the treating source's medical opinion and the reason for that weight." SSR 96-2p, 1996 WL 374188, at *5 (1996). The ALJ must "always give good reasons" to support the weight he gives to a treating physician's opinion. 20 C.F.R. § 404.1527(c)(2).

The ALJ addressed Dr. McMeekin's opinion as follows:

I direct some weight to the claimant's treating mental health doctor's opinion in 2014 that the claimant had moderate to severe difficulties with attention/concentration depending on stress, her mood was fragile when stressed, and she had mild to severe deficits in memory depending on stress (Ex. 6F). She noted good ability to complete basic activities of daily living and her ability to relate to others and complete simple, routine tasks or complex tasks varied. Although vague, the claimant's mental health doctor's opinion is partially consistent with the evidence, although the evidence shows that the claimant is limited to performing simple, routine tasks; maintaining concentration, persistence and pace during two-hour periods during the workday; no contact with the public; no team-type work with co-workers; and a work environment where there are infrequent changes to the work routine based on the medical evidence above under the State agency opinions regarding the claimant's mental impairments.

The ALJ declined to accord controlling weight to Dr. McMeekin's opinion because it was "vague" and inconsistent with the RFC assessment in the decision. See id. Neither reason is supported by substantial evidence.

Dr. McMeekin provided an unambiguous opinion that Plaintiff was likely to decompensate when subjected to stressful situations in the workplace. See Tr. at 328-29. He completed the opinion form at the request of the state disability determination agency and responded to the specific questions presented. See Tr. at 327-29. He indicated Plaintiff's mental status was characterized by multiple abnormalities, including labile affect, fragile mood, obsessive thought process, loose associations, paranoid perceptual distortions, moderately-to-severely distractible attention and concentration, and mild-to-severe memory deficit. Tr. at 329. He indicated Plaintiff had variable abilities to relate to others and complete simple, routine and complex tasks, as demonstrated by her loss of multiple jobs within the prior year. Id.

As the ALJ did not explain her reasons for assessing the restrictions in the RFC assessment, the undersigned is unable to discern why she concluded Dr. McMeekin's opinion was not supported by medically-acceptable clinical and laboratory diagnostic techniques or inconsistent with the other substantial evidence of record. See 20 C.F.R. § 404.1527(c)(2).

Even if the court is to construe the ALJ's recitation of evidence that supported lesser restrictions as adequate to support her decision not to accord controlling weight to Dr. McMeekin's opinion, it cannot excuse the ALJ's failure to weight the treating physician's opinion based on the relevant factors in 20 C.F.R. § 404.1527(c). The record contains evidence that arguably suggests Dr. McMeekin's opinion is supported by his observations and treatment records and is consistent with Dr. Ritterspach's and Counselor Jackson's observations and opinions. See20 C.F.R. § 404.1527(c)(3), (4). The ALJ's opinion is also devoid of evidence that she considered the lengthy treatment history between Plaintiff and Dr. McMeekin. See 20 C.F.R. § 404.1527(c)(2). As the ALJ did not reconcile this evidence with her assignment of "some weight" to Dr. McMeekin's opinion, substantial evidence does not support her weighing of the opinion. III. Conclusion and Recommendation

The court's function is not to substitute its own judgment for that of the ALJ, but to determine whether the ALJ's decision is supported as a matter of fact and law. Based on the foregoing, the court cannot determine that the Commissioner's decision is supported by substantial evidence. Therefore, the undersigned recommends, pursuant to the power of the court to enter a judgment affirming, modifying, or reversing the Commissioner's decision with remand in Social Security actions under sentence four of 42 U.S.C. § 405(g), that this matter be reversed and remanded for further administrative proceedings.

IT IS SO RECOMMENDED. December 18, 2019
Columbia, South Carolina

/s/

Shiva V. Hodges

United States Magistrate Judge

The parties are directed to note the important information in the attached

"Notice of Right to File Objections to Report and Recommendation."

Notice of Right to File Objections to Report and Recommendation

The parties are advised that they may file specific written objections to this Report and Recommendation with the District Judge. Objections must specifically identify the portions of the Report and Recommendation to which objections are made and the basis for such objections. "[I]n the absence of a timely filed objection, a district court need not conduct a de novo review, but instead must 'only satisfy itself that there is no clear error on the face of the record in order to accept the recommendation.'" Diamond v. Colonial Life & Acc. Ins. Co., 416 F.3d 310 (4th Cir. 2005) (quoting Fed. R. Civ. P. 72 advisory committee's note).

Specific written objections must be filed within fourteen (14) days of the date of service of this Report and Recommendation. 28 U.S.C. § 636(b)(1); Fed. R. Civ. P. 72(b); see Fed. R. Civ. P. 6(a), (d). Filing by mail pursuant to Federal Rule of Civil Procedure 5 may be accomplished by mailing objections to:

Robin L. Blume, Clerk

United States District Court

901 Richland Street

Columbia, South Carolina 29201

Failure to timely file specific written objections to this Report and Recommendation will result in waiver of the right to appeal from a judgment of the District Court based upon such Recommendation. 28 U.S.C. § 636(b)(1); Thomas v. Arn, 474 U.S. 140 (1985); Wright v. Collins, 766 F.2d 841 (4th Cir. 1985); United States v. Schronce, 727 F.2d 91 (4th Cir. 1984).