The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF NORTH CAROLINA
TYRUN W., )
)
Plaintiff, )
)
v. ) 1:23CV719
)
MARTIN J. O’MALLEY;,! )
Commissioner of Social Security, )
)
Defendant. )
MEMORANDUM OPINION AND ORDER
OF UNITED STATES MAGISTRATE JUDGE
Plaintiff Tyrun W. (“Plaintiff”) brought this action pursuant to Sections 205(g) and
1631(c)(3) of the Social Security Act (the “Act’”), as amended (42 U.S.C. §§ 405(g) and
1383(c)(3)), to obtain judicial review of a final decision of the Commissioner of Social Security
denying his claims for Disability Insurance Benefits (“DIB”) and Supplemental Security
Income (“SSI”) under, respectively, Titles I] and XVI of the Act. The parties have filed cross-
motions for judgment, and the administrative record has been certified to the Court for review.
L. PROCEDURAL HISTORY
Plaintiff protectively filed applications for DIB and SSI on June 2, 2020, alleging a
disability onset date of April 7, 2017 in both applications. (Tr. at 17, 281-96.) His applications
were denied initially (Ir. at 103-56, 185-91) and upon reconsideration (T'r. at 157-84, 192-201).
December 20, 2023, Martin J. O’Malley was sworn in as Commissioner of Social Security, replacing Acting
Commissionet Kilolo Kijakazi. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure, Martin J.
O’Malley should be substituted for Kilolo Kijakazi as Defendant in this suit. No further action need be taken
to continue this suit by reason of the last sentence of section 405(g) of the Social Security Act, 42 U.S.C. §
405(g).
2 Transcript citations refer to the Sealed Administrative Record [Doc. #5].
Thereafter, Plaintiff requested an administrative hearing de novo before an Administrative
Law Judge (“ALJ”). (It. at. 207-08.) On December 13, 2022, Plaintiff, along with his attorney,
attended the subsequent telephone hearing, at which both Plaintiff and an impartial vocational
expett testified. (Tr. at 17.) At the hearing, the ALJ noted that Plaintiff had previously applied
for benefits, and his claims had been denied by the same ALJ in a decision dated May 15, 2019,
which concluded that Plaintiff remained capable of a limited range of light work. (See Tr. at
49-51, 86, 92.) That decision was not appealed. At the heating in the present case, Plaintiff
amended his alleged onset date to September 20, 2019, four months after the date of the prior
decision. (Tr. at 17, 49.) Following the hearing, the ALJ concluded that Plaintiff was not
disabled within the meaning of the Act (T'r. at 34), and on June 27, 2023, the Appeals Council
denied Plaintiff's request for review of the decision, thereby making the ALJ’s conclusion the
Commissionet’s final decision for purposes of judicial review (I'r. at 1-6).
Il. LEGAL STANDARD
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 review of such a decision is “extremely limited.” Frady v. Harris, 646 F.2d 143, 144
(4th Cir. 1981). “The courts are not to try the case de novo.” Oppenheim v. Finch, 495 F.2d
396, 397 (4th Cir. 1974). Instead, “a reviewing court must uphold the factual findings of the
AL] if they are supported by substantial evidence and were reached through application of the
cottect legal standard.” Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012) (internal
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)
(quoting Richardson v. Perales, 402 U.S. 389, 390 (1971)). “It consists of more than a mete
scintilla of evidence but may be somewhat less than a preponderance.” Mastto v. Apfel, 270
F.3d 171, 176 (4th Cir. 2001) Gnternal citations and 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 court should not undertake to re-weigh
conflicting evidence, make credibility determinations, or substitute its judgment for that of the
[AL}].” 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 ALJ.” Hancock, 667 F.3d at 472. “The issue before
[the reviewing 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 cottect application of the relevant law.” Craig v. Chater, 76 F.3d 585,
589 (4th Cir. 1996).
In undertaking this limited review, the Court notes that “[a] claimant for disability
benefits bears the burden of proving a disability.” Hall v. Harris, 658 F.2d 260, 264 (4th Cir.
1981). 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
petiod 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)). “Under this process, the
Commissioner asks, in sequence, whether the claimant: (1) worked during the alleged period
of disability; (2) had a severe impaitment; (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.
A finding adverse to the claimant at any of several points in this five-step sequence
forecloses a disability designation 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 the first two steps, and if
the claimant’s impairment meets or equals a “listed impairment” at step three, “the claimant
is disabled.” Mastro, 270 F.3d at 177. Alternatively, if a claimant cleats steps one and two,
but falters at step three, ie., “[i]f a claimant’s impairment is not sufficiently severe to equal or
exceed a listed impairment,” then “the AL] must assess the claimant’s residual functional
3 “The Social Security Act comprises two disability benefits programs. The Social Security Disability Insurance
Program (SSDI), established by Title II of the Act as amended, 42 U.S.C. § 401 et seq., provides benefits to
disabled persons who have contributed to the progtam while employed. The Supplemental Security Income
Program (SSI), established by Title XVI of the Act as amended, 42 U.S.C. § 1381 et seq., provides benefits to
indigent disabled persons. The statutory definitions and the regulations promulgated by the Secretary for
determining disability, see 20 C.F.R. pt. 404 (SSDI); 20 C.F.R. pt. 416 (SSI), governing these two programs ate,
in all aspects relevant here, substantively identical.” Craig, 76 F.3d at 589 n.1.
capacity (RFC’).” Id. at 179.4 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. Id. 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 [Government] to prove that
a significant number of jobs exist which the claimant could perform, despite the claimant’s
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 Government 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.
III. DISCUSSION
In the present case, the ALJ found that Plaintiff had not engaged in “substantial gainful
activity” since his amended alleged onset date of September 20, 2019. The AL] therefore
concluded that Plaintiff met his burden at step one of the sequential evaluation process. (I'r.
at 19.) At step two, the ALJ further determined that Plaintiff suffered from the following
severe impairments:
+ “REC 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 telated symptoms (¢.g, patn).”
Hines, 453 F.3d at 562-63.
satcoidosis; neutosatcoidosis; seizure disorder; right shoulder impingement;
degenerative disc disease [of the] cervical spine; headache; depressive disorder;
anxiety disorder; and sleep disturbance[.|
(Tr. at 19-20.) The ALJ found at step three that none of the impairments identified at step
two, individually or in combination, met or equaled a disability listing. (Tr. at 20-22.) The
ALJ therefore assessed Plaintiff's RFC and determined that he could perform light work with
the following, non-exertional limitations:
[Plaintiff] has the residual functional capacity to perform light work as defined
in 20 CFR 404.1567(b) and 416.967(b) except frequent climbing of ramps and
staits, but only occasional climbing of stepladders up to 4 vertical feet in height,
with no climbing of higher ladders or of ropes or scaffolds of any height. [He]
can have frequent balancing, stopping, kneeling, crouching, and crawling;
frequent pushing and pulling with the tight (dominant) upper extremity;
frequent overhead reaching with the bilateral upper extremities; and can have
occasional exposure to extreme cold and heat, vibration, atmospheric
conditions, and moving mechanical parts. There can be no exposure to high,
exposed places; no operation of motor vehicles ot heavy equipment tequited as
part of the assigned work; no work performed in or on large bodies of water
such as oceans, lakes, tivers, or swimming pools, and only occasional use of
computer and video monitors, further defined as no more than one third of the
workday, with no more than 45 minutes during any one sustained period of
time, which must be followed by 60 minutes of no use of such devices before
resumption of use. [Plaintiff] can have exposure up to and including moderate
noise. [He is] limited to work needing little or no judgment to do simple duties
that can be learned on the job or in a short period of time, usually within 30
days, and for which little specific vocational preparation and judgment ate
needed. [He is] limited to work tequiting sustained concentration and
persistence for no greater than approximately 2 hours at a time; limited to work
that is not frequently performed on an assembly line or at a similar production-
pace; can have occasional changes to the work setting and the manner and
method of performing the assigned work; work that frequently provides for two
15-minute breaks and one 30-minute break for each 8-hour shift worked,
occutting at such times as directed by the employer; and can have occasional
interaction with supetvisors, coworkers, and the public when performing the
assigned work.
(Tr. at 22-23.) Based on this determination and the testimony of a vocational expert, the AL]
determined at step four of the analysis that Plaintiffs past relevant work exceeded his RFC.
(Tr. at 32.) However, the ALJ found at step five that, given Plaintiff's age, education, work
experience, RFC, and the testimony of the vocational expert as to these factors, he could
perform other jobs available in significant numbers in the national economy. (Tr. at 33-34.)
Therefore, the ALJ concluded that Plaintiff was not disabled under the Act. (Ir. at 34.)
Plaintiff now challenges the RFC assessment in two respects. First, he argues that,
when assessing Plaintiffs RFC, the AL] “erred by failing to adequately account for the
vocationally limiting effects of Plaintiffs well-documented fatigue and shortness of breath.”
Br. [Doc. #11] at 1, 5-9.) Second, Plaintiff contends that the ALJ “erred in his evaluation
of the medical opinion evidence.” (Pl.’s Br. at 1, 9-14.) Because Plaintiffs first argument
relies, in part, on the medical opinion evidence supporting his fatigue and shortness of breath,
the Court addresses these contentions in reverse order.
A. Medical Opinion Evidence
Plaintiff contends that in formulating the RFC assessment, the AL] failed to properly
evaluate the medical opinion of Plaintiffs treating rheumatologists, Drs. Rami Eltaraboulst
and Christopher Overton, both of whom posited that Plaintiffs physical impairments
ptecluded employment. (See Tr. at 342, 3778.) Under the applicable regulations for claims
filed on or after Match 27, 2017,
[The ALJ] will not defer or give any specific evidentiary weight, including
controlling weight, to any medical opinion(s) or prior administrative medical
finding(s), including those from your medical sources. When a medical soutce
provides one ot more medical opinions or prior administrative medical findings,
we will consider those medical opinions or prior administrative medical findings
from that medical source together using the factors listed in paragraphs (c)(1)
through (c)(5) of this section, as appropriate. . . .
(1) Supportability. The more relevant the objective medical evidence and
suppotting explanations presented by a medical source ate to support his
ot her medical opinion(s) or prior administrative medical finding(s), the
mote petsuasive the medical opinions or prior administrative medical
finding(s) will be.
(2) Consistency. The more consistent a medical opinion(s) or prior
administrative medical finding(s) is with the evidence from other medical
soutces and nonmedical sources in the claim, the more persuasive the
medical opinion(s) or prior administrative medical finding(s) will be.
(3) Relationship with the claimant . . . [which includes]: @) Length of the
treatment relationship. . . (ii) Frequency of examinations. ... (iii) Purpose
of the treatment relationship. . . . (iv) Extent of the treatment relationship.
.. [and] (v) Examining relationship. . . .
(4) Specialization. The medical opinion or prior administrative medical finding
of a medical source who has received advanced education and training to
become a specialist may be more persuasive about medical issues related to
his or her atea of specialty than the medical opinion or prior administrative
medical finding of a medical source who is not a specialist in the relevant
atea of specialty.
(5) Other factors. .. . This includes, but is not limited to, evidence showing a
medical source has familiarity with the other evidence in the claim or an
understanding of our disability program’s policies and evidentiary
requirements. ...
20 C.F.R. § 404.1520c(a) and (c). The regulations also tequite decision-makers to “articulate
in... [their] decisions how persuasive [they] find all of the medical opinions . . . in [a claimant’s]
case record.” 20 C.F.R. § 404.1520c(b). Although all of the factors listed in paragraphs (c)(1)
through (c)(5) of § 404.1520c should be considered in making this determination, the
regulations specifically provide that the most important factors when evaluating the
persuasiveness of an opinion are the first two: supportability and consistency. 20 C.P.R.
§ 404.1520c(a), 404.1520c(c) (1)-(€) (2).
Hete, as set out in the administrative decision, Dr. Eltaraboulsi opined on December
16, 2019 “that due to satcoidosis with neurological involvement, severity of the disease, side
effects from medications, and the need for frequent clinic and effusion visits, [Plaintiff] was
not able to work at this time.” (Tr. at 31, 342.) The AL] found Dr. Eltaraboulsi’s opinion
unpersuasive, noting that “it is conclusory and addresses a decision specifically reserved for
the Commissioner.” (Tr. at 31.) The ALJ further explained that
[Plaintiff's symptoms are not described in detail, nor do [the opinions] describe
how [Plaintiffs symptoms] would impact [his] ability to work on a full-time
basis. While [Plaintiff] continues to have sarcoidosis, an examination in April
2021 showed he was “quiet,” and had no signs of ocular sarcoidosis. He had
some issues with compliance in March 2021, but he was to continue taking
methotrexate (Exhibit B21F, page 15). [Plaintiff] remains able to perform at
the range of light [work] with some additional limitations since the last decision
in May 2019.
(Tt. at 31.) Similarly, the ALJ recounted that, on May 24, 2022, Dr. Overton “stated that due
to continued intermittent seizures, numbness of head/face and bilateral lower extremities, and
debilitating fatigue from {his] underlying inflammatory condition, [Plaintiff] remains unable to
work at this time.” (Tr. at 31, 3778.) As with Dr. Eltaraboulsi’s opinion, the ALJ noted that
Dr. Overton’s opinion was conclusory and addressed an issue reserved to the Commissioner.
(Tr. at 31-32.) The ALJ further explained that,
[w]hile Dr. Overton does note specific disabling symptoms, the vagueness,
including reporting “intermittent” seizures without further explanation|,] results
in the opinion being non-specific. The longitudinal evidence, including a note
from November 2021 where [Plaintiff] denied any “major” seizures over the
past year but reported several “mini seizures” at night, generally after a day of
strenuous physical activity, is consistent with the limitation to a range of light
fwork] as outlined in the [RFC assessment].
(Tr. at 32.)
Plaintiff now argues that the AL]’s explanations for discounting both rheumatologists’
opinions were insufficient under 20 C.F.R. § 404.1520c. In particular, Plaintiff contends that
the AL] failed to specifically address the consistency and supportability of Drs. Eltaraboulsi
and Overton’s opinions, as required by 20 C.F.R. § 404.1520c(b)(2), which dictates that the
AL] “will explain” how the consistency and supportability factors were considered in the
decision. (Pl.’s Br. at 10.) As expressed in a one recent decision,
[an ALJ’s] failure to articulate the consistency factor in his evaluation of [the
physician’s] opinion constitutes ertor. See 20 C.F.R. § 404.1520c(b)(2). This
court cannot “fill in the blanks for the ALJ” by finding substantial evidence
supports the AL]’s evaluation of [an] opinion when the ALJ did not even
address the consistency factor, nor may the court “bolster[ | inconclusive
findings” when the ALJ did not discuss the extent to which [the physician’s]
opinion was either consistent or inconsistent with the evidence in the tecord.
See Patterson [v. Comm’s of Soc. Sec Admin.], 846 F.3d [656,] 662 [(4th Cir.
2017)]. Absent any explanation by the ALJ whether [the medical] opinion was
consistent ot inconsistent with the record, this court cannot meaningfully
teview how the ALJ evaluated the persuasiveness of [the] opinion and whether
substantial evidence supports the ALJ’s determination.
Cantrell v. Kijakazi, No. 2:21CV00021, 2022 WL 3335778, at *10 (W.D. Va. Aug. 12, 2022).
Nevertheless, there is no requirement that an ALJ use any “magic words” in making findings
regarding consistency and supportability. See Weidner v. Kijakazi, No. 20-1250-MN, 2022
WL 610702, at *12 (D. Del. Feb. 1, 2022) (finding the fact that the ALJ did not use
“consistency” ot “supportability” is not sufficient to remand where the “ALJ plainly
considered the consistency of the medical opinions with the evidence of record”). Thus, the
ALJ’s failure to specify which factor, ie., supportability, consistency, ot otherwise, was eroded
by contrary evidence is inapposite, so long as he (1) analyzed the relevant evidence when
considering the persuasiveness of the medical opinion and (2) made his analysis of that
evidence cleat enough for the court to meaningfully review it.
Here, the unfavorable, final decision in Plaintiffs prior disability claim and the other
medical opinion evidence of record clearly support the ALJ’s consistency determination. On
May 15, 2019, just four months before the September 20, 2019 amended alleged onset date in
10
the present case, the same ALJ determined that Plaintiff remained capable of a limited range
of light work. (See Tr. at 86, 92.) In the present case, the ALJ therefore considered Albright
Comm’r of Soc. Sec. Admin., 174 F.3d 473 (4th Cir. 1999) and Acquiescence Ruling (“AR”)
00-1(4) when evaluating the prior determination. (I't. at 29.) Specifically, the ALJ found as
follows:
[I]his decision remains generally consistent with the evidence during the
current petiod under consideration, although some modification is appropriate.
Therefore, this previous decision is generally, but not entirely, persuasive. In
the previous decision, the evidence generally supported the limitation to light
work with mental restrictions. However, later evidence showing reduced
streneth results in only frequent overhead reaching with the bilateral upper
extremities as opposed to only the right dominant upper extremity with the
bilateral upper extremities as opposed to only the right dominant upper
extremity.
(Tr. at 29.) The ALJ therefore included in the RFC a limitation to only frequent overhead
teaching with the bilateral upper extremities, and noted that review of the record reflected that
the previous decision was generally persuasive, and that the record reflected “less seizures
overall” since the prior determination, which was not appealed. (T'r. at 29.)
Following this analysis, the ALJ considered the nine medical opinions postdating his
ptior administrative decision. Six of these opinions, including those of Drs. Eltaraboulsi and
Overton, assessed Plaintiffs physical limitations. (Tr. at 29-32.) Despite Plaintiffs assertion
that the opinions of his rheumatologists were supported by, and consistent with, not only his
own testimony but the other medical opinions of record as well (see Pl.’s Br. at 13), Drs.
Eltataboulsi and Overton were the only two of the six providers to posit that Plaintiff was
limited beyond a range of light work (Tr. at 29-32). Of the other four, the two State agency
medical consultants, Dr. Steven Levin and Dr. Harty Gallis, opined on March 25, 2021 and
11
December 17, 2021, respectively, that Plaintiff was limited to light work with further
restrictions. (Tr. at 30-31.)
[Dr. Levin] opined that [Plaintiff] was limited to light work with frequent
pushing, pulling with the right upper extremity; [no] climbing of ladders, ropes,
ot scaffolds; occasional climbing of ramps and stairs; frequent balancing,
stooping, kneeling, crouching, and crawling; occasional overhead reaching with
the right upper extremity; [no] even moderate exposure to extreme cold or heat,
noise, [or] hazards; and [no] concentrated exposute to vibration, humidity, and
pulmonary irritants.
(Tr. at 30-31, 105-119.) Although the ALJ found that Dr. Levin’s opinion was “not entitely
persuasive,” he acknowledged that “it is generally supported by the record showing some non-
compliance historically in November 2020 and some difficulty sitting and rising in March
2021.” (Tr. at 30.) The ALJ also noted that the longitudinal record demonstrates greater
stability, fewer seizures, and continued reports of weakness and dizziness “consistent with
only occasional use of computer and video monitors and the other limitations as outlined in
the residual functional capacity. (Tr. at 30.)
Nine months later, at the reconsideration level, Dr. Gallis largely confirmed Dr. Levin’s
eatlier findings. Dr. Gallis specifically considered Plaintiff's symptoms, including shortness of
breath, and noted that “[r]ecent exams show no evidence of catdiac sarcoidosis. Exams over
time show intermittent dyspnea with exams overall intact.” (Tr. at 163, 165.) Dr. Gallis
concluded that Plaintiff could perform “light work except was further limited with frequent
pushing, pulling of the bilateral upper extremities but the other limitation remained the same.”
(Tr. at 31.) The ALJ largely adopted Dr. Gallis’ limitations, but found Dr. Gallis’ opinion “not
entitely persuasive” to the extent that the AL] noted he had “place[d] additional limitations
that ate consistent with the overall evidence demonstrating some continued difficulty
12
breathing with worsening joint pains.” (Tr. at 31.) The ALJ also specifically found that the
evidence of “decreased lung sounds and a mildly ataxic gait does support the limitations to a
light range of work.” (Tr. at 31.)
Notably, as part of their review of the record, the State agency physicians considered
the findings of Danielle Adkins, PA-C, who performed a consultative examination of Plaintiff
on March 20, 2021. (Tr. at 31, 3220-29.) As recounted in the administration decision,
The examination revealed vision of 20/30 [in] both eyes, medical deviation of
lateral rectus bilaterally; positive ophthalmoplegia; and decreased lung sounds
fin the] lower fields bilaterally. Ms. Adkins noted [that Plaintiff] had reduced
function [of] cranial nerves 2, 4, and 6, had difficulty rising from sitting to
standing, and had mild gait ataxia. He could squat and tise with some difficulty
and had some difficulty getting up and down from [the] exam table, but
otherwise had an unremarkable exam. Ms. Adkins opined that [Plaintiff] was
mildly restricted in standing, walking, lifting, and carrying... and had visual
accommodation deficiencies with moderate limitation.
(Tr. at 31.) In finding Ms. Adkins’ opinions “not entirely persuasive,” the ALJ correctly noted
that Ms. Adkins “does not define what ‘mild’ difficulties means or what a ‘mild’ gait ataxia
means in vocational terms.” (It. at 31.) Nevertheless, the AL] concluded that Ms. Adkins’
overall findings “of sarcoidosis that was relatively stable” supported the range of light work
set out in the RFC assessment. (Tr. at 31.) In particular, the AL] noted that “[t]he overall
evidence, including report of no major seizures in the past yeat on November 2021 shows that
[Plaintiffs] seizures are infrequent and his sarcoidosis has stabilized.” (Tr. at 31.)°
Finally, the AL] considered the opinion of Dr. Siddarth Ninan, Plaintiffs treating
neurologist. On November 17, 2021, Dr. Ninan opined that Plaintiff “was to continue seizure
5° This is consistent with the findings of Dr. Levin and Dr. Gallis, both of whom considered and relied on the
examination and report by PA Adkins in reaching the conclusion that Plaintiff was capable of light work with
the additional limitations noted. (Tr. at 105, 111, 115, 160, 163-64.)
13
precautions including but not limited to [no] swimming alone, cooking alone, climbing high
altitudes, [and] operating heavy machinery.” (Tr. at 32, 3740.) Dr. Ninan also advised that,
“to avoid headaches, [Plaintiff] should limit screen time as able, [and] consider using blue
blocking filters/glasses.” (Tr. at 32, 3740.) The AL] found these restrictions persuasive and
“generally incorporated” them in Plaintiffs RFC. (Tr. at 32.) The AL] further noted that with
respect to Dr. Ninan’s opinion, Plaintiff “endorsed 5 nocturnal seizures the past yeat despite
report[ing] good compliance with medication. His seizures tended to occur after a strenuous
day proceeding the seizures, so the limitations are supported by self-report and the stability of
his immunotherapy.” (Tr. at 32.)
Again, none of these opinions suggest the need for limitations beyond those ultimately
included in the RFC, let alone the total disability opined by Drs. Eltaraboulsi and Overton.
Thus, the ALJ cleatly explained how the opinions of Plaintiffs treating rheumatologists were
inconsistent with the findings from other medical sources, prior administrative findings, and
other evidence, as contemplated by the regulations. See 20 C-F.R. § 404.1520c(c).
The same holds true for the supportability factor at issue here. In fact, the AL]
specifically found both opinions conclusory. In the case of Dr. Eltaraboulsi, he also noted
that Plaintiffs “symptoms were not described in detail, nor do they describe how they would
impact [Plaintiffs] ability to work on a full-time basis.” (Tr. at 31.) In the case of Dr. Overton,
the AL] found that the opinion “[did] note specific disabling symptom,” but the AL] further
determined that the listed symptoms, particularly “intermittent” seizures, were vague and non-
specific given both (1) the lack of further explanation from Dr. Overton and (2) contradictory
evidence elsewhere in the record. (I'r. at 32.)
14
Notably, Plaintiffs sarcoidosis involves multiple body systems, necessitating treatment
by neurology, pulmonology, and ophthalmology, as well as theumatology. As the AL]
explained earlier in his decision, records from all of these providers reflect that Plaintiff had
ongoing compliance issues with his neurosatcoidosis medications throughout the relevant
time period. (See Tr. at 25, 26, 3582, 3677, 3799, 3800, 4093, 4094.) Nevertheless, Plaintiff
generally reported decreased seizure activity, with rare nocturnal seizures occurring after
particularly active days. (It. at 26.) Rheumatology treatment notes also reflect that Plaintiff
was “doing well from [a] respiratory standpoint,” but still reported some dyspnea and use of
an albuterol inhaler multiple days per week. (Ir. at 26, 3582, 4094.) Moreover, Plaintiff
reported only “intermittent” fatigue, joint pain, and night sweats throughout this time, despite
his lack of medication compliance. (Tr. at 25-26, 3582, 3625, 3677, 3800.) In short, none of
the clinical findings recorded by Dr. Eltaraboulsi, Dr. Overton, or their colleagues appear to
support their opinions that Plaintiff suffered from “debilitating fatigue” or other disabling
symptoms. In discussing the underlying evidence in this case, along with the opinions of Drs.
Eltaraboulsi and Overton, the ALJ explained the lack of supporting evidence in a manner
susceptible to judicial review. "Therefore, the Court concludes that substantial evidence
supports the AL]’s treatment of the opinion evidence in this case.
B. Function-by-Function Assessment
In a related argument, Plaintiff contends that the ALJ failed to “adequately account
for the vocationally limiting effects of Plaintiffs well-documented fatigue and shortness of
breath” when assessing his RFC. (Pl’s Br. at 1, 5-9.) In particular, Plaintiff argues that,
although the evidence supports additional RFC limitations, including additional breaks,
15
absences, and time off-task, the AL] failed to include these limitations or, alternatively, explain
their omission. (PI.’s Br. at 6.)
As Social Security Ruling (“SSR”) 96-8p instructs, “[t]he RFC assessment must first
identify the individual’s functional limitations or restrictions and assess his or her work-related
abilities on a function-by-function basis,” including the functions listed in the regulations.
Social Security Ruling 96-8p: Policy Interpretation Ruling Titles IT and XVI: Assessing
Residual Functional Capacity in Initial Claims, 1996 WL 374184, at *1 (July 2, 1996) (“SSR 96-
8p”). “Only after such a function-by-function analysis may an ALJ express RFC in terms of
the exertional levels of work.” Monroe v. Colvin, 826 F.3d 176, 179 (4th Cir. 2016) (internal
quotations and citations omitted). Further, the “RFC assessment must include a narrative
discussion describing how the evidence supports each conclusion, citing specific medical facts
laboratory findings) and nonmedical evidence (e.g., daily activities, obsetvations).” SSR
96-8p, 1996 WL 374184, at *7. An AL] must “both identify evidence that supports his
conclusion and build an accurate and logical bridge from [that] evidence to his conclusion.”
Woods v. Bertyhill, 888 F.3d 686, 694 (4th Cir. 2018) (emphasis omitted).
The Fourth Circuit has noted that a per se rule requiting remand when the ALJ does not
perform an explicit function-by-function analysis “is inappropriate given that remand would
prove futile in cases where the ALJ does not discuss functions that are ‘irrelevant or
uncontested.” Mascio v. Colvin, 780 F.3d 632, 636 (4th Cir. 2015) (quoting Cichocki v.
Astrue, 729 F.3d 172, 177 (2d Cir. 2013) (per curiam)). Rather, remand may be appropriate
“where an AL] fails to assess a claimant’s capacity to perform relevant functions, despite
contradictory evidence in the record, or where other inadequacies in the AL]’s analysis
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frustrate meaningful review.” Mascio, 780 F.3d at 636 (quoting Cichocki, 729 F.3d at 177).
The court in Mascio concluded that remand was appropriate because it was “left to guess
about how the ALJ arrived at his conclusions on [the claimant’s] ability to perform relevant
functions” because the ALJ had “said nothing about [the claimant’s] ability to perform them
for a full workday,” despite conflicting evidence as to the claimant’s RFC that the AL] did not
address. Mascio, 780 F.3d at 637.
Here, Plaintiff challenges the AL]’s analysis of evidence relating to Plaintiffs fatigue
and shortness of breath. As Plaintiff correctly notes, “the ALJ found [Plaintiffs] sarcoidosis
and neurosatcoidosis, which ate the primary cause of his fatigue and [shortness of breath], to
be severe impairments (see Tr. at 19-20) and summarized some of his complaints and portions
of his course of treatment from the record.” (Pl.’s Br. at 6.) Plaintiff now contends that the
ALJ failed to create a “logical bridge between the evidence describing [Plaintiff's] severe fatigue
and [shortness of breath] and [his] conclusion that no non-exertional limitations related to
these symptoms such as additional breaks, absences or time off-task were required in the
REC.” (PL’s Br. at 6.)
Plaintiff further argues that the omission of these additional limitation was “potentially
outcome determinative” in light of the vocational expert’s testimony at step five of the
sequential analysis. (Pl.’s Br. at 6.) In particular, the expert testified that, outside of normal
breaks consisting of a 30-minute meal break and two additional 15-minute breaks per 8-hour
workday, employers typically tolerate up to 10% off-task time. (Tr. at 75.) “Thus,” Plaintiff
atoues, “it would appear that if [his] testimony regarding his fatigue and [shortness of breath]
ate true and impact his life in the ways he stated, then his condition would be disabling because
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he would certainly be off-task due to his [impairments] more than 10% of the workday.” (PL’s
Br. at 5.) In other words, Plaintiffs function-by-function challenge relies on the premise that
the ALJ also erred in his assessment of Plaintiffs subjective statements.
With respect to evaluation of a claimant’s symptoms, the AL]’s decision must “contain
specific reasons for the weight given to the individual’s symptoms, be consistent with and
suppotted by the evidence, and be clearly articulated so the individual and any subsequent
reviewer can assess how the adjudicator evaluated the individual’s symptoms.” Social Security
Ruling 16-3p, Titles I] and XVI: Evaluation of Symptoms in Disability Claims, 2017 WL
5180304, at *10 (Oct. 25, 2017) (“SSR 16-3p”); see also 20 C.F.R. § 416.929. In Arakas v.
Commissioner of Social Security, 983 F.3d 83 (4th Cir. 2020), the Fourth Circuit clarified the
ptocedure an ALJ must follow when assessing a clatmant’s statements:
When evaluating a claimant's symptoms, ALJs must use the two-step
framework set forth in 20 C.F.R. § 404.1529 and SSR 16-3p, 2016 WL 1119029
(Mar. 16, 2016). First, the ALJ must determine whether objective medical
evidence presents a “medically determinable impaitment” that could reasonably
be expected to produce the claimant’s alleged symptoms. 20 C.F.R. §
404.1529(b); SSR 16-3p, 2016 WL 1119029, at *3.
Second, after finding a medically determinable impairment, the ALJ must assess
the intensity and persistence of the alleged symptoms to determine how they
affect the claimant’s ability to work and whether the claimant is disabled. See 20
C.F.R. § 404.1529(c); SSR 16-3p, 2016 WL 1119029, at *4. At this step,
objective evidence is mot requited to find the claimant disabled. SSR 16-3p, 2016
WL 1119029, at *4-5. SSR 16-3p recognizes that “[s]ymptoms cannot always
be measured objectively through clinical or laboratory diagnostic
techniques.” Id. at *4. Thus, the AL] must consider the entire case recotd and
may “not disregard an individual’s statements about the intensity, persistence,
and limiting effects of symptoms solely because the objective medical evidence
does not substantiate” them. Id. at *5.
Atakas, 983 F.3d at 95-96. This approach facilitates the ALJ’s ultimate goal, which is to
accurately determine the extent to which a claimant’s pain or other symptoms limit his ability
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to perform basic work activities. Relevant evidence for this inquiry includes the claimant’s
“medical history, medical signs, and laboratory findings,” Craig, 76 F.3d at 595, as well as the
following factors set out in 20 C.F.R. § 416.929(c)(3) and 20 C.F.R. § 404.1529(c)(3):
(1) [The claimant’s] daily activities;
Gi) The location, duration, frequency, and intensity of [the claimant’s] pain
ot other symptoms;
(iii) Precipitating and aggravating factors;
(iv) The type, dosage, effectiveness, and side effects of any medication [the
claimant] take[s] or [has] taken to alleviate [his] pain or other symptoms;
(v) Treatment, other than medication, [the claimant] receive[s] or [has]
received for relief of [his] pain or other symptoms;
(vi) Any measures [the claimant] use[s] or [has] used to telieve [his] pain or
other symptoms (e.g., lying flat on [his] back, standing for 15 to 20
minutes every hour, sleeping on a board, etc.); and
(vii) Other factors concerning [the claimant’s] functional limitations and
restrictions due to pain or other symptoms.
In the present case, the ALJ recounted Plaintiffs testimony that he “got winded when
he did chores,” including walking to the mailbox, and that he experienced spells of shortness
of breath or dizziness. (Tr. at 23-24, 64-65.) Plaintiff further testified that these spells typically
lasted 5-10 minutes, requiting him to sit down, drink water, and then lay down. (I'r. at 24, 67.)
The AL] ultimately found that Plaintiff “generally overstates his limitations based on the whole
recotd and the greater weight of the evidence.” (Tr. at 24, 27-28.) In doing so, the AL]
specifically relied on Plaintiff's activities, his treatment records, and objective medical
evidence. For example, the ALJ explained that Plaintiff “endorsed typical daily activities of
sleeping, playing games, and walking outside,” and that “examination revealed that while he
did have reduced lung sounds, he had no wheezes, rales, or rhonchi.” (Tr. at 28.) The ALJ
also noted that “once he began being more compliant with his medication, his symptoms
decreased,” and that ultimately he remained “able to perform a range of light work with mental
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limitations.” (Tr. at 28.) Similarly, in assessing the severity of Plaintiff's impairments, the AL]
explained that
[Plaintiff] testified that he would get winded walking to his mailbox, but the
evidence shows he presented in September 2022 and had been feeling well from
a breathing standpoint until he recently developed chest pain and dyspnea that
improved with inhalers. His examination was negative with no pedal edema,
clubbing ot cyanosis and good ait movement bilaterally. The record from March
2021 showed that [Plaintiff] enjoyed walking outside. . . .
The medical evidence shows [that Plaintiff] presented to pulmonology on
September 21, 2022. He had an essentially normal CPET test in August 2017
with exception of a slight increase in ventilation relative to his VO2. The test
was ptematutely stopped before he reached the anaerobic threshold due to knee
pain. A computed tomography (CT) of the chest in January 2018 revealed near
complete resolution of bilateral nodule and groundglass opacities, compatible
with infection. A repeat pulmonary function test on May 18, 2021, showed he
had mild obstructive lung disease with his FEV1 improved compated to prior.
He had mildly reduced DLCO, worse compated to prior. . . .
[Plaintiff] presented to the rheumatology clinic on June 21, 2022, for evaluation.
He had previously been treated with Remicade that was discontinued due to
side effects. He was mote tecently on methotrexate, but this was discontinued
in Januaty 2021 due to gastrointestinal upset. So, he was then started on Humita,
but his adherence remained incomplete. Nevertheless, he had a reassuring exam
and tecent evaluations by colleagues showed no evidence of ocular, cardiac or
active pulmonary satcoidosis. His recent[] imaging revealed no evidence of
active satcoidosis or progression, he had improvement in his mediastinal
adenopathy, and had no concerning parenchymal changes for active sarcoidosis.
Finally, he had no recent seizures.
(Tr. at 20-21.)
Most crucially, as noted above, the ALJ also relied on (1) an unfavorable prior
administrative decision and (2) the findings of the State agency medical consultants and other
medical opinion evidence when assessing both Plaintiffs statements and his overall RFC.
Regatding the prior decision, the ALJ described the previous findings as “generally
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persuasive.” (Ir. at 29.) The ALJ noted that Plaintiff required additional reaching restrictions,
but also noted that records showed “less seizures overall,” and that his “mental fog from
seizutes” had stabilized compared to the previous time period. (Tr. at 29.) Notably, the RFC
in the prior decision included no testrictions involving the need for additional breaks,
absences, or time off-task (Tr. at 86), and it does not appear that Plaintiff asserts that his
fatigue and/or shortness of breath appreciably worsened between May 15, 2019 and his alleged
onset date of September 20, 2019.° Similarly, as detailed extensively in subsection A of this
Opinion, the AL] relied on the medical opinion evidence. (See Tr. at 29-32.) Because the
AL)’s decision clearly links the findings in the prior decision and the opinion evidence with
the RFC assessment in the present case, the Court finds no basis for remand. See Sineath v.
Colvin, 1:16CV28, 2016 WL 4224051, at *5 (M.D.N.C. Aug. 9, 2016) (“An AL] may satisfy
the function-by-function analysis requirement by referencing a properly conducted analysis of
state agency consultants.””) (quoting Herren v. Colvin, No. 1:15-CV-00002-MOC, 2015 WL
5725903, at *5 (W.D.N.C. Sept. 30, 2015) (collecting cases)).
Ultimately, it is not the function of this Court to re-weigh the evidence or reconsider
the ALJ’s determinations if they are supported by substantial evidence. As noted above,
“Tw]here conflicting evidence allows reasonable minds to differ as to whether a claimant 1s
disabled, the responsibility for that decision falls on the ALJ.” Hancock, 667 F.3d at 472
(internal brackets omitted). Thus, the issue before the Court is not whether a different fact-
©The AL] reviewed the intervening medical records, noting in particular that, “[tJhe record from August 2021
showed [Plaintiff] reported feeling well from a breathing standpoint. He had no shortness of breath, orthopnea,
ot chest pain.” (Tr. at 26.) Similarly, “evidence shows he presented in September 2022 and had been feeling
well from a breathing standpoint until he tecently developed chest pain and dyspnea that improved with
inhalers.” (Tr. at 20.)
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finder could have drawn a different conclusion, or even “whether [Plaintiff] is disabled,” but
rather, “whether the ALJ's finding that [Plaintiff] is not disabled is supported by substantial
evidence and was reached based upon a correct application of the relevant law.” Craig, 76 F.3d
at 589. Here, the AL] reviewed the evidence, explained his decision, and explained the reasons
for his determination. That determination is supported by substantial evidence in the record.
Plaintiff has not identified any errors that requite remand, and Plaintiffs Motion to Reverse
the Decision of the Commissioner will therefore be denied.
IT IS THEREFORE ORDERED that the Commissioner’s decision finding no
disability is AFFIRMED, that Plaintiffs Dispositive Brief [Doc. #11] is DENIED, that First
Defendant’s Dispositive Brief [Doc. #12] is GRANTED, and that this action is DISMISSED
with prejudice.
This, the 30% day of September, 2024.
LO aS?
nited States Magistrate Judge
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