Opinion
5:20-CV-569-FL
02-27-2022
AMANDA MCINTOSH SULLIVAN, Plaintiff, v. KILOLO KIJAKAZI, Acting Commissioner of Social Security, Defendant.
MEMORANDUM AND RECOMMENDATION
Brian S. Meyers United States Magistrate Judge.
This matter is before the court on the parties' cross-motions for judgment on the pleadings [DE-23, -27] pursuant to Fed.R.Civ.P. 12(c). Plaintiff Amanda McIntosh Sullivan (“Plaintiff” or, in context, “Claimant”) filed this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3) seeking judicial review of the denial of her application for a period of disability and Supplemental Security Income (“SSI”). Both parties submitted memoranda in support of their respective motions. [DE-24, -28]. The time for filing responsive briefs has expired and the pending motions are ripe for adjudication. The motions were referred to the undersigned magistrate judge for a memorandum and recommendation pursuant to 28 U.S.C. § 636(b)(1). Having carefully reviewed the administrative record and the motions and memoranda submitted by the parties, it is recommended that Plaintiff's Motion for Judgment on the Pleadings be allowed, Defendant's Motion for Judgment on the Pleadings be denied, and the case be remanded to the Commissioner for further proceedings consistent with the Memorandum and Recommendation.
I. STATEMENT OF THE CASE
Plaintiff protectively filed an application for a period of disability and SSI on October 9, 2018, alleging disability beginning October 9, 2018. Transcript of Proceedings (“Tr.”) 200-05. Her claim was denied initially. Tr. 107. Plaintiff filed a request for reconsideration (Tr. 133-35), and was denied upon reconsideration on April 11, 2019 (Tr. 126). On June 11, 2019, Plaintiff requested a hearing before the Administrative Law Judge (“ALJ”). Tr. 141-44. A hearing before the ALJ was held on December 12, 2019, at which Plaintiff, represented by counsel, and a vocational expert (“VE”) appeared and testified. Tr. 35-71. On February 6, 2020, the ALJ issued a decision denying Plaintiff's request for benefits. Tr. 15-34.
On April 3, 2020, Plaintiff requested a review of the ALJ's decision by the Appeals Council. Tr. 197-99. On August 28, 2020, the Appeals Council denied Plaintiff's request for review. Tr. 1-6. Plaintiff then filed a complaint in this court seeking review of the now-final administrative decision.
II. STANDARD OF REVIEW
The scope of judicial review of a final agency decision regarding disability benefits under the Social Security Act (“Act”), 42 U.S.C. § 301 et seq., is limited to determining whether substantial evidence supports the Commissioner's factual findings and whether the decision was reached through the application of the correct legal standards. See Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987). “The findings of the Commissioner . . . as to any fact, if supported by substantial evidence, shall be conclusive . . . .” 42 U.S.C. § 405(g). Substantial evidence is “evidence which a reasoning mind would accept as sufficient to support a particular conclusion.” Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966). While substantial evidence is not a “large or considerable amount of evidence, ” Pierce v. Underwood, 487 U.S. 552, 565 (1988), it is “more than a mere scintilla . . . and somewhat less than a preponderance.” Laws, 368 F.2d at 642. “In reviewing for substantial evidence, [the court should not] undertake to re-weigh conflicting evidence, make credibility determinations, or substitute [its] judgment for that of the [Commissioner].” Mastro v. Apfel, 270 F.3d 171, 176 (4th Cir. 2001) (quoting Craig v. Chater, 76 F.3d 585, 589 (4th Cir. 1996), superseded by regulation on other grounds, 20 C.F.R. § 416.927(d)(2)). Rather, in conducting the “substantial evidence” inquiry, the court's review is limited to whether the ALJ analyzed the relevant evidence and sufficiently explained his or her findings and rationale in crediting the evidence. Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438, 439-40 (4th Cir. 1997). “Judicial review of an administrative decision is impossible without an adequate explanation of that decision by the administrator.” DeLoatche v. Heckler, 715 F.2d 148, 150 (4th Cir. 1983).
III. DISABILITY EVALUATION PROCESS
The disability determination is based on a five-step sequential evaluation process as set forth in 20 C.F.R. § 416.920 under which the ALJ is to evaluate a claim:
The claimant (1) must not be engaged in “substantial gainful activity [“SGA”], ” i.e., currently working; and (2) must have a “severe” impairment that (3) meets or exceeds [in severity] the “listings” of specified impairments, or is otherwise incapacitating to the extent that the claimant does not possess the residual functional capacity [“RFC”] to (4) perform . . . past work or (5) any other work.Albright v. Comm'r of the Soc. Sec. Admin., 174 F.3d 473, 475 n.2 (4th Cir. 1999). “If an applicant's claim fails at any step of the process, the ALJ need not advance to the subsequent steps.” Pass v. Chater, 65 F.3d 1200, 1203 (4th Cir. 1995) (citation omitted). The burden of proof and production during the first four steps of the inquiry rests on the claimant. Id. At the fifth step, the burden shifts to the ALJ to show that other work exists in the national economy which the claimant can perform. Id.
When assessing the severity of mental impairments, the ALJ must do so in accordance with the “special technique” described in 20 C.F.R. §§ 416.920a(b)-(c). This regulatory scheme identifies four broad functional areas in which the ALJ rates the degree of functional limitation resulting from a claimant's mental impairment(s): understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; and, adapting or managing oneself. Id. § 416.920a(c)(3). The ALJ is required to incorporate into his written decision pertinent findings and conclusions based on the “special technique.” Id. § 416.920a(e)(4).
IV. ALJ'S FINDINGS
Applying the above-described sequential evaluation process, the ALJ found Plaintiff “not disabled” as defined in the Act. Tr. 28-29.
At step one, the ALJ determined Plaintiff had not engaged in substantial gainful employment since October 9, 2018, the alleged onset date. Tr. 20. Next, at step two, the ALJ determined Plaintiff had the following severe impairments: residuals from gastric bypass surgery; anemia; vomiting; gastro-esophageal reflux disease; bipolar disorder; generalized anxiety disorder; post-traumatic stress disorder; and personality disorder. Tr. 20. The ALJ also found Plaintiff had non-severe impairments of: syncope; hyperthyroidism; pancreatitis; cannabis abuse; toe fracture; fracture of the fifth finger; and migraine. Tr. 21.
However, at step three, the ALJ concluded these impairments, both physical and mental, were not severe enough, either individually or in combination, to meet or medically equal one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. Tr. 21. Applying the technique prescribed by the regulations, the ALJ found that Plaintiff's mental impairments have resulted in moderate limitation in understanding, remembering, or applying information; moderate limitation in interacting with others; moderate limitation in concentrating, persisting, or maintaining pace; and moderate limitation in adapting or managing oneself. Tr. 22. The ALJ found no episodes of decompensation. Tr. 23.
Prior to proceeding to step four, the ALJ assessed Plaintiff's RFC, finding Plaintiff had the ability to perform light work with the following limitations:
“Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.” 20 C.F.R. §§ 404.1567(a), 416.967(a); S.S.R. 96-9p, 1996 WL 374185, at *3 (July 2, 1996). “Occasionally” generally totals no more than about 2 hours of an 8hour workday. S.S.R. 96-9p, 1996 WL 374185, at *3. “Sitting” generally totals about 6 hours of an 8-hour workday. Id. A full range of sedentary work includes all or substantially all of the approximately 200 unskilled sedentary occupations administratively noticed in 20 C.F.R. Part 404, Subpart P, Appendix 2, Table 1. Id. “Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If an individual can perform light work, he or she can also perform sedentary work, unless there are additional limiting factors such as the loss of fine dexterity or the inability to sit for long periods of time.” 20 C.F.R. §§ 404.1567(b), 416.967(b).
she can climb, balance, stoop, kneel, crouch, and crawl frequently. She can tolerate occasional exposure to vibration but cannot have exposure to hazards. She can apply commonsense understanding to carry out detailed but uninvolved written or oral instructions. She can deal with problems involving a few concrete variables in or from standardized situations. She can tolerate occasional interaction with coworkers and supervisors but cannot have interaction with the public. She can sustain concentration, persistence, and pace in two-hour increments but cannot perform fast-paced production work. She can adapt to few or no changes in the work setting.
Tr. 23. In making this assessment, the ALJ found Plaintiff's statements about her limitations not entirely consistent with the medical evidence and other evidence in the record. Tr. 24.
At step four, the ALJ concluded that Plaintiff had no past relevant work. Tr. 27. Nonetheless, at step five, upon considering Plaintiff's age, education, work experience, and RFC, the ALJ determined there is work that exists in significant numbers in the national economy that Plaintiff can perform. Tr. 27.
V. DISCUSSION
A. The ALJ's evaluation of the medical opinion evidence
Plaintiff contends that the ALJ failed to adequately explain how the medical opinions were weighed. Pl.'s Mem. [DE-24] at 2. Specifically, at issue is whether the ALJ failed to adequately explain why she rejected the opinions of Barbara Youngblood, LPC. Id. at 8. Plaintiff argues that the ALJ did fail to adequately explain why she discredited the opinions, as the ALJ only noted that the opinions were “‘unpersuasive in light of the foregoing reasons' while gesturing towards the rest of the decision” but failed to articulate any particular reason. Id. The court agrees.
All page citations herein are to the page numbers assigned by the court's CM/ECF electronic filing system.
Because Plaintiff filed her claims on October 9, 2018 (Tr. 200-05), the applicable regulation regarding the evaluation of medical source opinions is 20 C.F.R. § 416.920c, titled “How we consider and articulate medical opinions and prior administrative medical findings for claims filed on or after March 27, 2017.” Section 416.920c instructs that the Social Security Administration “will not defer or give any specific evidentiary weight, including controlling weight, to any medical opinion(s) or prior administrative medical finding(s), including those from your medical sources.” 20 C.F.R. § 416.920c(a). Instead, the regulation provides five factors for evaluating the persuasiveness of medical opinions and prior administrative medical findings, the five factors being: “(1) Supportability . . . (2) Consistency . . . (3) Relationship with the claimant . . . (4) Specialization . . . [and] (5) Other factors . . . that tend to support or contradict a medical opinion or prior administrative finding. Id. §§ 416.920c(c)(1)-(5). The regulation specifies that supportability and consistency are the most important factors in the evaluation. Id. § 416.920c(a).
The regulation also requires that an ALJ “articulate how [they] considered the medical opinions and prior administrative medical findings in [the] case record.” Id. In particular, the ALJ must explain how the factors of supportability and consistency were considered for a medical source's medical opinions. Id. § 416.920c(b)(2). The ALJ may, but is not required to, explain the remaining factors. Id. Additionally, among the articulation requirements is the requirement that the ALJ engage in a source-level articulation. Id. § 416.920c(b)(1). While the ALJ does not need to articulate how he or she considered the § 416.920c(c) factors for each individual medical opinion, the ALJ must articulate how he or she considered the factors for each medical source that has provided a medical opinion(s) or prior administrative medical finding(s). Id.
Here, Plaintiff contends that the ALJ erred by failing to explain why she rejected the opinions of licensed professional counselor Barbara Youngblood, LPC. Pl.'s Mem. [DE-24] at 8. The opinions of Ms. Youngblood cited to by the ALJ are contained in an April 23, 2019 medical source statement by Ms. Youngblood, as well as a July 2, 2019 letter by Ms. Youngblood. See Tr. 27 (citing Tr. 4048-51, 4270).
To note, although not cited by the ALJ when discussing Ms. Youngblood's medical opinions, the record also contains additional treatment notes from the Waynesboro Family Clinic, P.A., many of which are signed by Ms. Youngblood. See Tr. 402-57, 4059-4269.
On April 23, 2019, Ms. Youngblood completed a “Medical Source Statement Concerning the Nature and Severity of an Individual's Mental Impairment” on Plaintiff's behalf. See Tr. 4048-51. The statement was comprised of a check-box form relating to, amongst other things, Plaintiff's abilities in understanding and memory, sustained concentration and persistence, social interaction, and adaptation. Tr. 4048-50. In the check-box form, Ms. Youngblood indicated that Plaintiff was “markedly limited” in several areas. Tr. 4048-50. For example, she indicates that Plaintiff is markedly limited in all aspects of understanding and memory, all aspects in sustained concentration and persistence, and all but one aspect of social interaction, and all aspects of adaptation. Tr. 4048-50. Further, Ms. Youngblood included the following handwritten “clarifying” comment:
[Plaintiff] has dealt with severe and persistent mental illness problems for many years. She has suffered from trauma in childhood and as a young adult that has
made it difficult for her to find any stability or positive foundation in her life. These issues and other complications with depression, anxiety, panic attacks have complicated her life and created financial distress, frustration with current life events and complicated medical problems as moods swing, memory and concentration problems continues in the long term.
Tr. 4051.
Additionally, on July 2, 2019, Ms. Youngblood provided a letter to Plaintiff's attorney that states, in relevant part, the following:
[Plaintiff] has been in mental health counseling at our office for many years searching for solutions to her severe and persistent mental health problems. She has also seen several psychiatrists at this facility since her first evaluation for psychiatric medication and has been tried on several different psychiatric medications with little success overall.
[Plaintiff] has made a concerted effort to cope with her mental health problems, but has had difficulty over the years finding any level of stability in her life. She was able to be receive [sic] housing assistance through Eastpointe Local Management Entity due to her inability to work and provide for her basic needs.
[Plaintiff] has struggled with her depressive episodes, high anxiety, sleeplessness, grief, trauma from past physical and sexual abuse and her anger toward her abusers from the past, most especially her father . . . .
Cognitive-behavioral therapeutic interventions, anger management, stress management, relaxation exercises and mindfulness strategies have been helpful when in a therapeutic setting in the office, but it has been difficult for [Plaintiff] to integrate these mental health strategies into her life at home. She continues to deal with multiple medical problems especially digestive problems exacerbated by gastric by-pass several years ago.
Tr. 4270.
In the RFC, the ALJ's discussion and analysis of Ms. Youngblood's opinions appears as follows:
The undersigned finds the opinion from Barbara Youngblood, LPC, a licensed professional counselor, unpersuasive in light of the foregoing reasons. Ms. Youngblood opined that [Plaintiff] had generally marked limitations in all areas of mental functioning (Exhibit B24F). Similarly, the undersigned finds the limitations stated by Ms. Youngblood unpersuasive in light of the foregoing reasons (See
Exhibit B27F).
Tr. 27.
In finding the opinions of Ms. Youngblood “unpersuasive, ” the ALJ here fails to adequately articulate her decision as required by the regulations. Specifically, the ALJ fails to “explain how [she] considered the supportability and consistency factors for [Ms. Youngblood's] medical opinions . . . .” 20 C.F.R. § 416.920c(b)(2). While the ALJ does not need to explicitly refer to the terms “supportability” and “consistency, ” the ALJ must “sufficiently address[] and consider[] these factors.” Cody v. Comm'r of Soc. Sec. Admin., No. 9:20-cv-02620-JD-MHC, 2021 WL 6012228, at *6 (D.S.C. Oct. 27, 2021) (citing Hobbs v. Saul, No. 2:20cv00004, 2021 WL 1574421, at *10 (W.D. Va. Apr. 22, 2021)). The ALJ here provides no explanation at all of Ms. Youngblood's opinions as they relate to either supportability or consistency.
Defendant argues that “[r]ead as a whole, [] the ALJ's decision and supporting explanation is clear and well-supported by substantial evidence.” Def.'s Mem. [DE-28] at 21. Defendant maintains that “rather than repeat herself, the ALJ referred to her prior discussions of the State agency consultants' findings and the treatment and examination records, as discussed above.” Id. Defendant also points to the record as a whole, arguing that it does not support that Plaintiff is as limited as Ms. Youngblood found her to be. Id. at 21-22.
The regulations, however, provide that “[a]ll medical sources are to be considered, and a rationale articulating how the ALJ applied the factors specified in the regulations must be stated for each source.” Hardy v. Comm'r of Soc. Sec., ___ F.Supp.3d ___, No. 20-10918, 2021 WL 3702170, at *6 (E.D. Mich. Aug. 13, 2021) (emphasis added) (citing 20 C.F.R. § 404.1520c(b) (“We will articulate in our determination or decision how persuasive we find all of the medical opinions . . . in your case record.”)). Here, the ALJ does not sufficiently address how the factors in the regulations are applied for Ms. Youngblood's opinions. To the extent that the ALJ does attempt to rely on “the foregoing reasons” in discrediting Ms. Youngblood's opinions, it is unclear what evidence the ALJ used to find Ms. Youngblood's opinions unsupported or inconsistent, precluding meaningful review by the court. Further, it is unclear how referring to “the foregoing reasons” can satisfy the ALJ's obligation to explain the “supportability” of Ms. Youngblood's opinions. In assessing the supportability of an opinion, the ALJ must look at whether “the objective medical evidence and supporting explanations presented by a medical source . . . support his or her medical opinion(s) . . . .” 20 C.F.R. § 416.920c(c)(1). None of the “foregoing reasons” explain how Ms. Youngblood's treatment notes and other records do or do not support her medical opinions. While the ALJ may have had good reasons to find Ms. Youngblood's opinions unpersuasive, the ALJ does not include any such reasons in the written decision, and fails to comply with the requirements of 20 C.F.R. § 416.920c.
Accordingly, the undersigned RECOMMENDS this case be remanded to the Commissioner for further proceedings. On remand, the Commissioner should be sure to articulate how persuasive she finds each medical opinion to be. In articulating the persuasiveness of each medical opinion, the Commissioner should be sure to explain how she considered the factors of supportability and consistency for each medical opinion, so that meaningful judicial review would be permitted, if necessary.
B. Social Security Administration's authority to enact new regulations
Plaintiff here also asserts one final argument relating to the Social Security Administration's enactment of 20 C.F.R. § 416.920c. See Pl.'s Mem. [DE-24] at 8-9. As discussed above, this regulation changes the way that the Commissioner considers medical opinions for disability cases filed after March 27, 2017. Plaintiff argues that these new regulations improperly attempts to “wipe away Fourth Circuit precedent[, ]” by allowing ALJs to avoid their obligation to thoroughly explain all RFC findings. Id. Plaintiff asserts that “[t]he SSA does not have the authority to administratively overrule Fourth Circuit precedent as it is attempting to do here.” Id. In support of her argument, Plaintiff states that the regulations are at odds with the holdings of Monroe v. Colvin, 826 F.3d 176 (4th Cir. 2016) and Mascio v. Colvin, 780 F.3d 632 (4th Cir. 2015).
Because it is recommended that this matter be remanded for other reasons, the undersigned does not address whether the Social Security Administration acted outside of its authority by enacting 20 C.F.R. § 416.920c. However, the undersigned does note that much of Plaintiff's contention here is simply incorrect. For example, 20 C.F.R. § 416.920c does not “administratively overrule” Monroe and Mascio. While these regulations do change the way that the Commissioner is to “consider and articulate medical opinions and prior administrative medical findings for claims filed on or after March 27, 2017” (20 C.F.R. §§ 404.1520c, 416.920c), they do not undermine the Commissioner's responsibility to “include a narrative discussion describing how the evidence supports each conclusion, citing specific medical facts (e.g., laboratory findings) and nonmedical evidence (e.g., daily activities, observations).” Monroe, 826 F.3d at 189 (quoting Mascio v. Colvin, 780 F.3d at 636). Put differently:
Although these amended regulations do away with the idea of assigning “weight” to medical opinions, the ALJ's reasons for finding the opinion of a medical source unpersuasive must still be supported by substantial evidence. The United States Court of Appeals for the Fourth Circuit has repeatedly stated that “[a]n ALJ has the obligation to consider all relevant medical evidence and cannot simply cherrypick facts that support a finding of nondisability while ignoring evidence that points to a disability finding.” Lewis, 858 F.3d at 869 (quoting Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 2010)); see also Arakas v. Comm'r, Soc. Sec. Admin., 983 F.3d 83, 98 (4th Cir. 2020). Moreover, an ALJ continues to have an obligation to “include a narrative discussion describing how the evidence supports each conclusion.” Monroe v. Colvin, 826 F.3d 176, 190 (4th Cir. 2016) (quoting Mascio, 780 F.3d at 636); see also SSR 96-8p, 1996 WL 374184 at *7 (S.S.A. July 2, 1996) (“The RFC assessment must include a narrative discussion describing how the
evidence supports each conclusion, citing specific medical facts (e.g., laboratory findings) and nonmedical evidence (e.g., daily activities, observations).”). Similarly, remand may be appropriate when the courts are left to guess at how the ALJ arrived at the conclusions and meaningful review is frustrated. Mascio, 780 F.3d 636-37. The ALJ must “build an accurate and logical bridge from the evidence to [her] conclusion.” Monroe, 826 F.3d at 189 (citation omitted).Cody, 2021 WL 6012228, at *4 (alterations in original).
VI. CONCLUSION
For the reasons stated above, IT IS RECOMMENDED that Plaintiff's Motion for Judgment on the Pleadings [DE-23] be ALLOWED, Defendant's Motion for Judgment on the Pleadings [DE-27] be DENIED, and the case be REMANDED to the Commissioner for further proceedings consistent with the Memorandum and Recommendation.
IT IS DIRECTED that a copy of this Memorandum and Recommendation be served on each of the parties or, if represented, their counsel. Each party shall have until March 11, 2022 to file written objections to this Memorandum and Recommendation. The presiding district judge must conduct her own review (that is, make a de novo determination) of those portions of the Memorandum and Recommendation to which objection is properly made and may accept, reject, or modify the determinations in the Memorandum and Recommendation; receive further evidence; or return the matter to the magistrate judge with instructions. See, e.g., 28 U.S.C. § 636(b)(1); Fed.R.Civ.P. 72(b)(3); Local Civ. R. 1.1 (permitting modification of deadlines specified in local rules), 72.4(b), E.D. N.C. Any response to objections shall be filed by March 21, 2022.
If a party does not file written objections to the Memorandum and Recommendation by the foregoing deadline, the party will be giving up the right to review of the Memorandum and Recommendation by the presiding district judge as described above, and the presiding district judge may enter an order or judgment based on the Memorandum and Recommendation without such review. In addition, the party's failure to file written objections by the foregoing deadline will bar the party from appealing to the Court of Appeals from an order or judgment of the presiding district judge based on the Memorandum and Recommendation. See Wright v. Collins, 766 F.2d 841, 846-47 (4th Cir. 1985).