# BROWN v. O'MALLEY

> District Court, M.D. North Carolina · March 29, 2024

URL: https://www.frixlaw.com/law-library/cases/10254544

## Case

- **Court:** District Court, M.D. North Carolina
- **Decided:** March 29, 2024
- **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/10254544

## How later opinions describe it (automated extraction)

- reversing where “the ALJ did not sufficiently explain how she weighed significant evidence related to [the claimant’s] mental- health treatment”
- describing evidence as “new” when it is “not duplicative or cumulative” and as “material” when “there is a reasonable possibility that the new evidence would have changed the outcome”
- observing error in ALJ describing treatment as “conservative” when treatment aligned with what is typical for condition

## Opinion text

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF NORTH CAROLINA

CHRISTOPHER B., )
)
Plaintiff, )
)
v. ) 1:22-CV-920
)
MARTIN J. O’MALLEY, )
Commissioner of Social )
Security, )
)
Defendant. )

MEMORANDUM OPINION AND ORDER

THOMAS D. SCHROEDER, District Judge.
Plaintiff Christopher B. challenges the decision of the
Commissioner of the Social Security Administration,1 who denied
his application for disability insurance benefits under the Social
Security Act. Before the court are Plaintiff’s objections to the
magistrate judge’s report recommending that the court affirm the
final decision of the Commissioner. (Doc. 17.) For the reasons
set forth below, the decision of the Commissioner will be reversed,
and this matter will be remanded for further proceedings.
I. BACKGROUND
Plaintiff protectively filed an application for disability
insurance benefits on January 14, 2021, alleging disability as of
July 21, 2020, due to psychosis, attention deficit hyperactivity

1 Martin J. O’Malley was sworn in as the Commissioner of Social Security
on December 20, 2023. Pursuant to Federal Rule of Civil Procedure 25(d),
Martin J. O’Malley is substituted for Kilolo Kijakazi as the Defendant
in this suit.
disorder (“ADHD”), insomnia, high blood pressure, low
testosterone, anxiety, and opioid addiction. (Tr. at 27, 196.)2
The North Carolina state agency denied his claim at the initial

and reconsideration levels of review. (Tr. at 59-84.) On March
9, 2022, an administrative law judge (“ALJ”) held a telephonic
hearing at which Plaintiff and an impartial vocational expert
testified. (Tr. at 43-58.) On March 18, 2022, the ALJ issued a
written decision unfavorable to Plaintiff. (Tr. at 27-38.)
Finding no basis to disturb the ALJ’s decision, the Appeals Council
denied Plaintiff’s request for review, making the ALJ’s decision
the Commissioner’s final decision for purposes of judicial review.
(Tr. at 1-7.) This civil action followed.
In rendering his decision, the ALJ made the following
findings:
1. The claimant meets the insured status requirements of
the Social Security Act through December 31, 2025
(Exhibit 6D, page 1).

2. The claimant has not engaged in substantial gainful
activity since July 21, 2020, the alleged onset date (20
CFR 404.1571 et seq.).

3. The claimant has the following severe impairments:
Attention-deficit/hyperactivity disorder (ADHD);
generalized anxiety disorder (GAD); major depressive
disorder (MDD); and opioid dependence (20 CFR
404.1520(c)).

2 Transcript references are to the sealed administrative record at docket
entry 8.
4. The claimant does not have an impairment or
combination of impairments that meets or medically
equals the severity of one of the listed impairments in
20 CFR Part 404, Subpart P, Appendix 1 (20 CFR
404.1520(d), 404.1525 and 404.1526).

5. [T]he claimant has the residual functional capacity
to perform a full range of work at all exertional levels
but with the following nonexertional limitations: The
claimant could perform simple, routine, and repetitive
tasks in a work environment free of fast-paced
production requirements, involving only simple work-
related decisions, and with few, if any, workplace
changes; he could perform work requiring no interaction
with the public; and he could have occasional
interaction with co-workers and he could be around them
throughout the day.

6. The claimant is unable to perform any past relevant
work (20 CFR 404.1565).3

7. The claimant was born on April 19, 1978 and was 42
years old, which is defined as a younger individual age
18-49, on the alleged disability onset date (20 CFR
404.1563).

8. The claimant has at least a high school education (20
CFR 404.1564).

9. Transferability of job skills is not material to the
determination of disability because using the Medical-
Vocational Rules as a framework supports a finding that
the claimant is “not disabled,” whether or not the
claimant has transferable job skills (See SSR 82-41 and
20 CFR Part 404, Subpart P, Appendix 2).

10. Considering the claimant’s age, education, work
experience, and residual functional capacity, there are
jobs that exist in significant numbers in the national
economy that the claimant can perform (20 CFR 404.1569
and 404.1569a).

11. The claimant has not been under a disability, as
defined in the Social Security Act, from July 21, 2020,
through the date of this decision (20 CFR 404.1520(g)).

3 Plaintiff was previously employed as a jailer. (Tr. at 36.)
(Tr. at 29-38.)

Following briefing by the parties (Docs. 12, 13, 14), the
magistrate judge issued a recommended ruling on November 14, 2023
(Doc. 15). He found that the “Commissioner’s decision is legally
correct, supported by substantial evidence, and susceptible to
judicial review,” and recommended that it be upheld. (Doc. 15 at
19-20.) Plaintiff timely filed objections. (Doc. 17). The
Commissioner has not filed a response.4
II. ANALYSIS
A. Legal Standard
1. Review of Magistrate Judge’s Recommendation
When considering a magistrate judge’s report and
recommendation, a district court must conduct a “de novo

4 Plaintiff submitted two medical records to the Appeals Council, dated
April 6, 2022, and July 27, 2022, that appear to demonstrate an
escalation in symptoms following the ALJ’s opinion. (Tr. at 8-18.) The
Appeals Council declined to consider these records because they did “not
relate to the period at issue” — i.e., the period prior to the March 18,
2022 ALJ decision date. (Tr. at 2.) The records are, in any event,
part of the certified administrative record. Plaintiff cited them in
this action in an index to his brief, (Doc. 12-1), but has not explicitly
requested that the court consider them or challenged the Appeals
Council’s decision not to consider them. Thus, the court has not
considered the records here and does not base its ruling on the Appeals
Council’s decision not to consider them. 20 C.F.R. § 404.970(b)-(c)
(describing when Appeals Council will consider additional evidence);
Wilkins v. Sec’y, Dep’t of Health & Hum. Servs., 953 F.2d 93, 96 (4th
Cir. 1991) (describing evidence as “new” when it is “not duplicative or
cumulative” and as “material” when “there is a reasonable possibility
that the new evidence would have changed the outcome”); see also Norris
v. Colvin, 142 F. Supp. 3d 419, 423-25 (D.S.C. 2015) (remanding to
Commissioner where only discernible rationale for Appeals Council not
considering new evidence that appeared to relate back was that it was
dated after the ALJ’s opinion).
determination of those portions of the report or specified proposed
findings or recommendations to which objection is made.” 28 U.S.C.
§ 636(b)(1); Fed. R. Civ. P. 72(b)(3). In doing so, the district

court “may accept, reject, or modify, in whole or in part, the
findings or recommendations made by the magistrate judge.” 28
U.S.C. § 636(b)(1).
The district court must review the entire record to determine
whether the magistrate judge’s findings are adequately supported
by the record. See Johnson v. Knable, 934 F.2d 319 (Table), 1991
WL 87147, at *1 (4th Cir. May 28, 1991) (per curiam). Where a
party fails to object to a recommendation, however, the court’s
review is for clear error. Diamond v. Colonial Life & Accident
Ins. Co., 416 F.3d 310, 315 (4th Cir. 2005).
2. Judicial Review of Commissioner’s Decision
“[A] reviewing 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.” Hancock v.
Astrue, 667 F.3d 470, 472 (4th Cir. 2012) (internal brackets and
quotation omitted). “Substantial 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. 1993)
(internal quotation omitted). “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)
(internal brackets and quotation omitted).
“A claimant for disability benefits bears the burden of
proving a disability.” Hall v. Harris, 658 F.2d 260, 264 (4th

Cir. 1981). “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)).
“The Commissioner uses a five-step process to evaluate
disability claims.” Hancock, 667 F.3d at 472 (citing 20 C.F.R.
§§ 404.1520(a)(4), 416.920(a)(4)). The Commissioner evaluates
whether the claimant “(1) worked during the alleged period of
disability; (2) had a severe impairment; (3) had an impairment
that met or equaled the requirements of a listed impairment; (4)

could return to her past relevant work; and (5) if not, could
perform any other work in the national economy.” Id.
Where, as here, a claimant clears steps one and two, but
falters at step three, then “the ALJ must assess the claimant’s
residual functional capacity (‘RFC’).” Mastro, 270 F.3d at 179.
RFC measures the most a claimant can do despite any physical and
mental limitations. Hines v. Barnhart, 453 F.3d 559, 562 (4th
Cir. 2006). After determining a claimant’s exertional and non-
exertional capacity in consideration of all of his impairments and
symptoms, the ALJ must determine an appropriate level of work.
Id. at 562-63.
“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).” SSR 96-8p, 1996
WL 374184, at *7. The ALJ is also obligated to “explain how any
material inconsistencies or ambiguities in the evidence in the
case record were considered and resolved.” Id. While the ALJ
need not discuss every piece of evidence, the decision must supply
an “accurate and logical bridge” between the evidence and the
conclusions. Lewis v. Berryhill, 858 F.3d 858, 868 (4th Cir.
2017); Thomas v. Berryhill, 916 F.3d 307, 311 (4th Cir. 2019), as
amended (Feb. 22, 2019) (“[A] proper RFC analysis has three
components: (1) evidence, (2) logical explanation, and (3)

conclusion. The second component, the ALJ's logical explanation,
is just as important as the other two.”).
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. Mastro, 270 F.3d at
179-80. However, if the claimant establishes an inability to
return to prior work, the analysis proceeds to the fifth step,
which “requires the Commissioner to prove that a significant number
of jobs exist which the claimant could perform, despite his
impairments.” Hines, 453 F.3d at 563. In making this
determination, 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.
B. Plaintiff’s Objections
Plaintiff objects to the ALJ’s RFC analysis, which the
magistrate judge recommended be affirmed. First, Plaintiff argues
that the ALJ’s “RFC rationale” is “not supported by substantial
evidence, flouts the law, and conflicts with the ALJ’s other
findings.” (Doc. 17 at 3.) He points specifically to the ALJ’s

consideration of his daily activities and treatment notes and
inconsistencies between the ALJ’s step three analysis and the RFC
analysis. (Id. at 3-13.) Second, Plaintiff contends that the ALJ
erred in finding unpersuasive his treating psychiatric provider’s
medical opinions. (Id. at 13-18.) Third, Plaintiff asserts that
the ALJ erred in discounting his subjective complaints. (Id. at
18-22.)
The ALJ’s RFC analysis first addresses Plaintiff’s subjective
complaints. (Tr. at 33.) In doing so, the ALJ considers the
consistency of the subjective complaints with Plaintiff’s medical
records and daily activities. (Tr. at 34-35.) Thereafter, the
RFC incorporates by reference his findings on those topics in a

paragraph explaining the RFC. (Tr. at 35.) The opinion concludes
with a review of the medical opinions in the case. (Tr. at 35-
36.)
Preliminarily, Plaintiff’s first objection regarding the “RFC
rationale” almost entirely parallels his third objection regarding
the subjective complaints, as both maintain that the ALJ erred
when considering daily activities and medical records. (See Doc.
17 at 3-13, 18-22.) The ALJ’s most explicit “rationale,” (Tr. at
35 (paragraph beginning “The objective findings. . .”),
incorporates by reference the ALJ’s analysis on the subjective
complaints. The court will therefore consider the third objection
regarding subjective complaints first. In doing so, the court

finds that the ALJ erred, including in those portions of his
opinion that incorporate by reference the below-mentioned
erroneous analysis, most notably the paragraph beginning “The
objective findings . . .” (Tr. at 35). See also infra (discussing
same error regarding ALJ’s review of treating psychiatric
provider’s medical opinion (see Tr. at 36)).
1. Subjective Complaints
Plaintiff objects to the ALJ’s dismissal of his subjective
complaints as not credible. (Doc. 17 at 18-22.) The ALJ here
“evaluated the claimant’s and [his wife’s] statements about the
intensity, persistence, and limiting effects of his symptoms and
determined that they were not generally consistent with the record

as a whole.” (Tr. at 33.) The inconsistencies with Plaintiff’s
subjective complaints that the ALJ identified were Plaintiff’s
“positive response to psychiatric medication management, limited
positive psychiatric examination findings, and reported
functioning.” (Id.)
Plaintiff contends that the reliance on “positive response to
psychiatric medication management” and “limited positive
psychiatric examination findings” to discount his subjective
complaints is error because the ALJ “cherry-picked” the medical
record. (Doc. 17 at 9-11.) Additionally, Plaintiff argues that
the ALJ only considered the type of activities (i.e., “reported
functioning”), and not the extent to which the Plaintiff could

perform them, which, in Plaintiff’s view, reflects only an ability
to do unscheduled, abbreviated activities, rather than a 40-hour
work week. (Id. at 9.)
a. Plaintiff’s Subjective Symptoms
“The ALJ evaluates a claimant’s symptoms through a two-prong
framework found in SSR 16-3p, 2016 WL 1119029 (Mar. 16, 2016),
which is further elaborated in 20 C.F.R. § 404.1529.” Shelley C.
v. Comm’r of Soc. Sec. Admin., 61 F.4th 341, 359-60 (4th Cir.
2023). For the first prong, the ALJ must decide whether there is
“an underlying medically determinable physical or mental
impairment that could reasonably be expected to produce the
claimant’s symptoms.” Id. at 360 (citing SSR 16-3p, 2016 WL

1119029). For the second prong, the ALJ considers “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.’” Id. (citing
SSR 16-3p, 2016 WL 1119029, at *4).5 An ALJ may not disregard a
claimant’s subjective statements regarding the “intensity,
persistence, and limiting effects of symptoms solely because the
objective medical evidence does not substantiate the degree of
impairment-related symptoms alleged by the individual.” SSR 16-
3p, 2016 WL 1119029, at *5.

Critically, an ALJ precludes “meaningful review” of his
findings where he fails to “adequately explain his reasoning.”

5 These factors are further elaborated on in 20 C.F.R. § 404.1529(c)(3),
which lists as factors: 1. Daily activities; 2. The location, duration,
frequency, and intensity of pain or other symptoms; 3. Factors that
precipitate and aggravate the symptoms; 4. The type, dosage,
effectiveness, and side effects of any medication an individual takes
or has taken to alleviate pain or other symptoms; 5. Treatment, other
than medication, an individual receives or has received for relief of
pain or other symptoms; 6. Any measures other than treatment an
individual uses or has used to relieve pain or other symptoms (e.g.,
lying flat on his or her back, standing for 15 to 20 minutes every hour,
or sleeping on a board); and 7. Any other factors concerning an
individual’s functional limitations and restrictions due to pain or other
symptoms.
Radford v. Colvin, 734 F.3d 288, 296 (4th Cir. 2013). Moreover,
an ALJ may not “cherry-pick[] from the record” by highlighting
“good moments and bypassing the bad.” Shelley C., 61 F.4th at

362; Arakas v. Comm’r, Soc. Sec. Admin., 983 F.3d 83, 98 (4th Cir.
2020) (“In evaluating a disability claim, [a]n ALJ has the
obligation to consider all relevant medical evidence and cannot
simply cherrypick facts that support a finding of nondisability
while ignoring evidence that points to a disability finding.”
(internal quotations marks omitted)). In such instances, it is
not the “province of the district court” to “reweigh conflicting
evidence, make credibility determinations, or substitute [its]
judgment for that of the [ALJ].” Radford, 734 F.3d at 296
(internal quotations marks omitted). Rather, the appropriate
remedy is to vacate and remand for further investigation and
explanation. Mascio v. Colvin, 780 F.3d 632, 636 (4th Cir. 2015)

(“[R]emand may be appropriate . . . where an ALJ fails to assess
a claimant’s capacity to perform relevant functions, despite
contradictory evidence in the record, or where other inadequacies
in the ALJ's analysis frustrate meaningful review.” (internal
quotation marks omitted and alteration in original)).
Turning to Plaintiff’s subjective complaints identified by
the ALJ, in his application materials Plaintiff reported ADHD,
anxiety, insomnia, opioid addiction, psychosis with “extreme
paranoia” and psychotic break, high blood pressure, and low
testosterone, and later added asthma, major depression with
psychotic features, hallucinations, paranoia, and opioid
dependence. (Tr. at 33.) In a Functions Report, Plaintiff

reported problems with his memory, following instructions,
concentrating or paying attention, completing tasks, getting along
with others, handling stress, and medication side-effects,
including chills, confusion, cough, drowsiness, fever, headaches,
insomnia, memory loss, and “severe” anxiety. (Id.) In the March
9, 2022 hearing before the ALJ, Plaintiff reported mood symptoms,
poor memory and concentration, poor sleep, psychosis, and problems
leaving his home, as well as hallucinations, paranoid thought
content (such as thinking others were trying to kill him). (Id.)
He estimated he could only stay on task for thirty minutes at a
time. (Id.) Plaintiff’s wife submitted Third-Party Function
reports in 2021 that the ALJ noted “largely echoed the claimant’s

allegations.” (Id.)
The ALJ found that these subjective complaints were
undermined by Plaintiff’s “positive response to psychiatric
medication management” and “limited positive psychiatric
examination findings.” (Id.) The ALJ analyzed Plaintiff’s
symptoms as presented in the medical records as follows:
He consistently presented with “mild” or “stable”
symptoms throughout the period at issue, which further
suggested that his routine psychiatric medication
management was effective. His treatment notes also show
that he has not had any documented or reported incidents
of opioid relapse since starting Suboxone in December
2013. The claimant’s examination findings further
illustrated his positive response to psychiatric
medication management. With “mild” or sporadic
exceptions, the claimant has often had normal or
unremarkable psychiatric examination findings with no
signs of consistent or persistent behavioral or
cognitive abnormalities throughout the period at issue.
Even when the claimant periodically complained of
hallucinations, it was noteworthy that he was not
observed to be responding to internal stimuli.

(Tr. at 34.)

The ALJ observed that Plaintiff’s treatment consisted of
“just outpatient psychiatric medication management” rather than
“emergency, inpatient, or other more aggressive mental health
treatment.” (Id.) He stated that Plaintiff “required follow-up
appointments every two-to-three months for refills of those
medications, which were consistently noted as effective and from
which he did not report any side-effects.” (Id.) He later opined,
“If the claimant’s symptoms were as severe as alleged, they would
have likely prompted more aggressive or varied treatment or
presented more consistently or dramatically on examination.
However, they did not.” (Id.)
The ALJ’s analysis of the medical record is not susceptible
to meaningful judicial review. Monroe v. Colvin, 826 F.3d 176,
188 (4th Cir. 2016) (citing Mascio, 780 F.3d at 636). Critically,
the ALJ did not discuss Plaintiff’s medication regimen in any level
of detail. While the record appears to show that Plaintiff had a
positive response to medication, this relative assessment does not
necessarily speak to the question of disability. Arakas, 983 F.3d
at 102 (observing error in ALJ describing treatment as
“conservative” when treatment aligned with what is typical for

condition); Shelley C., 61 F.4th at 367-68 (discussing how
variation in symptoms of major depressive disorder “can appear —
from the outside looking in — as overall improvement” but
nevertheless finding disability). Indeed, the ALJ’s glancing
reference to “medication management” (Tr. at 34), without
reference to the fact that those medications included atypical
antipsychotics, Zyprexa and Risperdal, (Tr. at 353, 532),6 leaves
the court unable to meaningfully review the ALJ’s analysis
regarding Plaintiff’s treatment. Shelley C., 61 F.4th at 363
(describing trend among district courts that have held treatment
is anything but “routine and conservative” where claimants consume
antipsychotic drugs, attend consistent visits with mental health

professionals, and constantly adjust medication).
Further, while the ALJ correctly noted that Plaintiff has not
received inpatient or emergency care, there is no requirement that
a claimant be hospitalized or institutionalized to receive
disability benefits. Easterbrook v. Kijakazi, 88 F.4th 502, 515
(4th Cir. 2023) (“Much as it is beyond the role of a health care

6 General information on Zyprexa and Risperdal is available at
https://my.clevelandclinic.org/health/drugs/18192-olanzapine-tablets,
and https://my.clevelandclinic.org/health/drugs/20391-risperidone-
tablets.
provider to force his patient to undergo the most extreme, risky,
costly, or painful treatment, so it is an abuse of the role of an
ALJ, and indeed the role of the Social Security Administration, to

require that an applicant undergo such treatment before they
receive disability benefits.”). Moreover, the ALJ’s speculation
— that treatment would have been “more aggressive or varied” if
symptoms were as severe as Plaintiff reported (Tr. at 34) — is
without any reference to how these symptoms are ordinarily treated.
See Arakas, 983 F.3d at 102 (stating the claimant cannot be faulted
for receiving treatment “wholly consistent with how” a condition
is “treated generally”).
Additionally, the ALJ did not explain why he discounted or
did not discuss certain relevant evidence in the treatment notes.
While Plaintiff’s “overall severity of symptoms” was repeatedly
described as “mild” in treatment notes, (Tr. at 445, 451, 456,

461, 466), the ALJ entirely omits any discussion of symptoms that
include anxiety attacks, depressed mood, easy distraction,
excessive worry, paranoia, and racing thoughts, and the repeated
finding that these symptoms affect his ability to work (id.). The
ALJ also did not mention Plaintiff’s diagnosis of “MAJOR DEPRESSIVE
DISORDER, RECURRENT, SEVERE W PSYCH SYMPTOMS” and concluded as a
“sporadic exception” an escalation in symptoms in May 2021 when
Plaintiff reported experiencing visual and auditory
hallucinations. (Tr. at 34, 448.) Indeed, it is entirely unclear
from the opinion why the ALJ considered it “noteworthy” that the
hallucinations were triggered by “internal stimuli” (Tr. at 34)
and, without any citation to authority, why he considered the

effect that would have on Plaintiff’s overall ability to function
as mitigating.7 At a minimum, the ALJ did not meet the obligation
to address “all relevant medical evidence.” Arakas, 983 F.3d at
97 (quoting Lewis, 858 F.3d at 869); Thomas, 916 F.3d at 312
(reversing where “the ALJ did not sufficiently explain how she
weighed significant evidence related to [the claimant’s] mental-
health treatment”).
To be clear, the court takes no position on whether the
provided treatment was conservative or aggressive, or whether the
record is consistent with Plaintiff’s subjective complaints when
all of the relevant factors are considered. The court merely finds
that the ALJ’s failure to analyze all relevant medical evidence

and “build an accurate and logical bridge from the evidence to his
conclusion” precludes the court from engaging in a substantial

7 While the ALJ did not cite any authority, the published literature
indicates there is some basis to indicate that a more complete
explanation is warranted on this record. See, e.g., Nancy M. Docherty
et al., Internal versus External Auditory Hallucinations in
Schizophrenia: Symptom and Course Correlates, Cognitive Neuropsychiatry,
20:3, 187-97 (2015), available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372463 (finding that
“[p]atients with internal hallucinations did not differ from those with
external hallucinations on severity of other symptoms” and reported
“their hallucinations to be more emotionally negative, distressing, and
long-lasting, less controllable, and less likely to remit over time”).
evidence analysis. Lewis, 858 F.3d at 868 (stating that such a
failure is “reversible error”).8 Remand is therefore warranted.
b. Daily Activities

Plaintiff contends that the ALJ considered only the type of
daily activities he could perform without also considering the
extent to which he can perform them. It is proper for an ALJ to
consider daily activities when evaluating symptoms. 20 C.F.R.
§ 404.1529(c)(3). However, an “ALJ errs in extrapolating from
daily and life activities that a claimant has increased residual
functional capacity.” Oakes v. Kijakazi, 70 F.4th 207, 216 (2023).
The Fourth Circuit has insisted that “disability claimants should
not be penalized for attempting to lead normal lives in the face
of their limitations.” Id. For that reason, review of both the
type and extent of daily activities is required, whether or not
daily activities directly control the RFC analysis or indirectly
affect it, such as through a credibility assessment. Id.9

8 Plaintiff argues in his objections that the ALJ erred in light of the
Fourth Circuit’s decision in Shelley C., (Doc. 17 at 21-22), which was
published about one week after Plaintiff’s initial brief but nevertheless
discussed by the magistrate judge. (Doc. 15 at 18 n.9.) On this record,
the court is unable to assess whether the ALJ relied “entirely upon the
belief” that Plaintiff’s subjective complaints were not “corroborated
by the record’s medical evidence” because of the ALJ’s lack of
explanation. Shelley C., 61 F.4th at 360 (emphasis removed).

9 The Commissioner relies on Ladda v. Berryhill, 749 F. App’x 166, 173
n.4 (4th Cir. 2018), for the proposition that failure to consider the
extent of daily activities in a credibility assessment is permissible.
(Doc. 13 at 17.) Notably, the Commissioner’s brief was filed prior to
the publication of Oakes, which is now controlling. Oakes, 70 F.4th at
Here, the ALJ found that Plaintiff’s subjective complaints
were “undermined by his reported functioning.” (Tr. at 34.) The
ALJ wrote that Plaintiff reported in July 2021 that he lived and

spent time with his mother and wife, that he spoke with his
brother, and that he could still perform many of his activities of
daily living, including that he could do laundry and other
household chores, prepare simple meals, go shopping, drive
himself, and manage his finances. (Id.) The ALJ added that
Plaintiff testified in May 2022 that he takes his medications,
does laundry and other household chores, prepares simple,
microwavable meals, drives himself locally, and goes shopping.
(Id.)
The ALJ concluded, without any analysis of the extent
Plaintiff could perform these daily activities, that his “reported
functioning [] contrasted sharply” with the subjective complaints.

(Id.) The difficulty with this conclusion is that the court cannot
conduct meaningful judicial review of the ALJ’s analysis absent
discussion of the extent of Plaintiff’s daily activities.
Moreover, while the ALJ stated that Plaintiff’s wife’s Third-Party
Function reports “largely echoed” Plaintiff’s own complaints, this

216 (finding reversible error where ALJ did not “expressly consider”
daily activities when determining RFC, but did so (without attention to
extent) when expressing skepticism of medical provider’s opinion, which
“for all intents and purposes, [] influenced the capacity analysis —
even if indirectly”). Here, the ALJ used merely the type of daily
activities to assess Plaintiff’s subjective complaints and explicitly
relied on the same to explain the RFC. (Tr. at 35.)
depiction fails to account for relevant evidence, such as her role
in reminding Plaintiff to bathe, her having to take control of his
finances, his distraction while doing chores, his limits on cooking

on the stovetop due to forgetting about food and leaving burners
on, his inability to drive without his wife present (and his
pattern of driving home different routes to “shake” people he
believes are following him), etc. (See Tr. at 237-44.)
Accordingly, the “lack of explanation requires remand.” Oakes, 70
F.4th at 217 (quoting Mascio, 780 F.3d at 640).
Relatedly, the ALJ must explain how Plaintiff’s mental
limitations affect his ability to “perform job-related tasks for
a full workday — a benchmark established by the [SSA’s] own
regulations.” Thomas, 916 F.3d at 312 (emphasis added)
(citing SSR 96-8P, 1996 WL 374184 at *2). The ALJ’s analysis
regarding Plaintiff’s durational capacity to work is limited to

rejecting a doctor’s finding that Plaintiff could only perform
tasks for up to two hours at a time. (Tr. at 35.) The ALJ rejected
this conclusion by incorporating by reference the same grounds the
court has found were inadequately explained above. (Id. at 35-36
(stating that psychiatric findings and reported functioning “did
not indicate that he had problems with sustaining attention and
concentration for more than two hours”). In light of the reported
subjective complaints by Plaintiff and his wife that were
inconsistent with this conclusion, more explanation is needed to
“facilitate meaningful appellate review.” Thomas, 916 F.3d at
312; (see Tr. at 54 (Plaintiff stating that the longest period he
could stay on task is “30 to 45 minutes at a time”)); cf. Mascio,

780 F.3d at 638 (“[T]he ability to perform simple tasks differs
from the ability to stay on task.”).10
2. Treating Psychiatric Provider’s Opinion
Finally, Plaintiff objects to the ALJ’s review of the opinions
of Nurse Practitioner Sugaree Ganzman, his treating psychiatric
provider. (Doc. 17 at 13.) NP Ganzman supplied two opinions, on
June 2, 2021, and February 25, 2022. (Tr. at 521, 537.) These
one-page forms include the frequency and length of Plaintiff’s
contact with NP Ganzman, diagnoses, treatment and response, a list
of prescribed medications and side effects, and clinical findings.
(Id.) The final question asks:
Given the nature and severity of [Plaintiff’s]
psychological conditions, does he have the physical
and/or mental capacity to perform gainful employment on
a full-time continuing basis that is, 8 hours/day, 5
days/week or an equivalent schedule?

(Id.) On both opinion forms, NP Ganzman checked “No” and in the
space for explanation wrote “pt has uncontrolled paranoia,
hallucination, irritability,” (Tr. at 125) and “paranoia,
hallucinations, panic, insomnia, and agitation” (Tr. at 141). In

10 Plaintiff also argues that the ALJ failed in the RFC to adequately
address limitations identified at step three of the opinion. (Doc. 17
at 12; see also Doc. 12 at 26 (citing Mascio, 780 F.3d at 637–39).) The
court need not address this objection as remand on the grounds stated
would appear to resolve Plaintiff’s concern as well.
evaluating these opinions, the ALJ wrote:
The claimant’s treating psychiatrist, Nurse Practitioner
Sugaree Ganzman, prepared treating source statements in
June 2021 and February 2022. She opined in both
statements that the claimant was unable to sustain
gainful employment on a full-time continuing basis
because of “uncontrolled paranoia, hallucinations,
irritability” in June 2021 and then because of
“paranoia, hallucinations, panic, insomnia, agitation”
in February 2022. I found that Ms. Ganzman’s medical
opinions were not persuasive because she did not explain
how the claimant’s list of symptoms supported her
conclusions. Moreover, Ms. Ganzman’s medical opinions
were inconsistent with her treatment notes, which show
that the claimant had only “mild” symptoms, that his
symptoms improved or were stable with psychiatric
medication management, and that he had limited positive
psychiatric examination findings with no signs of
consistent or persistent behavioral or cognitive
abnormalities, all of which further undermined her
poorly supported conclusions.

(Tr. at 36.)
The ALJ was not required to “give any special significance to
the source of an opinion on issues reserved to the Commissioner.”
Shelley C., 61 F.4th at 356. This includes an opinion on whether
a claimant is “‘disabled’ or ‘unable to work.’” Id. (dismissing
as a “semantical dispute” whether “unemployable” and “unable to
work” are synonymous). Thus, the court cannot say, as Plaintiff
urges, that the ALJ erred in rejecting NP Ganzman’s specific
opinion as to Plaintiff’s “capacity to perform gainful
employment.”
However, when the ALJ “found that [NP] Ganzman’s medical
opinions were not persuasive,” (Tr. at 36 (emphasis added)), the
ALJ failed to consider the relevant factors for doing so under 20
C.F.R. § 404.1520c(c)(1)–(5).11 In fact, to the extent the ALJ
discussed NP Ganzman’s medical opinions, the analysis suffers from

the same lack of explanation regarding Plaintiff’s medical records
discussed above. (Tr. at 36 (relying again on reference to
“psychiatric medication management” and “limited positive
psychiatric examination findings”).) The court is therefore
unable to conduct a substantial evidence analysis of the ALJ’s
review of NP Ganzman’s medical opinions because the ALJ did not
build a “logical bridge” between the evidence and his conclusions.
Lewis, 858 F.3d at 868.
III. CONCLUSION
For the reasons stated,
IT IS THEREFORE ORDERED that Plaintiff’s objections (Doc. 17)
are SUSTAINED in part to the extent described herein;

IT IS FURTHER ORDERED that the Commissioner’s decision
finding no disability is REVERSED, and that this matter be REMANDED
to the Commissioner under sentence four of 42 U.S.C. § 405(g) for
further administrative proceedings consistent with this opinion.

11 These factors are (1) supportability; (2) consistency; (3) a
physician’s relationship with the claimant; (4) a physician’s
specialization; and (5) other factors, like a physician’s familiarity
with the evidentiary record or their understanding of the SSA’s policies
and evidentiary requirements. 20 C.F.R. § 404.1520c(c)(1)–(5). Of these
factors, supportability and consistency are the most important. Id.
§ 404.1520c(a), (b)(2).
To this extent, Defendant’s Dispositive Brief (Doc. 13) is DENIED,
and Plaintiff’s Dispositive Brief (Doc. 12) is GRANTED.

/s/ Thomas D. Schroeder
United States District Judge

March 29, 2024

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10254544. Public record. Not legal advice.