Opinion
8:22-cv-00129-TMC-JDA
11-03-2022
Candies A. Williams, Plaintiff, v. Commissioner of Social Security Administration, Defendant.
REPORT AND RECOMMENDATION OF MAGISTRATE JUDGE
JACQUELYN D. AUSTIN UNITED STATES MAGISTRATE JUDGE
This matter is before the Court for a Report and Recommendation pursuant to Local Civil Rule 73.02(B)(2)(a), D.S.C., and 28 U.S.C. § 636(b)(1)(B). Plaintiff brought this action pursuant to 42 U.S.C. §§ 405(G) and 1383(c)(3) to obtain judicial review of a final decision of the Commissioner of Social Security (“the Commissioner”), denying Plaintiff's claim for supplemental security income (“SSI”). For the reasons set forth below, it is recommended that the decision of the Commissioner be reversed and remanded for administrative action consistent with this recommendation, pursuant to sentence four of 42 U.S.C. § 405(g).
A Report and Recommendation is being filed in this case, in which one or both parties declined to consent to disposition by a magistrate judge.
Section 1383(c)(3) provides, “The final determination of the Commissioner of Social Security after a hearing under paragraph (1) shall be subject to judicial review as provided in section 405(g) of this title to the same extent as the Commissioner's final determinations under section 405 of this title.” 42 U.S.C. § 1383(c)(3).
PROCEDURAL HISTORY
In September 2019, Plaintiff filed an application for SSI, alleging a disability onset date of September 1, 1992. [R. 147.] Plaintiff later amended her alleged onset date to August 28, 2019, the protective filing date. [R. 36-37.] The claim was denied initially and upon reconsideration by the Social Security Administration (“the Administration”). [R. 105, 114.] Plaintiff requested a hearing before an administrative law judge (“ALJ”), and, on December 9, 2020, ALJ Paul Elkin conducted a de novo hearing on Plaintiff's claims. [R. 28-79.]
The hearing was conducted by telephone due to COVID-19 precautions.
The ALJ issued a decision on January 6, 2021, finding Plaintiff was not disabled under the Social Security Act (“the Act”). [R. 14-23.] At Step 1, the ALJ determined that Plaintiff had not engaged in substantial gainful activity since August 28, 2019. [R. 17, Finding 1.] At Step 2, the ALJ found Plaintiff had the following severe impairments: obesity and bipolar disorder. [R. 17, Finding 2.] At Step 3, the ALJ determined that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. [R. 18, Finding 3.]
The five-step sequential analysis used to evaluate disability claims is discussed in the Applicable Law section, infra.
Before addressing Step 4, Plaintiff's ability to perform her past relevant work, the ALJ found Plaintiff retained the following residual functional capacity (“RFC”):
[T]he claimant has the [RFC] to perform medium work as defined in 20 CFR 416.967(c) except the individual is limited to simple routine tasks, but is able to maintain concentration,
persistence and pace for at least 2 hours at a time, perform activities within a schedule, maintain regular attendance, complete a normal workday and work week, can occasionally tolerate close “team-type” interactions with coworkers, but should have no interaction with the general public.[R. 19, Finding 4.] At Step 4, the ALJ found that Plaintiff had no past relevant work. [R. 21, Finding 5.] Upon considering Plaintiff's age, education, work experience, RFC, and the testimony of the vocational expert (“VE”), the ALJ found that there were jobs that existed in significant numbers in the national economy that Plaintiff could perform. [R. 22, Finding 9.] Thus, on that basis, the ALJ determined that Plaintiff had not been under a disability as defined in the Act from August 28, 2019, through the date of the decision. [R. 22, Finding 10.]
Plaintiff requested Appeals Council review of the ALJ's decision but the Council declined review. [R. 1-2.] Plaintiff filed this action for judicial review on January 14, 2022. [Doc. 1.]
THE PARTIES' POSITIONS
Plaintiff argues that this Court should reverse the ALJ's decision and remand this case for further proceedings. [Doc. 8.] In particular, Plaintiff argues the ALJ failed to properly consider Plaintiff's subjective complaints by omitting any discussion of lay witness testimony and failing to consider the side effects of Plaintiff's medications and the limited nature of her activities of daily living (“ADLs”). [Id. at 23-27.]
The Commissioner, on the other hand, contends that substantial evidence supports the ALJ's decision. [Doc. 9.] The Commissioner argues the ALJ complied with SSR 16-3p, considered Plaintiff's mother's testimony to the extent required under the regulations, and adequately addressed Plaintiff's allegations of medication side effects and limited ADLs. [ Id. at 9-17.]
STANDARD OF REVIEW
The Commissioner's findings of fact are conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is more than a scintilla-i.e., the evidence must do more than merely create a suspicion of the existence of a fact and must include such relevant evidence as a reasonable person would accept as adequate to support the conclusion. See Richardson v. Perales, 402 U.S. 389, 401 (1971); Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966) (“Substantial evidence, it has been held, is evidence which a reasoning mind would accept as sufficient to support a particular conclusion. It consists of more than a mere scintilla of evidence but may be somewhat less than a preponderance. If there is evidence to justify a refusal to direct a verdict were the case before a jury, then there is ‘substantial evidence.'”).
Where conflicting evidence “allows reasonable minds to differ as to whether a claimant is disabled, the responsibility for that decision falls on the [Commissioner] (or the [Commissioner's] designate, the ALJ),” not on the reviewing court. Craig v. Chater, 76 F.3d 585, 589 (4th Cir. 1996); see also Edwards v. Sullivan, 937 F.2d 580, 584 n.3 (11th Cir. 1991) (stating that where the Commissioner's decision is supported by substantial evidence, the court will affirm, even if the reviewer would have reached a contrary result as finder of fact and even if the reviewer finds that the evidence preponderates against the Commissioner's decision). Thus, it is not within the province of a reviewing court to determine the weight of the evidence, nor is it the court's function to substitute its judgment for that of the Commissioner so long as the decision is supported by substantial evidence. See Bird v. Comm'r, 699 F.3d 337, 340 (4th Cir. 2012); Laws, 368 F.2d at 642; Snyder v. Ribicoff, 307 F.2d 518, 520 (4th Cir. 1962).
The reviewing court will reverse the Commissioner's decision on plenary review, however, if the decision applies incorrect law or fails to provide the court with sufficient reasoning to determine that the Commissioner properly applied the law. Myers v. Califano, 611 F.2d 980, 982 (4th Cir. 1980); see also Keeton v. Dep't of Health & Human Servs., 21 F.3d 1064, 1066 (11th Cir. 1994). Where the Commissioner's decision “is in clear disregard of the overwhelming weight of the evidence, Congress has empowered the courts to modify or reverse the [Commissioner's] decision ‘with or without remanding the cause for a rehearing.'” Vitek v. Finch, 438 F.2d 1157, 1158 (4th Cir. 1971) (quoting 42 U.S.C. § 405(g)). Remand is unnecessary where “the record does not contain substantial evidence to support a decision denying coverage under the correct legal standard and when reopening the record for more evidence would serve no purpose.” Breeden v. Weinberger, 493 F.2d 1002, 1012 (4th Cir. 1974).
The court may remand a case to the Commissioner for a rehearing under sentence four or sentence six of 42 U.S.C. § 405(g). Sargent v. Sullivan, 941 F.2d 1207 (4th Cir. 1991) (unpublished table decision). To remand under sentence four, the reviewing court must find either that the Commissioner's decision is not supported by substantial evidence or that the Commissioner incorrectly applied the law relevant to the disability claim. See, e.g., Jackson v. Chater, 99 F.3d 1086, 1090-91 (11th Cir. 1996) (holding remand was appropriate where the ALJ failed to develop a full and fair record of the claimant's residual functional capacity); Brenem v. Harris, 621 F.2d 688, 690-91 (5th Cir. 1980) (holding remand was appropriate where record was insufficient to affirm but was also insufficient for court to find the claimant disabled). Where the court cannot discern the basis for the Commissioner's decision, a remand under sentence four is usually the proper course to allow the Commissioner to explain the basis for the decision or for additional investigation. See Radford v. Comm'r, 734 F.3d 288, 295 (4th Cir. 2013);see also Smith v. Heckler, 782 F.2d 1176, 1181-82 (4th Cir. 1986) (remanding case where decision of ALJ contained “a gap in its reasoning” because ALJ did not say he was discounting testimony or why); Gordon v. Schweiker, 725 F.2d 231, 235 (4th Cir. 1984) (remanding case where neither the ALJ nor the Appeals Council indicated the weight given to relevant evidence). On remand under sentence four, the ALJ should review the case on a complete record, including any new material evidence. See Smith, 782 F.2d at 1182 (“The [Commissioner] and the claimant may produce further evidence on remand.”). After a remand under sentence four, the court enters a final and immediately appealable judgment and then loses jurisdiction. Sargent, 941 F.2d 1207.
In contrast, sentence six provides:
The court may . . . at any time order additional evidence to be taken before the Commissioner of Social Security, but only upon a showing that there is new evidence which is material and that there is good cause for the failure to incorporate such evidence into the record in a prior proceeding ....42 U.S.C. § 405(g). A reviewing court may remand a case to the Commissioner on the basis of new evidence only if four prerequisites are met: (1) the evidence is relevant to the determination of disability at the time the application was first filed; (2) the evidence is material to the extent that the Commissioner's decision might reasonably have been different had the new evidence been before him; (3) there is good cause for the claimant's failure to submit the evidence when the claim was before the Commissioner; and (4) the claimant made at least a general showing of the nature of the new evidence to the reviewing court. Borders v. Heckler, 777 F.2d 954, 955 (4th Cir. 1985), superseded by amendment to statute, 42 U.S.C. § 405(g), as recognized in Wilkins v. Sec'y, Dep't of Health & Human Servs., 925 F.2d 769, 774 (4th Cir. 1991). With remand under sentence six, the parties must return to the court after remand to file modified findings of fact. Melkonyan, 501 U.S. at 98. The reviewing court retains jurisdiction pending remand and does not enter a final judgment until after the completion of remand proceedings. See Allen v. Chater, 67 F.3d 293 (4th Cir. 1995) (unpublished table decision) (holding that an order remanding a claim for Social Security benefits pursuant to sentence six of 42 U.S.C. § 405(g) is not a final order).
Though the court in Wilkins indicated in a parenthetical that the four-part test set forth in Borders had been superseded by an amendment to 42 U.S.C. § 405(g), courts in the Fourth Circuit have continued to cite the requirements outlined in Borders when evaluating a claim for remand based on new evidence. See, e.g., Brooks v. Astrue, No. 6:10-cv-152, 2010 WL 5478648, at *8 (D.S.C. Nov. 23, 2010); Ashton v. Astrue, No. TMD 09-1107, 2010 WL 3199345, at *3 (D. Md. Aug. 12, 2010); Washington v. Comm'r of Soc. Sec., No. 2:08-cv-93, 2009 WL 86737, at *5 (E.D. Va. Jan. 13, 2009); Brock v. Sec'y of Health & Human Servs., 807 F.Supp. 1248, 1250 n.3 (S.D. W.Va. 1992). Further, the Supreme Court of the United States has not suggested Borders' construction of § 405(g) is incorrect. See Sullivan v. Finkelstein, 496 U.S. 617, 626 n.6 (1990). Accordingly, the Court will apply the more stringent Borders inquiry.
APPLICABLE LAW
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). “Disability” is defined 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 a continuous period of not less than 12 consecutive months.Id. § 423(d)(1)(A).
I. The Five-Step Evaluation
To facilitate uniform and efficient processing of disability claims, federal regulations have reduced the statutory definition of disability to a series of five sequential questions. See, e.g., Heckler v. Campbell, 461 U.S. 458, 461 n.2 (1983) (noting a “need for efficiency” in considering disability claims). The ALJ must consider whether (1) the claimant is engaged in substantial gainful activity; (2) the claimant has a severe impairment; (3) the impairment meets or equals an impairment included in the Administration's Official Listings of Impairments found at 20 C.F.R. Pt. 404, Subpt. P, App. 1; (4) the impairment prevents the claimant from performing past relevant work; and (5) the impairment prevents the claimant from having substantial gainful employment. 20 C.F.R. § 416.920. Through the fourth step, the burden of production and proof is on the claimant. Grant v. Schweiker, 699 F.2d 189, 191 (4th Cir. 1983). The claimant must prove disability on or before the last day of her insured status to receive disability benefits. Everett v. Sec'y of Health, Educ. & Welfare, 412 F.2d 842, 843 (4th Cir. 1969). If the inquiry reaches Step 5, the burden shifts to the Commissioner to produce evidence that other jobs exist in the national economy that the claimant can perform, considering the claimant's age, education, and work experience. Grant, 699 F.2d at 191. If at any step of the evaluation the ALJ can find an individual is disabled or not disabled, further inquiry is unnecessary. 20 C.F.R. § 416.920(a)(4); Hall v. Harris, 658 F.2d 260, 264 (4th Cir. 1981).
A. Substantial Gainful Activity
“Substantial gainful activity” must be both substantial-involves doing significant physical or mental activities, 20 C.F.R. § 416.972(a)-and gainful-done for pay or profit, whether or not a profit is realized, Id. § 416.972(b). If an individual has earnings from employment or self-employment above a specific level set out in the regulations, he is generally presumed to be able to engage in substantial gainful activity. Id. § 416.974-975.
B. Severe Impairment
An impairment is “severe” if it significantly limits an individual's ability to perform basic work activities. See id. § 416.921. When determining whether a claimant's physical and mental impairments are sufficiently severe, the ALJ must consider the combined effect of all of the claimant's impairments. 42 U.S.C. §§ 423(d)(2)(B), 1382c(a)(3)(G). The ALJ must evaluate a disability claimant as a whole person and not in the abstract, having several hypothetical and isolated illnesses. Walker v. Bowen, 889 F.2d 47, 49-50 (4th Cir. 1989) (stating that, when evaluating the effect of a number of impairments on a disability claimant, “the [Commissioner] must consider the combined effect of a claimant's impairments and not fragmentize them”). Accordingly, the ALJ must make specific and well-articulated findings as to the effect of a combination of impairments when determining whether an individual is disabled. Id. at 50 (“As a corollary to this rule, the ALJ must adequately explain his or her evaluation of the combined effects of the impairments.”). If the ALJ finds a combination of impairments to be severe, “the combined impact of the impairments shall be considered throughout the disability determination process.” 42 U.S.C. §§ 423(d)(2)(B), 1382c(a)(3)(G).
C. Meets or Equals an Impairment Listed in the Listings of Impairments
If a claimant's impairment or combination of impairments meets or medically equals the criteria of a listing found at 20 C.F.R. Pt. 404, Subpt. P, App.1 and meets the duration requirement found at 20 C.F.R. § 416.909, the ALJ will find the claimant disabled without considering the claimant's age, education, and work experience. 20 C.F.R. § 416.920(a)(4)(iii), (d).
The Listing of Impairments is applicable to SSI claims pursuant to 20 C.F.R. §§ 416.911, 416.925.
D. Past Relevant Work
The assessment of a claimant's ability to perform past relevant work “reflect[s] the statute's focus on the functional capacity retained by the claimant.” Pass v. Chater, 65 F.3d 1200, 1204 (4th Cir. 1995). At this step of the evaluation, the ALJ compares the claimant's residual functional capacity with the physical and mental demands of the kind of work he has done in the past to determine whether the claimant has the residual functional capacity to do his past work. 20 C.F.R. § 416.960(b).
Residual functional capacity is “the most [a claimant] can still do despite [his] limitations.” 20 C.F.R. § 416.945(a)(1).
E. Other Work
As previously stated, once the ALJ finds that a claimant cannot return to her prior work, the burden of proof shifts to the Commissioner to establish that the claimant could perform other work that exists in the national economy. See 20 C.F.R. § 416.920(f)-(g); Hunter v. Sullivan, 993 F.2d 31, 35 (4th Cir. 1992). To meet this burden, the Commissioner may sometimes rely exclusively on the Medical-Vocational Guidelines (the “grids”). Exclusive reliance on the “grids” is appropriate where the claimant suffers primarily from an exertional impairment, without significant nonexertional factors. 20 C.F.R. Pt. 404, Subpt. P, App. 2, § 200.00(e); Gory v. Schweiker, 712 F.2d 929, 930-31 (4th Cir. 1983) (stating that exclusive reliance on the grids is appropriate in cases involving exertional limitations). When a claimant suffers from both exertional and nonexertional limitations, the grids may serve only as guidelines. Gory, 712 F.2d at 931. In such a case, the Commissioner must use a VE to establish the claimant's ability to perform other work. 20 C.F.R. § 416.969a; see Walker, 889 F.2d at 49-50 (“Because we have found that the grids cannot be relied upon to show conclusively that claimant is not disabled, when the case is remanded it will be incumbent upon the [Commissioner] to prove by expert vocational testimony that despite the combination of exertional and nonexertional impairments, the claimant retains the ability to perform specific jobs which exist in the national economy.”). The purpose of using a VE is “to assist the ALJ in determining whether there is work available in the national economy which this particular claimant can perform.” Walker, 889 F.2d at 50. For the VE's testimony to be relevant, “it must be based upon a consideration of all other evidence in the record, . . . and it must be in response to proper hypothetical questions which fairly set out all of claimant's impairments.” Id. (citations omitted).
An exertional limitation is one that affects the claimant's ability to meet the strength requirements of jobs. 20 C.F.R. § 416.969a(a). A nonexertional limitation is one that affects the ability to meet the demands of the job other than the strength demands. Id. Examples of nonexertional limitations include but are not limited to difficulty functioning because of being nervous, anxious, or depressed; difficulty maintaining attention or concentrating; difficulty understanding or remembering detailed instructions; difficulty seeing or hearing. Id. § 416.969a(c)(1).
II. Developing the Record
The ALJ has a duty to fully and fairly develop the record. See Cook v. Heckler, 783 F.2d 1168, 1173 (4th Cir. 1986). The ALJ is required to inquire fully into each relevant issue. Snyder, 307 F.2d at 520. The performance of this duty is particularly important when a claimant appears without counsel. Marsh v. Harris, 632 F.2d 296, 299 (4th Cir. 1980). In such circumstances, “the ALJ should scrupulously and conscientiously probe into, inquire of, and explore for all the relevant facts, . . . being especially diligent in ensuring that favorable as well as unfavorable facts and circumstances are elicited.” Id. (internal quotations and citations omitted).
III. Medical Opinions
For claims filed on or after March 27, 2017, as Plaintiff's is, the applicable regulations require ALJs to consider the persuasiveness of each medical opinion of record in accordance with the following factors: (1) supportability; (2) consistency; (3) relationship with the claimant; (4) specialization; and (5) other factors that tend to support or contradict the opinion. 20 C.F.R. § 416.920c(b), (c). Regarding supportability, “[t]he more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion . . . the more persuasive the medical opinion will be.” 20 C.F.R. § 416.920c(c)(1). As for the relationship with the claimant, ALJs consider the “length of the treatment relationship,” the “[f]requency of examinations,” the “[p]urpose of the treatment relationship,” the “[e]xtent of the treatment relationship,” and whether the source has examined the claimant. 20 C.F.R. § 416.920c(c)(3).
The new regulations define the term “medical opinion” as “a statement from a medical source about what you can still do despite your impairment(s) and whether you have one or more impairment-related limitations or restrictions.” 20 C.F.R. § 416.913(a)(2).
IV. Medical Tests and Examinations
The ALJ is required to order additional medical tests and exams only when a claimant's medical sources do not give sufficient medical evidence about an impairment to determine whether the claimant is disabled. 20 C.F.R. § 416.917; see also Conley v. Bowen, 781 F.2d 143, 146 (8th Cir. 1986). The regulations are clear: a consultative examination is not required when there is sufficient medical evidence to make a determination on a claimant's disability. 20 C.F.R. § 416.917. Under the regulations, however, the ALJ may determine that a consultative examination or other medical tests are necessary. Id.
V. Pain
Congress has determined that a claimant will not be considered disabled unless he furnishes medical and other evidence (e.g., medical signs and laboratory findings) showing the existence of a medical impairment that could reasonably be expected to produce the pain or symptoms alleged. 42 U.S.C. § 423(d)(5)(A). Social Security Ruling (“SSR”) 16-3p provides, “[i]n considering the intensity, persistence, and limiting effects of an individual's symptoms, we examine the entire case record, including the objective medical evidence; an individual's statements about the intensity, persistence, and limiting effects of symptoms; statements and other information provided by medical sources and other persons; and any other relevant evidence in the individual's case record.” Social Security Ruling 16-3p Titles II and XVI: Evaluation of Symptoms In Disability Claims, 82 Fed.Reg. 49,462, 49,464 (Oct. 25, 2017); see also 20 C.F.R. § 416.929(c)(1)-(c)(2) (outlining evaluation of pain).
In evaluating claims of disabling pain, the ALJ must proceed in a two-part analysis. Morgan v. Barnhart, 142 Fed.Appx. 716, 723 (4th Cir. 2005) (unpublished opinion); see also SSR 16-3p, 82 Fed.Reg. at 49,463. First, “the ALJ must determine whether the claimant has produced medical evidence of a ‘medically determinable impairment which could reasonably be expected to produce” the alleged symptoms. Id. (quoting Craig, 76 F.3d at 594); see SSR 16-3p, 82 Fed.Reg. at 49,463. Second, the ALJ must evaluate “the intensity and persistence of an individual's symptoms such as pain and determine the extent to which an individual's symptoms limit his or her ability to perform work-related activities . . . or to function independently.” SSR 16-3p, 82 Fed.Reg. at 49,464; see 20 C.F.R. § 416.928 (noting that the ALJ must consider all of a claimant's statements about his symptoms, including pain, and determine the extent to which the symptoms can reasonably be accepted as consistent with the objective medical evidence). The factors to consider in evaluating the intensity, persistence, and limiting effects of the claimant's symptoms include the claimant's daily activities; the location, duration, frequency, and intensity of the claimant's pain or other symptoms; factors that precipitate or aggravate the symptoms; the type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate pain or other symptoms; treatment, other than medication, the claimant receives or has received for relief of pain or other symptoms; any measures other than treatment the individual uses or has used to relieve pain or other symptoms; and any other factors concerning the individual's functional limitations and restrictions due to pain or other symptoms. SSR 16-3p, 82 Fed.Reg. at 49,465-66; see also 20 C.F.R. § 416.929(c). The ALJ is not required to accept a claimant's subjective complaints “to the extent they are inconsistent with the available evidence, including objective evidence of the underlying impairment.” Craig, 76 F.3d at 594.
APPLICATION AND ANALYSIS
Plaintiff asserts the ALJ's RFC determination is flawed because he failed to properly evaluate her subjective symptoms. [Doc. 8 at 23-27.] The Commissioner asserts the ALJ's RFC determination is supported by substantial evidence and allows for meaningful review. [Doc. 9 at 9-17.]
Social Security Ruling 96-8p provides the process for determining RFC. Mascio v. Colvin, 780 F.3d 632, 636 (4th Cir. 2015). The ruling states that the “‘assessment must first identify the individual's functional limitations or restrictions and assess his or her work-related abilities on a function-by-function basis, including the functions' listed in the regulations.” Id. (quoting SSR 96-8p, 61 Fed.Reg. 34,474, 34,475 (July 2, 1996)). “Only after such a function-by-function analysis may an ALJ express RFC in terms of the exertional levels of work.” Monroe v. Colvin, 826 F.3d 176, 187 (4th Cir. 2016) (internal quotation marks omitted). The Fourth Circuit has explained that, were the ALJ to express the RFC before he engaged in this function-by-function analysis, it would “create[] the danger that the adjudicator will overlook limitations or restrictions that would narrow the ranges and types of work an individual may be able to do.” Id. (internal quotation marks omitted).
SSR 96-8p also provides that 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).'” Mascio, 780 F.3d at 636 (quoting SSR 96-8p, 61 Fed.Reg. at 34,478). Additionally, the Fourth Circuit has held that “[a] necessary predicate to engaging in substantial evidence review is a record of the basis for the ALJ's ruling, including a discussion of which evidence the ALJ found credible and why, and specific application of the pertinent legal requirements to the record evidence.” Monroe, 826 F.3d at 189 (alteration in original and internal quotation marks omitted). To create such a record, the ALJ must “explain how material inconsistencies or ambiguities in the evidence in the case record were considered and resolved.” Rehoric v. Berryhill, No. 1:17-cv-02634-MGL-SVH, 2018 WL 7021611, at *12 (D.S.C. Dec. 28, 2018) (internal quotation marks omitted), Report and Recommendation adopted by 2019 WL 188690 (D.S.C. Jan. 14, 2019). The Fourth Circuit has described the required discussion as “build[ing] an accurate and logical bridge from the evidence to [the ALJ's] conclusion.” Monroe, 826 F.3d at 189 (internal quotation marks omitted).
In an evaluation of a claimant's subjective complaints, the following factors are relevant: daily activities; the location, duration, frequency, and intensity of pain or other symptoms; precipitating and aggravating factors; type, dosage, effectiveness, and side effects of any medication taken to alleviate pain or other symptoms; treatment, other than medication, used to alleviate pain or other symptoms; any measures used to relieve pain or other symptoms; and other factors concerning functional limitations due to pain or other symptoms. 20 C.F.R. § 416.929(c)(3). In evaluating the non-objective evidence, the ALJ is to consider the claimant's “statements about the intensity, persistence, and limiting effects of symptoms” and should “evaluate whether the statements are consistent with objective medical evidence and other evidence.” SSR 16-3p, 2017 WL 4790249, at *49465. The ALJ may compare the claimant's statements to information he provided to his medical sources regarding the onset, character, and location of his symptoms; factors that precipitate and aggravate his symptoms; the frequency and duration of his symptoms; change in his symptoms; and activities of daily living. Id.
Record Evidence
At the hearing, Plaintiff testified she moved back in with her mother 18 months prior to the hearing and now lived in a house with her mother and younger sister. [R. 38-39.] Plaintiff weighed 305 pounds and her doctors had recommended she start a diabetic-friendly diet and an exercise regimen. [R. 39-40.] Plaintiff stated she walked twice a week, up and down the street, for about ten minutes. [R. 40.] She had never obtained a driver's license or learner's permit because she had problems with her eyesight and was worried she could not see well enough to drive; however, no medical provider had ever told her she could not drive. [R. 41-42.] If Plaintiff needed to go somewhere, her mother or another family member would take her. [R. 42.] Plaintiff graduated high school and attended one year of college. [R. 43.] She never tried to get a job because of her poor eyesight and outbursts associated with her bipolar disorder. [R. 44.]
Plaintiff testified she was supposed to wear prescription glasses but did not own a pair because she could not afford them. [R. 45-46.] She cannot read small print but was able to fill out her disability paperwork because it was in larger print. [R. 46.] She has to sit close to the TV screen and cannot always read street signs from the car. [R. 46.]
Plaintiff has diabetes and tests her own blood sugar twice a day. [R. 46-47.] She takes metformin and glipizide to help control her blood sugar and her levels had been good around the time of the hearing. [R. 47.]
Plaintiff testified she has depression, just wants to be by herself, gets emotional and sad, has changes in appetite, and gets nervous to the point that her hands would shake. [R. 47-48.] Plaintiff's anxiety increases when things did not feel right to her or she has to ask or tell somebody something. [R. 48.] Plaintiff was admitted to the hospital for one week in February 2020 and then treated with a mental health clinic every three months after her discharge. [R. 48-49.] She took 100mg of Seroquel and 450mg of lithium twice a day. [R. 49.] She was hospitalized because she could not afford to refill her medication. [R. 49.] Plaintiff stated the Seroquel made her sleepy and hungry. [R. 50.] She took the Seroquel at night and was tired when she woke up but not for long. [R. 55.]
Plaintiff stated she could care for her own personal needs “[a]t times” but that her mother sometimes helped her get dressed when her body hurt. [R. 50-51.] She experienced neuropathy, mainly in her feet. [R. 51.] Her doctor gave her an ointment to help and she had to take an over-the-counter pain medication two or three times a week. [R. 51-52.] She helps clean “a little bit” and does not cook but does know how to make herself a sandwich and use a microwave. [R. 53-54.] She could walk one-half to one block and help her mother shop for and unload groceries. [R. 52.] She could “maybe” lift and carry grocery bags multiple times per day and could sit in a chair for 15 minutes. [R. 52-53.]
Plaintiff stated she felt so bad a few times per week that she could not do much of anything all day. [R. 53.] Plaintiff gets tired during the day, she thinks because of her diabetes, and has to lay down for a minute or take a nap for an hour every day. [R. 55-56.] In her free time, Plaintiff listens to music and colors. [R. 54.] She spends almost all of her time in her room, unless she is going to the store with her mother, taking a walk, or cleaning up. [R. 56.] She stays in her room by choice because she is most comfortable there. [R. 57.] Plaintiff and her mother have gotten into disagreements where law enforcement has had to intervene. [R. 57.] Plaintiff testified she hoped she would be able to get along with co-workers, supervisors, or the public, but that it would depend on how she was feeling and how people treated her. [R. 57-58.] She stated she may lash out at anyone who got out of line with her. [R. 58.] Plaintiff is prone to bad days if she senses people are talking about her, trying to argue with her, or calling her a liar. [R. 58.] Plaintiff stated her medication helped but she still had racing thoughts that caused her to feel depressed and to want to retreat to her room. [R. 59-60.]
Plaintiff's mother also testified at the hearing. She stated Plaintiff had been living with a boyfriend and his parents in Mississippi but got into altercations, tried to break things, and threatened to harm herself. [R. 63.] The police were called several times and Plaintiff received court-ordered mental health treatment. [R. 63.] She had moved back home with her mother three years prior to the hearing. [R. 62.] Plaintiff's mother testified Plaintiff could not work because she has a poor attention span, is always confined to herself, is prone to outbursts, and does not always bathe herself. [R. 64-65.] She stated Plaintiff's outbursts had improved since her last inpatient treatment but she still exhibited that behavior sometimes. [R. 66.] Plaintiff's mother worked full-time and was out of the house a good part of the day. [R. 67.] She often observed Plaintiff spinning in her room and talking to herself. [R. 68.] Plaintiff's mother would find Plaintiff sleeping at 3:00 in the afternoon about three times a week. [R. 70.] She stated Plaintiff left the house maybe three times a month. [R. 70.] She testified Plaintiff had been in and out of mental health hospitals since she was 14 years old and that Plaintiff would likely try to work but would not be able to stay focused long enough or interact well with employers, coworkers, or the public. [R. 71-72.]
The VE testified there were jobs available in significant numbers for a hypothetical individual of Plaintiff's age and education with no past relevant work and who was limited to medium work and simple, routine tasks, occasional close team-type interactions with coworkers, and no interaction with the general public, but can maintain concentration, persistence and pace for two-hour blocks of time, perform activities within a schedule, maintain regular attendance, and complete a normal workday and work week. [R. 74.] However, that individual would be precluded from work if she would be off-task for more than 10% of the workday or absent more than one day per month. [R. 74-76.]
Medical Records
Plaintiff's amended alleged onset date is the date of her SSI application, August 28, 2019. However, some understanding of Plaintiff's psychiatric history prior to that date is relevant. Plaintiff first received inpatient psychiatric treatment in 2008 during a manic episode. [R. 236.] She received mental health treatment and medications over the next several years and was hospitalized again in 2011 due to depression and mood swings. [R. 266.] She was discharged with a diagnosis of bipolar disorder, mixed. [R. 266.] Plaintiff continued to receive regular mental health treatment and, in 2013, she was started on Seroquel, which she reported helped tremendously. [R. 257-66.]
In September 2014, Plaintiff was attending classes at a community college and reported no problems with her medications or otherwise. [R. 251.] In April 2015, Plaintiff received court-ordered inpatient treatment after anger outbursts and destroying property. [R. 242.] Plaintiff reported not taking her medication for a “couple of days” prior to the incident. [R. 242.] Her Seroquel dosage was increased and she was also prescribed Vistaril and Zoloft. [R. 242.] She indicated the medications worked well when she took them. [R. 242.] Plaintiff continued to exhibit symptoms of hypermania, but was noted to be “basically functional” and her provider was reluctant to prescribe anti-mania medications because he was uncertain about her ability to take medications regularly. [R. 237.]
Throughout most of 2016, Plaintiff appeared stable. [R. 235, 282.] However, in October 2016, Plaintiff informed her counselor that she had been acting out and her boyfriend and his family may kick her out of the house. [R. 277.] She reported difficulty with motivation, focus, anger, and irritability to another provider and endorsed fleeting suicidal thoughts. [R. 281.] In December 2016, Plaintiff reported things had gone “very well” since her last appointment, except one incident when she lost her temper, yelled at people, and the police had to take her to the emergency department where she was given an injection. [R. 280.]
In August 2019, shortly before the amended alleged onset date, Plaintiff was hospitalized for ten days after another violent outburst. [R. 326-27, 348-50.] Emergency room notes indicate Plaintiff and her mother had been trying to find a psychiatrist to treat Plaintiff but there was a three to four month back up. [R. 327.] Plaintiff had not been on medication for two months prior this incident. [R. 348.] Plaintiff was admitted to a crisis stabilization unit, placed back on Seroquel, and provided daily group and individual therapy. [R. 348-49.] She did well while hospitalized. [R. 349.] At discharge, Plaintiff had poor insight and judgment; however, her attention, concentration, and memory appeared intact. [R. 348.] The discharge summary notes she was “[a]ble to perform activities of daily living.” [R. 349.]
After that hospitalization, Plaintiff began receiving regular outpatient mental health treatment at Pee Dee Mental Health. [R. 391.] Plaintiff reported daily mood instability and recurrent suicidal thoughts. [R. 391.] She indicated she had attempted suicide twice, in 2011 and 2017. [R. 391.] Plaintiff had been prescribed other mood stabilizers and antipsychotic medications in the past but was not able to tolerate the side effects. [R. 391.] On August 21, 2019, Plaintiff's mental status examination was normal, except that her judgment and insight were fair. [R. 392.] She was prescribed 300mg of Lithium Carbonate twice per day to control her mood instability and referred for weekly psychotherapy. [R. 392.]
During a September 19, 2019 follow-up appointment with Pee Dee Mental Health, Plaintiff reported taking her medications as prescribed and “doing very well.” [R. 393.] She denied any side effects or manic symptoms. [R. 393.] Her mental status examination again noted fair judgement and insight, but was otherwise normal. [R. 393.] She was continued on Lithium for mood instability and Seroquel for psychotic symptoms. [R. 394.]
In December 2019, the initial review state agency psychological consultant found Plaintiff's mental impairments non-severe and opined she had only mild functional limitations based on the most recent treatment note from Pee Dee Mental Health and indications that she had reacted well to medication. [R. 86-87.]
On February 4, 2020, Plaintiff was admitted to McLeod Behavioral Health for seven days after another violent outburst. [R. 539.] She had run out of her medication and had not taken it for “a few days.” [R. 540.] Her ongoing problems were listed as bipolar disorder, depression, and morbid obesity. [R. 539.] She reported trouble with focus and concentration and feeling depressed, but reported good energy levels and denied feeling hopeless, helpless, or worthless. [R. 539.] Plaintiff's Lithium dosage was increased to 300mg in the morning and 450mg before bed. [R. 544-45.] Plaintiff participated in group therapy and education sessions and agreed to be compliant with her treatment and medication. [R. 545.] Her mental status examination at discharge was normal, with adequate insight and judgment. [R. 545.]
Plaintiff followed up with Pee Dee Mental Health on March 19, 2020 and reported doing well. [R. 491.] Plaintiff's provider noted she tolerated psycho-pharmacotherapy well with no signs of side effects. [R. 491.] Plaintiff appeared stable and denied depressive or manic symptoms. [R. 491.] Plaintiff's judgment and insight were noted as fair, but her mental status examination was otherwise normal. [R. 491.] She was continued on Lithium and Seroquel. [R. 492.]
Plaintiff followed up again on May 19, 2020, via telephone due to COVID-19 precautions. [R. 493.] She reported doing well and denied mood changes, medication side effects, depressive or manic symptoms, anxiety, or feeling depressed. [R. 493.] She had not had her lithium levels checked yet but reported taking her medications as prescribed. [R. 493.] Plaintiff's judgment was noted as fair and her insight was noted as poor, but her mental status examination was otherwise normal. [R. 493.] She was continued on Lithium and Seroquel. [R. 494.]
On August 11 and November 3, 2020, during telehealth visits with Pee Dee Mental Health, Plaintiff reported doing “fine.” [R. 497, 495.] She denied medication side effects and depressive, anxious, or manic symptoms. [R. 497, 495.] Plaintiff reported spending most of her time in her house. [R. 497, 495.] She had a normal mental status examination, except for fair judgment and poor and fair insight. [R. 497-98 (poor insight), 496 (fair insight).] She was continued on Lithium and Seroquel. [R. 498, 496.]
In July 2020, the reconsideration level state agency psychological consultant found Plaintiff's mental impairments severe and that she had moderate limitations in interacting with others and concentrating, persisting, and maintaining pace. [R. 98-99.] Plaintiff indicated she was doing better since her medications had been changed, had not had any outbursts, and that her mother helped her remember to take her medication. [R. 100.] She stated she could do household chores, but often needed encouragement to complete tasks, could care for her own personal grooming without reminders or assistance, did not drive, went shopping one to two times per month with her mother, and did well in public but could get easily agitated. [R. 100.] The consultant noted Plaintiff had two psychiatric admissions within the past year related to agitation, outbursts, and threats of violence toward her mother, and a history of noncompliance with her medication. [R. 100.] She concluded Plaintiff had moderate limitations but was capable of simple work tasks with limited public interaction. [R. 100.]
In assessing Plaintiff's mental RFC, the agency consultant relied mostly on Plaintiff's ADLs and opined Plaintiff's statements about her symptoms were partially consistent with the record evidence. [R. 101.] She found Plaintiff had no understanding, memory, or adaptation limitations. [R. 101, 102.]
Regarding sustained concentration and persistence, the consultant found Plaintiff had moderate limitations in her abilities to maintain attention and concentration for extended periods; perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances; and complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods. [R. 101-02.] However, she found Plaintiff was not significantly limited in her abilities to carry out very short and simple instructions, carry out detailed instructions, sustain an ordinary routine without special supervision, or make simple work-related decisions. [R. 101-02.] She concluded Plaintiff could attend to and perform simple, unskilled tasks for reasonable periods of time but would have difficulty focusing and persisting in order to carry our complex tasks for extended periods of time. [R. 103.] In addition, the agency consultant opined Plaintiff may miss an occasional day of work due to her mental conditions but could maintain regular attendance. [R. 103.]
Regarding social interactions, the agency consultant found Plaintiff was moderately limited in her abilities to interact appropriately with the general public, accept instructions and respond appropriately to criticism from supervisors, and get along with coworkers or peers without distracting them or exhibiting behavioral extremes. [R. 102.] She found Plaintiff was not significantly limited in her abilities to ask simple questions or request assistance or maintain socially appropriate behavior and adhere to basic standards of neatness and cleanliness. [R. 102.] The agency consultant concluded Plaintiff may have occasional difficulties relating appropriately to supervisors and coworkers but could relate adequately overall. [R. 103.] She opined Plaintiff was not suited for frequent contact with the general public, but was able to respond appropriately to requests for change and protect herself from common workplace safety hazards. [R. 103.]
The ALJ's Analysis
The ALJ found Plaintiff's bipolar disorder severe and acknowledged she had been treated for that disorder since at least 2011. [R. 17.] The ALJ considered Listing 12.04 but found Plaintiff did not meet the Paragraph B criteria. [R. 18.] The ALJ found Plaintiff had moderate limitations in interacting with others and concentrating, persisting, or maintaining pace and only mild limitations in understanding, remembering or applying information and adapting or managing oneself. [R. 18.] In making these findings, the ALJ noted Plaintiff had more serious limitations in some areas during periods of “noncompliance and decompensation,” but that she was “able to take her medications as directed when adequately motivated to do so” and her mental status examinations were mostly normal when she is on her medication. [R. 18.]
The ALJ summarized Plaintiff's hearing testimony that she continued to have mental health problems, particularly with depression, had difficulty concentrating and getting along with others, and that her medication made her drowsy. [R. 20.] He then found as follows:
The claimant's allegations that she is frequently non-functional due to mental health symptoms is inconsistent with the claimant's mental health treatment notes showing that since March 2020, the claimant consistently reports that she is doing well and mental status examinations are essentially normal. The claimant required one week of inpatient treatment in February 2020. However, treatment notes state that this episode of decompensation was due to the claimant's noncompliance with medication. The claimant promptly improved with treatment. However, it is noteworthy that even during decompensation, the claimant's mental status examination notes the claimant is fairly groomed, alert and fully oriented. Her speech has normal rate and volume and her language is intact. Her thought processes are logical, linear and goal oriented. Her memory and concentration are intact, and her fund of knowledge is average. Only insight and judgment were noted as poor.
The same is true for the claimant's episode of decompensation in August 2019. Treatment notes state that the claimant's inpatient admission was in the context of noncompliance with medications for a period of two months. Again, however, even at this point, the mental status examination noted the claimant was alert and oriented. Her speech was normal. She had no hallucinations or delusions. Attention and concentration were intact. Short-term and long-term memory were intact. Only insight and judgment were noted as poor. However, she improved and was stabilized with treatment. At discharge, she was able to perform activities of daily living. During follow-up outpatient treatment later that month, the claimant's mental status examination was completely normal. Overall, treatment notes show the claimant does well on medication and reports no side effects. The claimant reports she is doing fine. She denies feeling depressed, manic, or anxious. She reports she sleeps well at night. She reports tolerating her medications well and denied side effects from medications. Psychiatric evaluations are essentially normal and note the claimant is calm, cooperative, verbal, open and with appropriate behavior. Concentration is normal. She is articulate and with fair insight and judgement.[R. 20-21 (citations omitted).] The ALJ then found the state agency psychological consultant's opinion “largely persuasive” but concluded “the evidence of record does not support the need for any limitation to interact w/supervisors or a limitation to be absent.” [R. 21.]
Discussion
Plaintiff alleges “[t]he most critical legal error in this matter concerns the omission of the testimony provided by Plaintiff's mother . . . in the decision.” [Doc. 8 at 24.] The undersigned agrees.
Under the current regulations, the ALJ is required to “consider descriptions and observations of [the claimant's] limitations from [a claimant's] impairment(s), including limitations that result from [the claimant's] symptoms, . . . provided by [the claimant], [the claimant's] family, neighbors, friends, or other persons,” 20 C.F.R. § 416.945(a)(3), but is “not required to articulate how he considered evidence from nonmedical sources” under the more detailed framework applicable to discussion of evidence from medical sources. 20 C.F.R. § 416.920c(d). In addition, SSR 16-3p provides:
c. Non-Medical Sources
Other sources may provide information from which we may draw inferences and conclusions about an individual's statements that would be helpful to us in assessing the intensity, persistence, and limiting effects of symptoms. Examples of such sources include . . . non-medical sources such as family and friends ....The adjudicator will consider any personal observations of the individual in terms of how consistent those observations are with the individual's statements about his or her symptoms as well as with all of the evidence in the file.2017 WL 5180304, at *7.
The ALJ noted in the procedural history that Plaintiff's mother “also testified as a witness at the hearing.” [R. 14.] The Commissioner argues this acknowledgment, along with the ALJ's statement that he considered all “symptoms and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence,” are enough to show the ALJ properly considered Plaintiff's mother's testimony. [Doc. 9 at 14.] Citing 20 C.F.R. § 416.920b(c), the Commissioner contends, “[u]nder the new Regulations, third party statements, like the one provided by Plaintiff's mother, regarding Plaintiff's ability to work do not require any analysis about how the ALJ considered such evidence in making the decision.” [Doc. 9 at 14 (emphasis in the original).] Section 416.920b(c) provides that any statements on issues reserved to the Commissioner, such as a claimant's residual functional capacity or ability to work, are inherently neither valuable or persuasive. However, “descriptions about functional abilities and limitations,” such as Plaintiff's mother's personal observations, are expressly excluded from this section. Id., § 416.920b(c)(3)(vi).
While an ALJ does not have to discuss lay witness evidence with the same specificity as medical evidence, “[t]he regulatory changes do not absolve ALJs of the requirement to consider lay witness statements.” Jerri v. Kijakazi, 2021 WL 3362227, at *14 (D.S.C. July 29, 2021). Rather, lay witness statements are among the relevant evidence an ALJ must consider and may be particularly important in cases like this where the claimant has a mental impairment that impacts her insight and judgement. The ALJ relies heavily on Plaintiff's reports of doing well to her mental health provider. [R. 20-21.] However, Plaintiff's provider continued to note Plaintiff's judgment and insight as “fair” and “poor.” [R. 392, 393, 491, 493, 496, 497-98.] In addition, several of the treatment notes the ALJ relies on are from telehealth visits where the provider and Plaintiff spoke over the phone and the provider was not able to observe Plaintiff's demeanor or behavior. [R. 493, 495, 497.] Contrary to the treatment records the ALJ relies on, Plaintiff's mother testified Plaintiff continued to exhibit erratic behavior after her most recent hospitalization and stated she had discussed her concerns with Pee Dee Mental Health as recently as two days prior to the hearing. [R. 66.] Under these circumstances, testimony from Plaintiff's mother, who observes Plaintiff daily and has witnessed the entirety of Plaintiff's mental health journey, seems especially relevant.
In addition, the ALJ failed to properly discuss Plaintiff's periods of medication noncompliance. SSR 16-3p provides that “if the individual fails to follow prescribed treatment that might improve symptoms, we may find the alleged intensity and persistence of an individual's symptoms are inconsistent with the overall evidence of record.” 2017 WL 5180304, at *9. However, the regulation continues, “[w]e will not find an individual's symptoms inconsistent with the evidence in the record on this basis without considering possible reasons he or she may not comply with treatment,” including that “[a]n individual may have structured his or her activities to minimize symptoms to a tolerable level by avoiding . . . mental stressors that aggravate his or her symptoms,” “may not be able to afford treatment,” or “due to various limitations (such as . . . mental limitations), an individual may not understand the . . . need for consistent treatment.” Id. at *9-10.
Here, the ALJ noted Plaintiff's periods of decompensation resulted from her noncompliance with medication but did not discuss any reasons for that noncompliance. [R. 18, 20.] The ALJ concluded Plaintiff “is able to take her medications as directed when adequately motivated to do so,” but provided no further explanation for this conclusion. [R. 18.] However, the record shows Plaintiff and her mother have, at times, had trouble paying for the medication and finding a provider to prescribe it. [R. 49-50, 67, 326-27.] Plaintiff's mother's testimony suggests Plaintiff may sometimes choose not to take her medication. [R. 70.] And treatment records showing consistently impaired judgement and insight suggest Plaintiff's bipolar disorder may interfere with her ability to consistently comply with prescribed treatment. [See also R. 544 (February 2020 admission note stating Plaintiff did not know exactly why she was admitted to the hospital).] Whatever the reason, the regulations require more explanation before Plaintiff's noncompliance can be used to discount her subjective statements.
The undersigned also notes the ALJ's reliance on Plaintiff's daily activities, without further discussion, is misplaced. Plaintiff has a long history of bipolar disorder and the record shows she is subject to erratic psychotic breakdowns, many of which require intervention from law enforcement or extended hospitalization, despite receiving regular treatment. Plaintiff's minimal daily activities of isolating in her room, listening to music, coloring, light chores, making sandwiches, and occasionally leaving the house with her mother to shop for groceries are consistent with chronic mental disability and the ALJ fails to explain how those activities translate to an ability to work on a sustained basis. See Hutsell v. Massanari, 259 F.3d 707, 713 (8th Cir. 2001) (minimal daily activities consistent with chronic mental disability); Woods v. Berryhill, 888 F.3d 686, 694 (4th Cir. 2018) (“An ALJ may not consider the type of activities a claimant can perform without also considering the extent to which she can perform them.”); Arakas v. Commissioner, 983 F.3d 83, 100-01 (4th Cir. 2020) (“A claimant's inability to sustain full-time work due to pain and other symptoms is often consistent with her ability to carry out daily activities.”).
The state agency psychological consultant noted Plaintiff may miss an occasional day of work due to her mental conditions. The ALJ found the consultant's overall opinion “largely persuasive” but found “the evidence of record does not support the need for any limitation . . . to be absent.” [R. 21.] As discussed above, the record indicates Plaintiff only leaves her house two to three times per month, feels most comfortable isolated in her room, and that being around other people can aggravate her symptoms. The ALJ fails to reconcile this inconsistency.
For the foregoing reasons, the Court cannot find that the ALJ's decision is supported by substantial evidence and that the proper legal standard was applied. As such, it is recommended that this matter be reversed and remanded.
CONCLUSION
Wherefore, based upon the foregoing, it is RECOMMENDED that the Commissioner's decision be REVERSED and REMANDED.
IT IS SO RECOMMENDED.