# MARAVEL v. SAUL

> District Court, M.D. North Carolina · May 4, 2021

URL: https://www.frixlaw.com/law-library/cases/10253749

## Case

- **Court:** District Court, M.D. North Carolina
- **Decided:** May 4, 2021
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10253749

## How later opinions describe it (automated extraction)

- holding that, if “the ALJ . . . stated that the whole record was considered, . . . absent evidence to the contrary, we take her at her word”
- observing that “[n]lo principle of administrative law or common sense requires us to remand a case in quest of a perfect opinion unless there is reason to believe that the remand might lead to a different result”

## Opinion text

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF NORTH CAROLINA
DEVIN JAMES MARAVEL, )
)
Plaintiff, )
)
v. ) 1:20CV624
)
ANDREW M. SAUL, )
Commissioner of Social Security, )
)
Defendant. )
MEMORANDUM OPINION AND RECOMMENDATION
OF UNITED STATES MAGISTRATE JUDGE
Plaintiff, Devin James Maravel, brought this action pursuant
to the Social Security Act (the “Act”) to obtain judicial review of
a final decision of Defendant, the Commissioner of Social Security,
denying Plaintiff’s claim for Adult Child’s Disability Benefits
(“CDB”) and Supplemental Security Income (“SSI”). (Docket Entry
1.) Defendant has filed the certified administrative record
(Docket Entry 11 (cited herein as “Tr. __”)), and both parties have
moved for judgment (Docket Entries 13, 15; see also Docket Entry 14
(Plaintiff’s Memorandum); Docket Entry 16 (Defendant’s
Memorandum)). For the reasons that follow, the Court should enter
judgment for Defendant.
I. PROCEDURAL HISTORY
Plaintiff applied for CDB and SSI (Tr. 268-74), alleging a
disability onset date of July 1, 2008 (see Tr. 268, 269).1
1 Plaintiff filed two applications for CDB, one based upon the earnings record
of his disabled mother, and the other based on the earnings record of his
(continued...)
Following denial of those applications initially (Tr. 69-110) and
on reconsideration (Tr. 111-73, 177-86), Plaintiff requested a
hearing de novo before an Administrative Law Judge (“ALJ”)
(Tr. 187-89). Plaintiff, his attorney, and a vocational expert
(“VE”) attended the hearing. (Tr. 36-68.) The ALJ subsequently
ruled that Plaintiff did not qualify as disabled under the Act.
(Tr. 12-27.) The Appeals Council thereafter denied Plaintiff’s
request for review (Tr. 1-6, 264-67, 401-04), thereby making the

' (...continued)
deceased father. (See Tr. 15, 268.) To qualify for CDB, an individual must, at
the time of application, 1) remain unmarried, 2) remain a dependent of the
person(s) on whose earnings record(s) the individual bases his CDB claim(s), and
3) either not have attained the age of 18 or have attained the age of 18 and
remain under a disability which began before the individual attained the age of
22. See 42 U.S.C. § 402(d); 20 C.F.R. § 404.350(a) (5). Plaintiff filed his CDB
applications shortly after attaining the age of 18, and the ALJ adjudicated
Plaintiff’s CDB claims before Plaintiff attained the age of 22. (See Tr. 17, 27,
268.) Thus, to qualify for CDB, Plaintiff must, at a minimum, show that he
remained disabled as of November 22, 2016, the date he filed his CDB
applications. See Smolen v. Chater, 80 F.3d 1273, 1280 (9th Cir. 1996) (holding
that CDB “claimant must be disabled continuously and without interruption
beginning before her twenty-second birthday until the time she applied for
[CDB]”). Similarly, notwithstanding Plaintiff’s onset date of July 1, 2008,
Plaintiff lacked eligibility for SSI benefits until his application date of
October 6, 2016. See 20 C.F.R. §$ 416.202 (explaining that a claimant remains
ineligible for SSI benefits until the date he or she files an SSI application);
20 C.F.R. § 416.501 (stating that a claimant may not receive SSI benefits for any
period that predates the first month he or she satisfies the eligibility
requirements, which cannot precede the application date). Threshold eligibility
requirements aside, the standards for demonstrating disability in a CDB claim
match those of claims for SSI. See 42 U.S.C. § 402(d) (providing that 42 U.S.C.
§ 423(d) supplies applicable definition of “disability” for CDB claims); 42
U.S.C. § 423(d) (1) (A) (setting forth standard definition of “disability” for
Disability Insurance Benefits (“DIB”) claims, i.e., “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 months”);
42 U.S.C. § 1382c(a) (3) (A) (describing same standard of disability for SSI
claims); see also Craig v. Chater, 76 F.3d 585, 589 n.1 (4th Cir. 1996) ([DIB]
provides benefits to disabled persons who have contributed to the program while
employed. [SSI] provides benefits to indigent disabled persons. The statutory
definitions and the regulations .. . for determining disability governing these
two programs are . . . substantively identical.” (internal citations omitted)).

ALJ’s ruling the Commissioner’s final decision for purposes of
judicial review.
In rendering that disability determination, the ALJ made the
following findings:
1. . . . [Plaintiff] had not attained age 22 as of July
1, 2008, the alleged onset date.
2. [Plaintiff] has not engaged in substantial gainful
activity since July 1, 2008, the alleged onset date.
. . .
3. [Plaintiff] has the following severe impairment(s):
fibromyalgia, hypertension, gastroesophageal reflux
disease (GERD), obesity, Asperger’s Disorder,
post-traumatic stress disorder [(“PTSD”)], mood disorder,
and bipolar affective disorder.
. . .
4. [Plaintiff] 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.
. . .
5. . . . [Plaintiff] has the residual functional
capacity to perform light work . . . except he has
frequent use of bilateral upper and lower extremities for
pushing, pulling, or hand and foot controls and frequent
use of bilateral upper extremities for handling,
fingering, and feeling. He can occasionally climb ramps,
stair, ladders, ropes or scaffolds. He can occasionally
balance, stoop, kneel, crouch, and crawl. He can have
frequent exposure to extreme heat and cold, unprotected
heights, and moving mechanical parts. He can understand
and carry out a variety of complex and simple
instructions, but can only sustain attention to perform
simple tasks in an environment with no work-related
contact with the general public and only occasional
interaction with coworkers.
. . .
3
6. [Plaintiff] has no past relevant work.

. . .
10. Considering [Plaintiff]’s age, education, work
experience, and residual functional capacity, there are
jobs that exist in significant numbers in the national
economy that [he] can perform.
. . .
11. [Plaintiff] has not been under a disability, as
defined in the . . . Act, from July 1, 2008, through the
date of this decision.
(Tr. 17-27 (bold font and internal parenthetical citations
omitted).)
II. DISCUSSION
Federal law “authorizes judicial review of the Social Security
Commissioner’s denial of social security benefits.” Hines v.
Barnhart, 453 F.3d 559, 561 (4th Cir. 2006). However, “the scope
of [the Court’s] review of [such a] decision . . . is extremely
limited.” Frady v. Harris, 646 F.2d 143, 144 (4th Cir. 1981).
Plaintiff has not established entitlement to relief under the
extremely limited review standard.
A. Standard of Review
“[C]ourts are not to try [a Social Security] case de novo.”
Oppenheim v. Finch, 495 F.2d 396, 397 (4th Cir. 1974). Instead,
the Court “must uphold the factual findings of the ALJ if they are
supported by substantial evidence and were reached through
application of the correct legal standard.” Hines, 453 F.3d at 561
(internal brackets and quotation marks omitted). “Substantial
4
evidence means ‘such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.’” Hunter v. Sullivan,
993 F.2d 31, 34 (4th Cir. 1992) (quoting Richardson v. Perales, 402
U.S. 389, 401 (1971)). “It consists of more than a mere scintilla
of evidence but may be somewhat less than a preponderance.” Mastro
v. Apfel, 270 F.3d 171, 176 (4th Cir. 2001) (brackets and internal
quotation marks omitted). “If there is evidence to justify a
refusal to direct a verdict were the case before a jury, then there
is substantial evidence.” Hunter, 993 F.2d at 34 (internal
quotation marks omitted).
“In reviewing for substantial evidence, the [C]ourt should not
undertake to re-weigh conflicting evidence, make credibility
determinations, or substitute its judgment for that of the [ALJ, as
adopted by the Commissioner].” Mastro, 270 F.3d at 176 (internal
brackets and quotation marks omitted). “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 ALJ).” Id. at 179 (internal quotation marks
omitted). “The issue before [the Court], therefore, is not whether
[the claimant] is disabled, but whether the ALJ’s finding that [the
claimant] is not disabled is supported by substantial evidence and
was reached based upon a correct application of the relevant law.”
Craig v. Chater, 76 F.3d 585, 589 (4th Cir. 1996).
When confronting that issue, the Court must take note that
“[a] claimant for disability benefits bears the burden of proving
5
a disability,” Hall v. Harris, 658 F.2d 260, 264 (4th Cir. 1981),
and that, in this context, “disability” means 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 months,’” id.
(quoting 42 U.S.C. § 423(d)(1)(A)). “To regularize the
adjudicative process, the Social Security Administration [(‘SSA’)]
has . . . detailed regulations incorporating longstanding medical-
vocational evaluation policies that take into account a claimant’s
age, education, and work experience in addition to [the claimant’s]
medical condition.” Id. “These regulations establish a
‘sequential evaluation process’ to determine whether a claimant is
disabled.” Id.
This sequential evaluation process (“SEP”) has up to five
steps: “The claimant (1) must not be engaged in ‘substantial
gainful activity,’ i.e., currently working; and (2) must have a
‘severe’ impairment that (3) meets or exceeds the ‘listings’ of
specified impairments, or is otherwise incapacitating to the extent
that the claimant does not possess the residual functional capacity
to (4) perform [the claimant’s] past work or (5) any other work.”
Albright v. Commissioner of the Soc. Sec. Admin., 174 F.3d 473, 475

6
n.2 (4th Cir. 1999).2 A finding adverse to the claimant at any of
several points in the SEP forecloses an award and ends the inquiry.
For example, “[t]he first step determines whether the claimant is
engaged in ‘substantial gainful activity.’ If the claimant is
working, benefits are denied. The second step determines if the
claimant is ‘severely’ disabled. If not, benefits are denied.”
Bennett v. Sullivan, 917 F.2d 157, 159 (4th Cir. 1990).
On the other hand, if a claimant carries his or her burden at
each of the first three steps, “the claimant is disabled.” Mastro,
270 F.3d at 177. Alternatively, if a claimant clears steps one and
two, but falters at step three, i.e., “[i]f a claimant’s impairment
is not sufficiently severe to equal or exceed a listed impairment,
the ALJ must assess the claimant’s residual functional capacity
(‘RFC’).” Id. at 179.3 Step four then requires the ALJ to assess
whether, based on that RFC, the claimant can perform past relevant
work; if so, the claimant does not qualify as disabled. See id. at
179-80. However, if the claimant establishes an inability to

2 “Through the fourth step, the burden of production and proof is on the
claimant. If the claimant reaches step five, the burden shifts to the
[Commissioner] . . . .” Hunter, 993 F.2d at 35 (internal citations omitted).
3 “RFC is a measurement of the most a claimant can do despite [the claimant’s]
limitations.” Hines, 453 F.3d at 562 (noting that administrative regulations
require RFC to reflect claimant’s “ability to do sustained work-related physical
and mental activities in a work setting on a regular and continuing basis . . .
[which] means 8 hours a day, for 5 days a week, or an equivalent work schedule”
(internal emphasis and quotation marks omitted)). The RFC includes both a
“physical exertional or strength limitation” that assesses the claimant’s
“ability to do sedentary, light, medium, heavy, or very heavy work,” as well as
“nonexertional limitations (mental, sensory, or skin impairments).” Hall, 658
F.2d at 265. “RFC is to be determined by the ALJ only after [the ALJ] considers
all relevant evidence of a claimant’s impairments and any related symptoms (e.g.,
pain).” Hines, 453 F.3d at 562-63.
7
return to prior work, the analysis proceeds to the fifth step,
whereupon the ALJ must decide “whether the claimant is able to
perform other work considering both [the claimant’s RFC] and [the
claimant’s] vocational capabilities (age, education, and past work
experience) to adjust to a new job.” Hall, 658 F.2d at 264-65.
If, at this step, the Commissioner cannot carry its “evidentiary
burden of proving that [the claimant] remains able to work other
jobs available in the community,” the claimant qualifies as
disabled. Hines, 453 F.3d at 567.4
B. Assignments of Error
Plaintiff asserts that the Court should overturn the ALJ’s
finding of no disability on these grounds:
1) “[t]he [ALJ]’s finding that [Plaintiff] does not meet a
Mental Disorder Listing is not supported by substantial evidence”
(Docket Entry 14 at 3 (bold font and single-spacing omitted));
2) “[t]he ALJ committed error by failing to include
schizoaffective disorder and anxiety disorder as severe
impairments” (id. at 12 (bold font and single-spacing omitted));
and

4 A claimant thus can establish disability via two paths through the SEP. The
first path requires resolution of the questions at steps one, two, and three in
the claimant’s favor, whereas, on the second path, the claimant must prevail at
steps one, two, four, and five. Some short-hand judicial characterizations of
the SEP appear to gloss over the fact that an adverse finding against a claimant
on step three does not terminate the analysis. See, e.g., Hunter, 993 F.2d at
35 (“If the ALJ finds that a claimant has not satisfied any step of the process,
review does not proceed to the next step.”).
8
3) “[t]he mental RFC is not supported by substantial evidence”
(id. at 15 (bold font omitted)).
Defendant contends otherwise and seeks affirmance of the ALJ’s
decision. (Docket Entry 16 at 12-22.)
1. Listings 12.04, 12.10, and 12.15
In Plaintiff’s first assignment of error, he asserts that
“[t]he [ALJ]’s finding that [Plaintiff] does not meet a Mental
Disorder Listing is not supported by substantial evidence.”
(Docket Entry 14 at 3 (bold font and single-spacing omitted).) In
particular, Plaintiff maintains that he met the requirements of
Listings 12.04 (“Depressive, bipolar and related disorders”), 12.10
(“Autism spectrum disorder”), and 12.15 (“Trauma- and stressor-
related disorders”), because his mental impairments caused extreme
limitation in his abilities to interact with others (see id. at 6-
8), concentrate, persist, or maintain pace (“CPP”) (see id. at 8-
9), and adapt/manage himself (see id. at 9-11). Plaintiff further
contends that “[t]he ALJ used non sequiturs in her [listings]
analysis,” in that “[t]he facts she cited did not support the
conclusions she reached.” (Id. at 11.) Plaintiff additionally
faults the ALJ for neither “discuss[ing] the detailed daily records
of Turning Point that specifically address the B criteria” of the
listings at issue, nor analyzing “how [Plaintiff]’s autism and
hallucinations affect his concentration or his interaction with

others.” (Id.) Those contentions fail to warrant relief.
9
“Under Step 3, the [SEP] regulation states that a claimant
will be found disabled if he or she has an impairment that ‘meets
or equals one of [the] listings in [A]ppendix 1 of [20 C.F.R. Pt.
404, Subpt. P] and meets the duration requirement.’” Radford v.
Colvin, 734 F.3d 288, 293 (4th Cir. 2013) (quoting 20 C.F.R.
§ 404.1520(a)(4)(iii)) (internal bracketed numbers omitted). “The
listings set out at 20 CFR [P]t. 404, [S]ubpt. P, App[’x] 1, are
descriptions of various physical and mental illnesses and
abnormalities, most of which are categorized by the body system
they affect. Each impairment is defined in terms of several
specific medical signs, symptoms, or laboratory test results.”
Sullivan v. Zebley, 493 U.S. 521, 529-30 (1990) (internal footnote
and parentheticals omitted). “In order to satisfy a listing and
qualify for benefits, a person must meet all of the medical
criteria in a particular listing.” Bennett, 917 F.2d at 160
(citing Zebley, 493 U.S. at 530, and 20 C.F.R. § 404.1526(a)); see
also Zebley, 493 U.S. at 530 (“An impairment that manifests only
some of th[e] criteria [in a listing], no matter how severely, does
not qualify.”).
The ALJ here apparently assumed without express analysis that
Plaintiff’s mood disorder/bipolar affective disorder, Asperger’s
disorder, and PTSD met the paragraph A criteria of Listings 12.04,
12.10, and 12.15, respectively, and proceeded to analyze whether
Plaintiff could meet the requirements of paragraphs B and C of
those listings, ultimately concluding that he could not do so.
10
(See Tr. 18-19.) Moreover, Plaintiff has not challenged the ALJ’s
determination that Plaintiff’s mental impairments failed to satisfy
the paragraph C criteria of Listings 12.04, 12.10, 12.15. (See
Tr. 19; see also Docket Entry 14 at 3-11.) Thus, the relevant
inquiry focuses on whether substantial evidence supports the ALJ's
findings with respect to the paragraph B criteria of the listings
in question.
Paragraph B of Listings 12.04, 12.10, and 12.15 all require
proof that the condition documented via Paragraph A resulted in at
least “[e]xtreme limitation of one, or marked limitation of two, of
the following areas of mental functioning:
1. Understand, remember, or apply information[;]
2. Interact with others[;]
3. Concentrate, persist, or maintain pace[; and]
4. Adapt or manage oneself.”
20 C.F.R. Pt. 404, Subpt. P, App’x 1, §§ 12.04B, 12.10B, 12.15B
(internal citations omitted) (emphasis added). In this context, to
qualify as “marked,” a limitation must “seriously” restrict the
ability to function “independently, appropriately, effectively, and
on a sustained basis.” Id., § 12.00F.2.d (emphasis added); see
also 20 C.F.R. §$§ 404.1520a(c) (4), 416.920a(c) (4) (explaining that
“marked” represents the fourth-highest of five levels, below
“extreme,” but above “none, mild, [and] moderate”); and an
“extreme” limitation means an individual has no “ab[ility] to
function . . . independently, appropriately, effectively, and on
11

a sustained basis,” id., § 12.00F.2.e. The ALJ here found that
Plaintiff’s mental symptoms caused no limitation in Plaintiff’s
ability to understand, remember, and apply information and moderate
limitation in his abilities to interact with others, maintain CPP,
and adapt/manage himself. (See Tr. 19.) Plaintiff has challenged
the ALJ’s findings with respect to interaction, CPP, and
adaptation/self-management. (See Docket Entry 14 at 3-11.)
a. Interaction
The ALJ provided the following analysis regarding Plaintiff’s
ability to interact with others:
In interacting with others, [Plaintiff] has a moderate
limitation. Medical records showed that [Plaintiff] has
[PTSD], mood disorder, and bipolar affective disorder,
requiring medications. He seems to respond well to
medications. He has friends who he socializes with. He
said he does not like to be around others and has
difficulty making friends. He has no recent inpatient
hospitalization. He can only sustain attention to
perform simple tasks in an environment with no
work-related contact with the general public and only
occasional interaction with co-workers.
(Tr. 19 (emphasis added).) Plaintiff challenges multiple aspects
of the ALJ’s above-quoted analysis, none of which ultimately carry
the day.
Plaintiff first objects to the ALJ’s observation that
Plaintiff “seem[ed] to respond well to medications” (Docket Entry
14 at 6 (referencing Tr. 19)), arguing that Plaintiff “t[ook] a
single medication - [W]ellbutrin for depression” and, “[a]ssuming
arguendo [Plaintiff wa]s responding to [W]ellbutrin, that has no
relevance as to Asperger’s Disorder[, which] is a developmental
12
disorder affecting the individual’s ability to effectively
socialize and communicate” (id.). In that regard, Plaintiff faults
the ALJ for “not discuss[ing] how Asperger’s Disorder affects
[Plaintiff]’s ability to interact with others.” (Id.)
The ALJ did not prejudicially err by omitting an express
discussion of Plaintiff’s Asperger’s disorder in the above-quoted
analysis, because the ALJ’s overall decision makes clear she
adequately considered the impact of Plaintiff’s Asperger’s disorder
on his ability to function socially. At step two, the ALJ
expressly found Plaintiff’s Asperger’s disorder to qualify as a
severe impairment (see Tr. 18), thus finding that Plaintiff’s
Asperger’s disorder significantly limited his ability to perform
work-related mental activities, see 20 C.F.R. § 404.1522(a),
416.922(a). Then, in the ALJ’s evaluation of Plaintiff’s RFC, the
ALJ acknowledged that 1) “[a] Child Diagnostic Evaluation from UNC
TEACCH Center in April 2009 show[ed Plaintiff] was diagnosed with
Asperger’s Disorder” (Tr. 21), 2) at Holly-Hill Behavioral Health
System hospital in January 2010, Plaintiff exhibited “suicidal
thoughts, hallucinations and paranoid thinking” and “received
treatment for bipolar disorder and Asperger’s syndrome” (id.
(emphasis added)), 3) Plaintiff “was hospitalized in September 2012
for agitation and aggression along with hallucinations[ and ] was
diagnosed with . . . Asperger’s disorder by history” (id. (emphasis
added)), 4) Plaintiff “received residential services from September
27, 2013 through April 3, 2015, [at Solutions Community Support
13
Agency] for [PTSD], autism spectrum disorder, Tourette’s Disorder
and obsessive compulsive disorder[, ] did not exhibit any
aggressive behaviors during his short stay in the level II
facilityl[, ] met [his] goal[,] and was discharged” (Tr. 22
(emphasis added)), 5) “[f]rom October 6, 2014 through July 13,
2015, [Plaintiff] attended [the Turning Point] day treatment
program where he .. . was diagnosed with Asperger’s disorder and
depression .. . [but] had difficulty connecting to other students,
particularly since he was gifted academically” (id. (emphasis
added)), 6) at a “psychological consultative evaluation on February
22, 2017, performed by Donna Mansour, licensed psychological
associate [(“LPA Mansour”}] and Christopher Clougherty, Ph.D.,
supervising psychologist,” LPA Mansour noted that Plaintiff “ha[d]
a diagnosis of depression and autism, which d[id] seem consistent
with his presentation,” “was very nervous at times and likely had
some awkward mannerisms that could cause some issues relating to
coworkers and supervisors,” but that Plaintiff “felt that he had
the ability to conform to social standards, comply with rules, and
cooperate with others” (id. (emphasis added); see also Tr. 24
(reflecting ALJ’s remarks that Plaintiff’s “Asperger’s manifest □□□□
itself as social awkwardness rather than limited cognition,” that
Plaintiff did “have some limitations related to mental health
issues . . . but they [we]re not disabling,” and that the RFC
“provide[d] limitations to social interaction consistent with the
evidence in the record”)). That discussion supports the ALJ’s
14

finding that Plaintiff’s mental impairments, including Asperger’s
disorder, caused Plaintiff to suffer moderate limitation, i.e., had
“fair” ability to function “independently, appropriately,
effectively, and on a sustained basis,” 20 C.F.R. Pt. 404, Subpt.
P, App’x 1, § 12.00F.2.c (emphasis added), in his ability to
interact with others.5
Plaintiff further contends that “the ALJ contradict[ed]
herself” by “stating [Plaintiff] ‘has friends who he socializes
with,’” but then remarking that Plaintiff “‘said he does not like
to be around others and has difficulty making friends.’” (Docket
Entry 14 at 7 (quoting Tr. 19).) However, that argument fails for
two reasons. First, both of the ALJ’s above-quoted remarks are
based on Plaintiff’s own statements (see Tr. 49-50 (documenting
Plaintiff’s testimony that he had friends whom he visited and that,
the day before the hearing, he had spent time with friends he had
not seen in awhile), 50 (recording Plaintiff’s statement that he
found it “hard” to make friends due to nervousness)) and thus, to
the extent the statements do contradict one another, the ALJ simply

5 As discussed above, Plaintiff must show that his mental impairments caused
listing level limitations in his ability to function mentally as of the time of
his application dates – October 6, 2016 (SSI) and November 22, 2016 (CDB).
Although mental health records discussed by the ALJ from 2009 to mid-2015 showed
that Plaintiff suffered greater levels of mental dysfunction during that time,
the records from mid-2015 to the date of the ALJ’s decision demonstrated
significant improvement in Plaintiff’s mental symptoms. (See Tr. 21-23; see also
Tr. 24 (containing ALJ’s observations that Plaintiff “experienced significant
traumatic events during childhood after his father passed away, including his
mother engaging in substance abuse and not having custody of [Plaintiff] for a
time[, but n]ow, as an adult, he and his mother have repaired their relationship,
she has stayed sober, and they support each other”).)
15
fulfilled her duty to deal with conflicting evidence. Second, that
argument glosses over the fact that, in finding a moderate
limitation in Plaintiff’s ability to interact with others, the ALJ
necessarily found evidence that supported some limitation in that
area, while also noting evidence that failed to support greater
limitations.
Next, Plaintiff argues that “the notes from the Turning Point
Day Treatment program document [Plaintiff] ha[d] an extreme
limitation interacting with others . . . and acting in a socially
appropriate manner” (Docket Entry 14 at 7 (citing Tr. 514, 520,
524, 526, 530, 541, 543, 545, 549, 551, 553, 555, 567, 570, 572,
574, 575, 578, 582, 585, 587, 598, 601, 602, 604, 607, 614, 615,
621, 628, 629, 652, 659, 698, 717, 751, 768)), as well as “an
extreme problem accepting authority and following instructions”
(id. (citing Tr. 514, 520, 524, 526, 530, 543, 545, 553, 555, 567,
570, 572, 578, 582, 586, 588, 598, 601, 607, 615, 628, 629, 659,
702, 713, 717)). Plaintiff additionally notes that “[t]he ALJ did
not discuss the Turning Point records.” (Id.)
As an initial matter, as quoted above, the ALJ did discuss
Plaintiff’s treatment at Turning Point, noting that, “[f]rom
October 6, 2014 through July 13, 2015, he attended [the Turning
Point] day treatment program where he received academic instruction
along with mental health treatment[, ] was diagnosed with
Asperger’s disorder and depression . . . [but] had difficulty
connecting to other students, particularly since he was gifted
16
academically.” (Tr. 22 (emphasis added).) Moreover, although the
ALJ did not expressly recite the daily details of Plaintiff’s
treatment at Turning Point (see id.), the ALJ labored under no
obligation to discuss every piece of evidence in the record. See,
e.g., Reid v. Commissioner of Soc. Sec., 769 F.3d 861, 865 (4th
Cir. 2014); Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998); Diaz
v. Chater, 55 F.3d 300, 308 (7th Cir. 1995). Furthermore,
Plaintiff has not shown how a remand for the ALJ to further discuss
the 2014-15 Turning Point records would lead to a different result
in this case. To qualify for CDB and SSI, Plaintiff must show that
he remained disabled as of his application dates of October 2 and
November 22, 2016, respectively. As discussed above, and as the
ALJ acknowledged (see Tr. 24), although records from 2009 to mid-
2015 (including the Turning Point records) show that Plaintiff
suffered from greater limitations in his ability to interact with
others (see, e.g., Tr. 1010-13, 1017-19, 1022-24, 1042-54, 1512-18,
1526-29, 1534-44, 1594-1677), records since mid-2015 demonstrate
improvement in his symptoms (see, e.g., Tr. 428-34, 444-46, 458-61,
467-70, 488-90, 497-500, 914-18, 923-24, 973-76).
Plaintiff also maintains that “the ALJ’s statement that
[Plaintiff] ‘has no recent inpatient hospitalization’ is a non
sequitur” (Docket Entry 14 at 7 (quoting Tr. 19)), because “[i]t
has no bearing on [Plaintiff]’s ability to interact with others”
(id.). According to Plaintiff, he “can have an extreme limitation

17

on interacting with others and have no need for inpatient
hospitalization.” (Id. at 7-8.) Contrary to Plaintiff’s
allegation, the fact that Plaintiff had no recent psychiatric
inpatient hospitalizations does hold relevance to an assessment of
his ability to interact with others. Indeed, Plaintiff’s
aggression towards himself and others and other inappropriate
social behavior triggered many of Plaintiff’s prior psychiatric
inpatient hospitalizations, as well as his stints in group homes.
(See, e.g., Tr. 1010-13, 1017-19, 1022-24, 1042-54, 1516-17, 1526-
29, 1657-58.) Thus, the absence of any psychiatric inpatient
hospitalizations (or group home stays) since mid-2015 provides
support for the ALJ’s finding that Plaintiff’s mental impairments
improved over time and now caused only moderate limitation in his
ability to interact with others.
Additionally, Plaintiff asserts that “the records from the
consulting examiners indicate [Plaintiff] ha[d] difficulty
interacting with others” (Docket Entry 14 at 8), pointing out that
consultative medical examiner Mike Dearinger, D.O., noted Plaintiff
“‘was anxious and constantly moving about the exam room[, ] had a
strange effect [sic][, and] was very sweaty’” (id. (quoting Tr.
790)). Plaintiff also singles out the following observations of
LPA Mansour as supporting extreme limitation in Plaintiff’s ability
to interact with others:
• “‘[Plaintiff] is described as getting very easily
angered and agitated with changes in his routine, which
18
could cause issues relating to others’” (id. at 8
(quoting Tr. 800) (emphasis added));
« “*ThjJe is described as isolating himself from others
because of depression and pain’” (id. (quoting Tr. 800)
(emphasis added));
« “*‘Th]e does have a diagnosis of depression and autism,
which do seem consistent with his presentation’” (id.
(quoting Tr. 802));
« “*‘Th]e was very nervous at times and likely has some
awkward mannerisms that could cause some issues relating
to coworkers and supervisors’” (id. (quoting Tr. 802)
(emphasis added)); and
* “‘thjle is described as having great difficulty
tolerating changes in his routine as well as stress and
pressures’” (id. (quoting Tr. 802) (emphasis added)).°®
As an initial matter and as emphasized above, three of the six
statements upon which Plaintiff relies constitute LPA Mansour’s
mere recitations of Plaintiff’s subjective symptom reports, rather
than LPA Mansour’s objective observations of Plaintiff’s behavior
during the examination or other independent verification. (See Tr.
800, 802.) The ALJ found Plaintiff’s “statements concerning the
intensity, persistence and limiting effects of [his] symptoms are
not entirely consistent with the medical evidence and other
evidence in the record for the reasons explained in th[e] decision”
(Tr. 24) and, as discussed below in the context of Plaintiff’s
third assignment of error, Plaintiff has not demonstrated error
with respect to that finding. Thus, Plaintiff’s above-quoted

° LPA Mansour ultimately concluded that Plaintiff could understand, retain, and
follow instructions and could sustain attention sufficiently to perform simple,
repetitive tasks. (See Tr. 802.)
19

statements (recounted by LPA Mansour) would not have compelled the
ALJ to find marked (let alone extreme) limitation in Plaintiff’s
ability to interact with others. The three remaining statements at
issue actually harmonize with the ALJ’s findings that Plaintiff’s
Asperger’s disorder constituted a severe impairment (see Tr. 18),
manifested as social awkwardness (see Tr. 24), caused moderate
limitation in Plaintiff’s ability to interact with others (see Tr.
19), but did not qualify as disabling (see Tr. 19, 24).
Lastly, Plaintiff argues that “the longitudinal evidence is
persuasive” because, “[s]Jince dropping out of Turning Point six
years ago, [Plaintiff] has not attended school, has not worked, []
has not participated □□□ any social activities[, and ] lives the
life of a recluse with his mother providing for all his needs.”
(Docket Entry 14 at 8 (emphasis added).) Although the record does
show that Plaintiff has neither attended school nor performed any
substantial gainful activity since dropping out of the Turning
Point program in 2015, the record refutes Plaintiff’s claim that,
during such time, he did not “participate[] in any social
activities” and “live[d] the life of a recluse” (id. (emphasis
added)). In that regard, Plaintiff (A) testified at the hearing in
May 2019 that he had friends whom he visited and that, the day
before the hearing, he had spent time with friends he had not seen
in awhile (see Tr. 49-50) and (B) stated, on a Function Report
dated December 9, 2016, that he could go out alone (see Tr. 316),
participated in social gatherings as a hobby (see Tr. 317), talked
20

and joked with others (see id.), and experienced no problems
getting along with others (see Tr. 318) or respecting authority
(see Tr. 319). Plaintiff additionally told LPA Mansour in February
2017 that he could conform to social standards and rules, as well
as that he could cooperate with others. (See Tr. 800.)
In short, Plaintiff has neither established prejudicial error
by the ALJ in her evaluation of Plaintiff’s ability to interact
with others, nor pointed to evidence that would have compelled the
ALJ to find marked (or extreme) limitation in that functional area.
lb. CPP
Here, the ALJ offered the following explanation for finding
moderate limitation in Plaintiff’s ability to maintain CPP:
With regard to [CPP], [Plaintiff] has a moderate
limitation. Medical records showed that [Plaintiff] has
[PTSD], mood disorder, and bipolar affective disorder.
He reported concentration issues that would interfere
with work activity. However, he watches television,
plays video games and does research on the internet. He
can sustain attention and follow instructions.
(Tr. 19 (emphasis added).) Plaintiff objects to the ALJ’s analysis
on three grounds; however, none of those grounds have merit.
First, Plaintiff maintains that the ALJ’s reliance on
Plaintiff’s above-emphasized leisure activities constitutes a “non
sequitur,” because “[t]he act of watching TV, playing video games
or surfing the internet provides no information about how long the
individual can concentrate” (Docket Entry 14 at 9 (emphasis
added)}), and “[t]he ability to perform simple tasks differs from

21

the ability to stay on task” (id. (citing Mascio v. Colvin, 780
F.3d 632, 638 (4th Cir. 2015))). Plaintiff’s argument fails,
because his own statements reflect “how long [he] c[ould]
concentrate” (id.). Plaintiff testified at the hearing that he
usually woke up at 4 am and read, played video games, or used his
computer until 8 or 9 am, i.e., a time period of four to five
hours. (See Tr. 50.) He later testified that he watched videos on
YouTube, looked at the news, and played video games that involved
history “for a couple of hours.” (Tr. 61 (emphasis added); see
also Tr. 21 (containing ALJ’s acknowledgment of Plaintiff’s
testimony that, “in a typical day[,] he goes on-line and watches
funny videos or the news[ and ] enjoys playing video games for a
couple of hours” (emphasis added)).) Thus, Plaintiff’s own
testimony provided the ALJ with a basis to gauge “how long
[Plaintiff] cfould] concentrate” (Docket Entry 14 at 9), and
supported the ALJ’s finding that Plaintiff had moderate limitation
in CPP.
Second, Plaintiff criticizes the ALJ for “not discuss[ing] any
of the records addressing concentration.” (Id. (emphasis added)
More specifically, Plaintiff points to LPA Mansour’s statement that
Plaintiff “is described as having difficulty with focusing, poor
concentration and attention, easily frustrated and angered with new
Situations” (id. (quoting Tr. 799) (emphasis added)), as well as to
“Turning Point records [which] document that [Plaintiff] has an
extreme lack of focus” (id. (citing Tr. 514, 526, 530, 532, 534,
22

537, 539, 541, 543, 545, 551, 553, 565, 567, 570, 572, 575, 587,
601, 602, 604, 607, 614, 615, 628, 629, 652, 656, 659, 661, 669,
671, 679, 700, 702, 704, 711, 715, 717, 725, 740, 743, 745, 749,
751, 754, 764, 766, 768)).
Plaintiff’s contention fails for two reasons. First,
Plaintiff again relies on LPA Mansour’s recitation of Plaintiff’s
subjective symptoms reports, rather than LPA Mansour’s objective
observations of Plaintiff during the examination (or other
independent verification). Notably, LPA Mansour actually concluded
that Plaintiff could sustain attention sufficiently to perform
simple, repetitive tasks. (See Tr. 802.) Second, as discussed
above, although the 2014-15 Turning Point records do reflect that
Plaintiff then struggled with focus and attention, Plaintiff must
show that he remained disabled as of his application dates in
October and November 2016, and treatment records since mid-2015,
which the ALJ did discuss (see Tr. 22-23), consistently reflected
normal attention and concentration (see Tr. 429, 437, 445, 452,
459, 468, 475, 482, 489, 498, 506, 802, 917, 924, 974).
Third, Plaintiff faults the ALJ for failing to discuss how
Plaintiff’s PTSD, mood disorder, bipolar disorder, fibromyalgia,
and hallucinations affect his concentration. (Docket Entry 14 at
9.) With regards to hallucinations, Plaintiff points to his
“testi[mony] that constantly hearing voices is absolutely
distracting.” (Id. (citing Tr. 55).) The ALJ expressly referenced
Plaintiff’s “[PTSD], mood disorder, and bipolar affective disorder”
23
in her discussion of Plaintiff’s ability to maintain CPP (Tr. 19)
and, although the ALJ did not explicitly evaluate the impact of
Plaintiff’s fibromyalgia on his ability to maintain CPP, the ALJ
did discuss Plaintiff’s fibromyalgia treatment as part of her
analysis of his RFC (see Tr. 23) and, in particular, Dr.
Dearinger’s observation that, despite objective signs of
fibromyalgia symptoms on examination, Plaintiff had normal
concentration (see Tr. 23-24; see also Tr. 786-96). Although
Plaintiff did testify that he found hearing voices distracting
(see Tr. 55), the ALJ found that Plaintiff’s “statements concerning
the intensity, persistence and limiting effects of [his] symptoms
[we]re not entirely consistent with the medical evidence and other
evidence in the record” (Tr. 24; see also Tr. 24-25 (“[Plaintiff]’s
testimony at the hearing was not persuasive as to intensity,
persistence and limiting effects of symptoms and not fully
consistent with the medical record.”)) and, as discussed below in
the context of Plaintiff’s third assignment of error, Plaintiff has
not demonstrated error with respect to that finding.
In sum, Plaintiff has failed to point to record evidence that
would have compelled the ALJ to find marked (or extreme) limitation
in Plaintiff’s ability to maintain CPP.
c. Adaptation/Self-Management
Regarding Plaintiff’s ability to adapt/manage himself, the ALJ
provided the following evaluation:

24
As for adapting or managing oneself, [Plaintiff] has a
mild limitation. There are no records from treating or
consultative sources showing consistent problems with
[Plaintiff]’s ability to regulate emotions, control
behavior and maintain well-being in a work setting. He
lives with his mother. He said he does not shower and
sometimes sleeps in his clothes several times per week.
He is often noted to have normal appearance and mood with
no evidence of trouble controlling his temper (see e.g.
Exhibit 9F). He has no recent inpatient hospitalization.
(Tr. 19-20 (emphasis added).) Plaintiff provides four rationales
to contest the ALJ’s analysis, none of which provide the Court with
a basis to disturb the ALJ’s adapation/self-management finding.
First, Plaintiff notes that “there are no records of
[Plaintiff]’s functioning in a work setting because he has no work
experience.” (Docket Entry 14 at 10.) Plaintiff’s effort to parse
the ALJ’s chosen verbiage misses the mark, as the ALJ clearly
tracked the language from the applicable regulation, which defines
the ability to adapt and mange onself as including “the abilit[y]
to regulate emotions, control behavior, and maintain well-being in
a work setting,” 20 C.F.R. Pt. 404, Subpt. P, § 12.00E.4 (emphasis
added). The ALJ’s analysis conveys the salient point that he found
“no records from treating or consultative sources showing
consistent problems with [Plaintiff]’s ability to regulate
emotions, control behavior and maintain well-being.” (Tr. 19
(emphasis added).) As discussed both above and below, the record
supports that observation by the ALJ.
Second, Plaintiff faults “the ALJ [for] cit[ing] Ex[hibit] 9
to support a finding of ‘normal’ appearance and mood,” noting that
25
Exhibit 9 “consists of a single visit with a therapist on 5/19/16,
three years prior to the Hearing[, and t]he therapist put an ‘X’ by
the box indicating normal general appearance, an ‘X’ by the box
indicating normal mood, and an ‘X’ by the box indicating normal
interview behavior[] . . . [without] comments on these topics.”
(Docket Entry 14 at 10 (citing Tr. 973-75).) Plaintiff’s argument,
however, ignores the fact that the ALJ cited “[s]ee eg Exhibit 9”
(Tr. 20 (emphasis added)), meaning “exempli gratia,” or “for
example.” Thus, the ALJ did not rely on a single instance of
normal appearance, mood, and behavior to support his moderate
finding in this functional area. Indeed, consistent with the
example singled out by the ALJ as representative of the record more
broadly, most of the mental status examinations since mid-2015
reflect Plaintiff’s normal appearance, mood, and/or behavior. (See
Tr. 428-30, 444-46, 458-60, 488-90, 497-99, 505-07, 917-18, 923-24,
973.)
Third, Plaintiff points to LPA Mansour’s finding that
Plaintiff “‘is described as having great difficulty tolerating
changes in his routine as well as stress and pressures.’” (Docket
Entry 14 at 10 (quoting Tr. 802) (emphasis added).) As discussed
above, Plaintiff again misrelies on LPA Mansour’s recitation of
Plaintiff’s subjective symptoms reports, rather than LPA Mansour’s
objective observations of Plaintiff during the examination (or
other independent determinations). LPA Mansour neither made any

26
objective findings nor offered any opinions relating to Plaintiff’s
ability handle stress or pressure. (See Tr. 800-02.)
Fourth, Plaintiff maintains that “the Turning Point records
show severe problems with [Plaintiff]’s ability to regulate his
emotions and control his behavior in a structured academic
setting.” (Docket Entry 14 at 10 (citing Tr. 514, 520, 524, 526,
530, 541, 543, 545, 549, 551, 553, 555, 567, 570, 572, 574, 575,
578, 582, 585, 587, 598, 601, 602, 604, 607, 614, 615, 621, 628,
629, 652, 659, 698, 717, 751, 768).) Although the 2014-15 Turning
Point records show that, during that time period, Plaintiff had
difficulty regulating his emotions, controlling his behavior, and
maintaining his well-being, Plaintiff must show that his disability
continued through his application dates in October and November
2016, and treatment records since mid-2015 consistently reflected
Plaintiff’s normal appearance, mood, and/or behavior. (See Tr.
428-30, 444-46, 458-60, 488-90, 497-99, 505-07, 917-18, 923-24,
973.)
Put simply, Plaintiff has not shown that the ALJ erred with
regard to finding moderate limitation in Plaintiff’s ability to
adapt and manage himself. As a result, the Court should deny
relief on Plaintiff’s first issue on review.
2. Schizoaffective and Anxiety Disorders
Next, Plaintiff asserts that “[t]he ALJ committed error by
failing to include schizoaffective disorder and anxiety disorder as

27
severe impairments.” (Docket Entry 14 at 12 (bold font and
single-spacing omitted).) More specifically, Plaintiff maintains
that he “has a psychotic disorder as defined by Listing 12.03 A”
(id. at 13), and points out that he “has been hearing voices since
his father died when he was eight years old” (id. at 12 (citing Tr.
1010)), that, “[a]t the hearing[, he] testified he still hear[d]
voices” (id. (citing Tr. 54-55)), and that “[t]he Turning Point
records also document hallucinations” (id. at 13 (citing Tr. 541)).
Plaintiff further contends that he “has an anxiety disorder as
defined by Listing 12.06 A” (id. at 15), and notes that, upon
discharge from Central Regional Hospital on January 30, 2013, “his
principal diagnosis was anxiety disorder, [no other specification
(‘NOS’)]” (id. at 13 (citing Tr. 1542)), that LPA Mansour “affirmed
anxiety, stating ‘[h]e does indicate that he can get really anxious
when he has too much information to focus on[ and ] can get
stressed and have anxiety attacks with shortness of breath and
heart palpitations’” (id. (citing Tr. 799, 801)), that “UNC
Psychiatry affirmed anxiety” (id. (citing Tr. 1467)), and that,
“[a]t the hearing[, Plaintiff] described his anxiety” (id. (citing
Tr. 52-54)). Plaintiff’s arguments fall short.
a. Schizoaffective Disorder
As a threshold matter, at step two, the ALJ found Plaintiff’s
Asperger’s disorder, PTSD, mood disorder, and bipolar affective
disorder to constitute severe impairments, and found Plaintiff’s
Tourette’s syndrome and obsessive-compulsive disorder non-severe
28
medically determinable impairments. (See Tr. 18.) Thus, the ALJ
did not find that schizoaffective disorder qualified as even a
medically determinable impairment, let alone a severe impairment.
The ALJ did not err in that regard.
The Commissioner’s regulations provide that a medically
determinable impairment “must result from . . . psychological
abnormalities that can be shown by medically acceptable clinical
and laboratory diagnostic techniques[ and, t]herefore, a . . .
mental impairment must be established by objective medical evidence
from an acceptable medical source.” 20 C.F.R. §§ 404.1521, 416.921
(emphasis added). In other words, a claimant’s own “statement of
symptoms” does not suffice “to establish the existence of a[
medically determinable] impairment[].” Id. (emphasis added).
Here, records from an inpatient psychiatric hospitalization in
July 2012 at age 13 reflect a diagnosis of “[s]chizoaffective
d[isorder], bipolar type v[ersus] schizophrenia” (Tr. 1010);
however, at another hospitalization just a couple of months later,
Plaintiff’s diagnoses no longer included schizoaffective disorder
(see Tr. 1019). More significantly, at an inpatient psychiatric
hospitalization in October 2012, the provider made the following
observations:
[Plaintiff] claims that he has delusions and visual
hallucinations and auditory hallucinations but declines
to discuss them with me and does not seem to be affected
by those delusions. He also mentions that he has split
personality. He believes that he talks to people that
are images of himself and that he creates situations that
are not true and then he believes in them.
29
Reason for admission was aggression, psychosis, mood
dyscontrol. We have not seen any of that throughout the
hospitalization. [Plaintiff] came in and during his
master treatment plan he insisted that his diagnosis
should change to schizophrenia. He said that he started
by having bipolar disorder then the evolution was to
schizoaffective but now he believed that he could be
given a diagnosis of schizophrenia. We never saw any
symptoms and our understanding of that was that
[Plaintiff] was made [to] believe that he was sick
throughout his life. He grew up in a dysfunctional
environment and he did tell us later that he saw his
mother being possessed by the demon and that step-dad was
abusive and he was always made [to] believe that _he was
crazy and delusional.
(Tr. 1540 (emphasis added) .) Plaintiff’s diagnoses at discharge
did not include schizoaffective disorder (or schizophrenia). (See
Tr. 1542.)
Most importantly, none of Plaintiff’s treatment records after
July 2012 contain a diagnosis of schizoaffective disorder. (See
Tr. 424, 433-34, 441-42, 463-64, 493-94, 502-03, 510-11, 819, 851,
858, 869, 874, 883, 888, 894, 905 (containing treating physician’s
diagnosis of “[m]ood disorder with history of psychosis” (emphasis
added)), 915, 921, 934, 970-71, 979-80, 1599, 1610, 1622, 1635-44,
1648-49, 1652-53, 1656, 1682, 1692 (reflecting treating physician’s
diagnosis of “[u]nderlying mood disorder previously characterized
as bipolar affective disorder with psychosis” (emphasis added)).)’

7 A treatment record dated October 25, 2013, contains a diagnosis of “psychotic
d[isorder NOS]” without accompanying explanation for that diagnosis (Tr. 1648),
which neither appeared before nor appeared after that date in the ongoing
treatment records of the Solutions Community Support Agency (see Tr. 1594-1677).

30

Moreover, LPA Mansour did not diagnose schizoaffective disorder
(see Tr. 801-02), and the reconsideration-level state agency
psychological examiner, whose opinions the ALJ credited (see Tr.
25), did not assess schizoaffective disorder as one of Plaintiff’s
mental impairments. (See Tr. 120-21.) Furthermore, although
Plaintiff testified to experiencing ongoing hallucinations, his
testimony alone does not suffice to establish schizoaffective
disorder as a medically determinable impairment. See 20 C.F.R.
404.1521, 416.921.
As Plaintiff has not shown “objective medical evidence from an
acceptable medical source,” 20 C.F.R. §§ 404.1521, 416.921
(emphasis added), that his schizoaffective disorder persisted past
2012, he has not shown that the ALJ erred by failing to categorize
it as a medically determinable impairment, let alone a severe
impairment.
b. Anxiety Disorder
Similar to schizoaffective disorder, the ALJ did not find that
Plaintiff’s anxiety disorder qualified as a medically determinable
impairment. (See Tr. 18.) Even assuming, arguendo, that the ALJ
erred in that regard, any such error remains harmless under the
circumstances presented here. See Fisher v. Bowen, 869 F.2d 1055,
1057 (7th Cir. 1989) (observing that “[n]lo principle of
administrative law or common sense requires us to remand a case in
quest of a perfect opinion unless there is reason to believe that
the remand might lead to a different result”). The ALJ clearly
31

acknowledged Plaintiff’s anxiety symptoms (see Tr. 21 (containing
ALJ’s recitation of Plaintiff’s testimony that he “has trouble
making friends due to nervousness,” “experiences anxiety attacks
that cause numbness in his wrists and ankles,” “becomes anxious
when he becomes depressed and vice versa,” and has “anxiety []
triggered by loud noises or being in a crowded place”)), but
evaluated them under Listing 12.15 for PTSD (see Tr. 19). Listings
12.06 and 12.15 contain the same paragraph B criteria, compare 20
C.F.R. Pt. 404, Subpt. P, App’x 1, § 12.06B, with id., § 12.15B,
and, as discussed above, Plaintiff has not shown that the ALJ erred
with respect to the paragraph B criteria findings. See Morrison v.
Saul, No. 1:19CV413, 2020 WL 5111251, at *8 (M.D.N.C. Aug. 31,
2020) (unpublished) (finding any error by ALJ regarding Listing
chosen to analyze mental impairment remained harmless, because
“remand for the ALJ to analyze [the p]laintiff’s intellectual
deficits under Listing 12.05B would not result in a different
outcome,” where “Listings 12.05B and 12.l1 share the same paragraph
B criteria”), recommendation adopted, 2020 WL 5821077 (M.D.N.C.
Sept. 30, 2020) (unpublished) (Osteen, Jr., J.).
In light of the above analysis, the Court should deny relief
on Plaintiff’s second issue on review.
3. Mental RFC
Lastly, Plaintiff maintains that “[t]he mental RFC is not
supported by substantial evidence.” (Docket Entry 14 at 15 (bold

32
font omitted).) In particular, Plaintiff raises three arguments
challenging the ALJ’s mental RFC: 1) “[t]he ALJ failed to provide
a logical bridge between the evidence cited and [RFC] conclusions
reached” (id. at 16), 2) the ALJ “placed too much weight on there
being no recent [inpatient psychiatric] hospitalizations” (id.
(bold font omitted)), and 3) “the ALJ [] cherry[-]picked the
evidence to support her conclusion” (id. at 18). Those contentions
fail to entitle Plaintiff to relief.
Plaintiff first asserts that “[t]he ALJ failed to provide a
logical bridge between the evidence cited and [RFC] conclusions
reached” (id. at 16) in two respects: 1) “[t]he ALJ cite[d]
records” in her evaluation of the RFC, but “did not explain why she
reached the conclusions she did,” stating only that Plaintiff’s
“‘testimony at the hearing was not persuasive as to intensity,
persistence and limiting effects of symptoms and not fully
consistent with the medical record’” (id. (quoting Tr. 24-25)), and
2) “[t]he ALJ mention[ed] hallucinations, but [neither] discuss[ed]
the impact hallucinations ha[d] on [Plaintiff]’s ability to
concentrate and interact with others,” nor “discuss[ed] the
synergistic effect the combination of depression, anxiety, PTSD and
autism ha[d] on the severity of symptoms” (id.).
The ALJ’s decision adequately explains why she did not find
Plaintiff’s testimony about his mental symptoms fully consistent
with the record. To begin, the ALJ provided more of an explanation
for finding Plaintiff’s testimony not fully consistent with the
33
record than Plaintiff’s above-listed quotation alleges. (See
Docket Entry 14 at 16 (quoting Tr. 24-25).) In fact, the ALJ
explained as follows:
[Plaintiff] experienced significant traumatic events
during childhood after his father passed away, including
his mother engaging in substance abuse and not having
custody of [Plaintiff] for a time. Now, as an adult, he
and his mother have repaired their relationship, she has
stayed sober, and they support each other. There are no
recent inpatient hospitalization for any mental
impairment.
(Tr. 24.)
The ALJ additionally discussed medical evidence which showed
that Plaintiff’s mental symptoms began to stabilize in late 2014
and then remained stable from mid-2015 through the time of the
ALJ’s decision:
[Plaintiff] began receiving medication management at
Freedom House on November 4, 2014, which he felt to be
helpful and kept him stabilized and out of the hospital.
. . .
Records from UNC Health Care on May 2, 2015, show
[Plaintiff] was seen for psychiatry evaluation. His mood
was depressed, but he had normal thoughts, orientation,
attention, concentration, and memory. He had fair
insight, judgment and impulse control. He had [PTSD];
mood disorder, [NOS]; and hypertension. On March 17,
2016, [Plaintiff] was dealing with stress considerably
well and had started back for GED tests. He felt more
independent and he was making good decisions. Notes show
[Plaintiff] had a job and was doing really well. He
denied suicidal ideation. His mental status examination
was normal. [Plaintiff] was making friends. He was
diagnosed with [PTSD], chronic; [PTSD] and Tourette’s
disorder. On May 19, 2016, [Plaintiff] was feeling less
depressed.
(Tr. 22 (internal parenthetical citations omitted).)
34
The ALJ’s discussion of the opinion evidence also supported
the ALJ’s mental RFC. In that regard, the ALJ afforded “great
weight” to the reconsideration-level state agency psychological
consultant (Tr. 25) who opined that, despite Plaintiff’s mental
impairments, he remained capable of simple, routine, and repetitive
tasks with limited interaction with the general public (see Tr.
122, 127, 142, 147, 162, 167). The ALJ also accorded “partial
weight” to LPA Mansour’s opinions, explaining further as follows:
. . . it is vague in degree of limitations, though
finding that he can understand, remember and follow
instructions is consistent with evidence of no limitation
in understand, remember and apply information, can
sustain attention to simple tasks and “likely has some
awkward mannerisms that could cause some issues relating
to coworkers and supervisors” is vague but with other
evidence, supports occasional interaction with coworkers
and no interaction with public.
(Tr. 25.) As the Court can trace the path of the ALJ’s reasoning
from the evidence to the mental RFC findings, Plaintiff has not
shown that “[t]he ALJ failed to provide a logical bridge” (Docket
Entry 14 at 16).
Regarding hallucinations, the ALJ did discuss Plaintiff’s
claim that “[h]e begins hearing voices in his head telling him to
run away or hurt himself” and “hears voices that say things that
upset him” (Tr. 21), but found his testimony not fully consistent
with the record (see Tr. 24), and Plaintiff has not shown error
with respect to that finding. Moreover, the ALJ found moderate
limitations in Plaintiff’s ability to interact with others and to
maintain CPP (see Tr. 19), and Plaintiff simply has not shown that
35
the evidence relating to his hallucinations should have compelled
the ALJ to adopt greater restrictions.
Plaintiff’s assertion that the ALJ failed to “discuss the
synergistic effect the combination of depression, anxiety, PTSD and
autism ha[d] on the severity of symptoms” (Docket Entry 14 at 16)
fares no better. At step three, the ALJ found that “[t]he severity
of [Plaintiff]’s mental impairments, considered singly and in
combination, d[id] not meet or medically equal the criteria of
listings 12.02, 12.04, 12.10, and 12.15” (Tr. 19 (emphasis added))
and, in formulating the RFC, the ALJ indicated that he had
“careful[ly] consider[ed ] the entire record” (Tr. 20 (emphasis
added)). Absent evidence to the contrary (not adduced here), the
Court may take the ALJ at her word. See Reid, 769 F.3d at 865
(holding that, if “the ALJ . . . stated that the whole record was
considered, . . . absent evidence to the contrary, we take her at
her word”).
Next, Plaintiff objects to the ALJ’s reliance on the lack of
recent inpatient psychiatric hospitalizations in formulating the
mental RFC. (Docket Entry 14 at 16-18.) As to that matter,
Plaintiff notes that “[t]he primary reason for a psychiatric
hospitalization is the individual represents an immediate suicidal
or homicidal risk,” and points out that “[a] person can have a
disabling mental disorder and at the same time not be suicidal or
homicidal.” (Id. at 17.) Thus, Plaintiff argues that his
testimony that “he [wa]s no longer experiencing significant
36
suicidal or homicidal ideation” does not preclude a finding of
mental disability, and that “[t]he only logical inference to be
derived from no recent hospitalizations is that [Plaintiff] ha[d]
not recently been suicidal or homicidal.” (Id. at 17.) The lack
of recent inpatient psychiatric hospitalizations does not, in an of
itself, disprove mental disability. However, the ALJ did not rely
solely on the absence of such hospitalizations in determining the
mental RFC, nor did she find that such absence meant that Plaintiff
lacked severe mental impairments or any limitations arising out of
those impairments. Rather, the ALJ found that the lack of such
hospitalizations constituted evidence, along with other factors in
the record, showing that Plaintiff’s mental symptoms stabilized
after mid-2015. (See Tr. 24.) The ALJ did not err in that regard.
Plaintiff further contends that “the ALJ used a negative (the
lack of hospitalizations) to prove a positive (medical
improvement)” and, “[a]lthough this assertion is not impossible,
. . . [t]here are several more plausible explanations for
[Plaintiff] not being hospitalized since he was sixteen.” (Docket
Entry 14 at 17.) According to Plaintiff, “a more reasonable
explanation for there being no recent hospitalizations is that
[Plaintiff] was traumatized by past hospitalizations.” (Id. at
18.) Plaintiff further emphasizes that he experienced “panic
attacks every time he le[ft] his house,” and “seclude[d] himself in
his bedroom because it [wa]s the safest place he kn[ew].” (Id.
(citing Tr. 1011).) Plaintiff’s argument glosses over the fact
37
that, although Plaintiff may opt against attending therapy, as he
testified at the hearing (see Tr. 58-59), involuntary commitment
for psychiatric reasons does not constitute a matter a choice. If
Plaintiff had continued to engage in the kind of aggressive and
violent behavior that lead to his earlier hospitalizations, he
likely would have faced involuntary commitment. Those
considerations bear relevance to the ALJ’s assessment of the
continuing severity of Plaintiff’s symptoms. For the same reasons,
Plaintiff’s reliance on his panic attacks to explain the lack of
hospitalizations falls short. Moreover, the record reflects that
Plaintiff’s panic attacks did not prevent him from going on walks
and attending regular medical appointments, church, shopping
excursions, and social gatherings. (See Tr. 49-50, 61, 316, 317,
428, 444, 770, 916.)
Finally, Plaintiff faults the ALJ for cherry-picking the
evidence to support the mental RFC. (Docket Entry 14 at 18.)
However, in that same paragraph, Plaintiff notes that “[t]Jhe ALJ
concluded that Plaintiff c[ould] perform Light work” (id. (emphasis
added)), i.e., an exertional component of the physical RFC rather
than a non-exertional component of the mental RFC, and then failed
to provide any support for the assertion that the ALJ “cherryl[-
]Jpicked” the evidence (id. at 18-19). That failure precludes
relief on this front. See United States v. Zannino, 895 F.2d 1, 17
(lst Cir. 1990) (“[A] litigant has an obligation to spell out its
arguments squarely and distinctly, or else forever hold its peace.”
38

(internal quotation marks omitted)); Hughes v. B/E Aerospace, Inc.,
No. 1:12CV717, 2014 WL 906220, at *1 n.1 (M.D.N.C. Mar. 7, 2014)
(unpublished) (Schroeder, J.) (“A party should not expect a court
to do the work that it elected not to do.”).
Under these circumstances, Plaintiff’s third assignment of
error lacks merit.
III. CONCLUSION
Plaintiff has not established an error warranting relief.
IT IS THEREFORE RECOMMENDED that the Commissioner’s decision
finding no disability be affirmed, that Plaintiff’s Motion for
Judgment on the Pleadings (Docket Entry 13) be denied, that
Defendant’s Motion for Judgment on the Pleadings (Docket Entry 15)
be granted, and that this action be dismissed with prejudice.

/s/ L. Patrick Auld
L. Patrick Auld
United States Magistrate Judge
May 4, 2021

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10253749. Public record. Not legal advice.