HOSKINSON v. BISIGNANO

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF NORTH CAROLINA

BRANDON H., )

)

Plaintiff, )

)

v. ) 1:24CV393

)

FRANK BISIGNANO, )

Commissioner of Social Secutity,! )

)

Defendant. )

MEMORANDUM OPINION AND RECOMMENDATION

OF UNITED STATES MAGISTRATE JUDGE

Plaintiff Brandon H. (‘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 Secutity

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.

I. PROCEDURAL HISTORY

Plaintiff protectively filed applications for DIB and SSI on August 11, 2021, alleging a

disability onset date of May 20, 2021, in both applications. (Tr. at 10, 244-64, 268-71, 273-

His applications were denied initially (Tr. at 91-112, 140-49) and upon reconsideration.

The United States Senate confirmed Frank Bisignano as the Commissioner of Social Security on May 6, 2025,

and he took the oath of office on May 7, 2025. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure,

Frank Bisignano should be substituted as the Defendant in this suit. Neither the Court nor the parties need

take any further action to continue this suit by reason of the last sentence of section 205(g) of the Social Secutity

Act, 42 U.S.C. § 405(g).

2 Transcript citations refer to the Sealed Administrative Record [Doc. #3].

(Tr. at 113-34, 159-68.) Thereafter, Plaintiff requested an administrative hearing de novo

before an Administrative Law Judge (“ALJ”). (T'r. at 169-70.) On September 25, 2023,

Plaintiff, along with his non-attorney representative, attended the subsequent telephonic

hearing, at which both Plaintiff and an impartial vocational expert testified. (Tr. at 10, 33-86.)

Following this hearing, the AL] concluded that Plaintiff was not disabled within the meaning

of the Act (Tr. at 20), and on March 19, 2024, the Appeals Council denied Plaintiffs request

for review of the decision, thereby making the ALJ’s conclusion the Commissioner’s final

decision for purposes of judicial review. (Tr. at 1-6.)

Il LEGAL STANDARD

Federal law “authorizes judicial review of the Social Security Commissionet’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 ate supported by substantial evidence and were reached through application of the

cortect legal standard.” Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012) (quotation and

brackets 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)). “[I]t 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) G@nternal 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

[ALJ].” 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

AL)’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).

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

period of not less than 12 months[.]” Id. (quoting 42 U.S.C. § 423(d)(1)(A)).3

3 “The Social Security Act comprises two disability benefits programs. The Social Security Disability Insurance

Program (SSDD),, established by Title II of the Act as amended, 42 U.S.C. § 401 ef seg., provides benefits to

disabled petsons who have contributed to the program while employed. The Supplemental Security Income

Program (SSI), established by Title XVI of the Act as amended, 42 U.S.C. § 1381 ef seg., 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 CFR. pt. 416 (SSI), governing these two programs are,

in all aspects relevant here, substantively identical.” Craig, 76 F.3d at 589 n.1.

“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 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.

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 carties 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.” Mastto, 270 F.3d at 177. Alternatively, if a claimant clears 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

capacity (RFC’).” Id. at 179.4 Step four then requires the AL] to assess whether, based on

+ “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 requite RFC to reflect claimant’s “ability to do sustained work-

telated 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 equtvalent work schedule” (internal emphasis and quotation marks

omitted)). The RFC tncludes 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. “REC is to be determined by the ALJ only after

[the ALJ] considers all relevant evidence of a claimant’s impairments and any related symptoms (eg, pain).”

Hines, 453 F.3d at 562-63.

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 catty 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.

Il. DISCUSSION

In the present case, the ALJ found that Plaintiff had not engaged in “substantial gainful

activity” since May 20, 2021, his alleged disability onset date. The AL] therefore concluded

that Plaintiff met his burden at step one of the sequential evaluation process. (Ir. at 12.) At

step two, the ALJ further determined that schizophrenia was Plaintiffs sole severe

impairment. (Tr. at 13.) The ALJ found at step three that this impairment did not meet or

equal a disability listing. (Ir. at 13-14.) The ALJ therefore assessed Plaintiffs RFC and

determined that he could perform a full range of work at all exertional levels, but with the

following, non-exertional limitations:

[Plaintiff ] remains capable of understanding, remembering, and cartying out

simple work-related instructions; he can complete simple work-related tasks and

make simple work-related decision in an environment requiting no mote than

occasional changes in work setting and duties; he can concentrate and persist

with such tasks for two-hour increments; he can occasionally interact with

supervisors and coworkers, and can never interact with the public as part of his

assigned work duties.

(Tr. at 14.) Based on this determination and the testimony of a vocational expert, the AL]

determined at step four of the analysis that all of Plaintiffs past relevant work exceeded his

REC. (Tr. at 18.) However, the ALJ found at step five that, given Plaintiffs 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 19.)

Therefore, the ALJ concluded that Plaintiff was not disabled under the Act. (Tr. at 19-20.)

Plaintiff now contends that substantial evidence fails to support the ALJ’s analysis of

the opinion evidence relating to Plaintiffs mental health. In particular, Plaintiff challenges the

ALJ’s treatment of medical opinion evidence provided by Plaintiff's treating psychiatrist, Dr.

Daniel Wurzelmann, and the State agency psychological consultants, Chang-Wuk Kang, M.D.,

and Melissa Parnell, Ph.D.

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

more persuasive 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]: (i) Length of the

treatment relationship. . . (it) Frequency of examinations. ... (ii) Purpose

of the treatment relationship. . . . (wv) 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

area 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 requite decision-makers to “articulate

in [their] ... decision[s] 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

patagraphs (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 persuastveness of an opinion are the first two: supportability and consistency.

20 C.F.R. §§ 404.1520c(a), 404.1520c(c)(1)-(c)(2). Therefore, paragraph (b) further provides

that ALJs “will explain how [they] considered the supportability and consistency factors for a

medical source’s medical opinions . . . in [the] determination or decision.” 20 C.F.R.

§ 404.1520c(b)(2). Express discussion of the remaining factors is not required. See 20 C.F.R.

§ 404.1520c(b)(3); see also Revisions to Rules Regarding the Evaluation of Medical Evidence,

82 FR 5844-01 (Jan. 18, 2017) (explaining that the final rules in § 404.1520c “require our [AL]s]

to consider all of the factors” in § 404.1520c(c) “for all medical opinions and, at a minimum,

to articulate how they considered the supportability and consistency factors” in determining

persuasiveness). In other words, § 404.1520c(b)-(c) define the “minimum level of

atticulation” an AL] must include in her written decision “to provide sufficient rationale for a

reviewing... court.” Revisions to Rules Regarding the Evaluation of Medical Evidence, 82

F.R. 5844-01; see also Drumgold v. Comm’r of Soc. Sec., 144 F.4th 596 (4th Cir. 2025).

Hete, as set out in the administrative decision, both Dr. Kang and Dr. Parnell opined

that Plaintiff “can understand, remember, and carry out very short and simple instructions and

can persist with simple routine tasks, and that while he may have difficulty interacting with the

public, he can interact with supervisors and coworkers and adjust to stress consistent with

simple, routine tasks.” (Tr. at 17.) The ALJ found these opinions persuasive and “agree[d]

that [Plaintiff] can perform some simple tasks with reduced stress and no public contact.” (Tr.

at 17.) In doing so, he noted that

Drs. Kang and Parnell supported their opinions with a detailed review of the

evidence available to them, citing to the generally stable and intact mental status

findings and reported activities of daily living that contradict [Plaintiff's]

allegations. These findings remain consistent with the record available at the

hearing level, which documents improvement with medication compliance and

reduced drinking, such that [Plaintiff] is able to work part-time, volunteer, and

engage with others.

(Tr. at 17 (citing Tr. at 694, 707, 710, 713, 725, 785).) The ALJ further asserted that Plaintiff's

mental status findings have remained stable since Dr. Kang and Dr. Parnell issued their

findings in January and August 2022, respectively. (Tr. at 17 (citing Tr. at 709, 715, 728, 746,

773-T4).)

Although the ALJ found the State agency opinions supported by and consistent with

the evidence without exception, Plaintiff correctly notes that the ALJ did not adopt them in

full when assessing Plaintiffs RFC. Specifically, the ALJ found Plaintiff “capable of

understanding, remembering, and carrying out simple work-related instructions” rather than

capable of understanding, remember, and carrying out “very short and simple instructions”

as found by Drs. Kang and Parnell. (Compare Tr. at 14 with Tr. at 107, 119.) This small

change appears innocuous at first blush. However, it has a significant impact at step five of

the sequential analysis, as the inclusion of “very short and simple” instructions in Plaintiffs

RFC would apparently preclude all of the jobs identified by the vocational expert at that step.

In Pearson v. Colvin, 810 F.3d 204, 210 (4th Cir. 2015), the Fourth Circuit recognized

that an ALJ has an affirmative “duty to make an independent identification of apparent

conflicts” between VE testimony and the provisions of the Dictionary of Occupational ‘Titles

(“DOT”), regardless of whether a conflict is identified by the VE. Pearson, 810 F.3d at 208-

09, 210. In Pearson, because of the apparent conflict between the VE’s testimony and the

DOT, remand was tequited so that the ALJ could elicit a reasonable “explanation from the

expert” before relying on the expert’s testimony. Id. at 208-09, 211. In 2019, in ‘Thomas v.

Berryhill, the Fourth Circuit applied the principles articulated in Pearson as they related to the

DOT?’s Reasoning Development scale. See Thomas v. Berryhill, 916 F.3d 307, 314 (4th Cir.

2019). That scale has six levels—Level 1 requires the least reasoning ability, and Level 6

tequites the most reasoning ability. See DOT, App. C, 1991 WL 688702.5 The DOT assigns

a Reasoning Development Level to each occupation identified therein. In Thomas, the

vocational expert identified three jobs, all with a Reasoning Level of 2, “requit[ing] employees

to ‘carry out detailed but uninvolved written or oral instructions.’ By comparison, Thomas’s

REC limit[ed] her to jobs that involve only ‘short, simple instructions.” ‘Thomas, 916 F.3d at

314 (internal citations omitted). The Fourth Circuit found

that Thomas, being limited to short, simple instructions, may not be able to

catty out detailed but uninvolved instructions. This is not a categorical rule—

some instructions, particularly if they are well-drafted, may be simultaneously

short, simple, detailed, and uninvolved. Even so, the conflict between

Thomas’s limitation to short, simple instructions and the VE’s testimony that

Thomas could perform jobs that include detailed but uninvolved instructions 1s

as appatent as the conflict we identified in Pearson. Since we held that an

apparent conflict existed in Pearson, we are satisfied that one exists in this case,

too. We temand so that the ALJ can resolve the conflict in accordance with the

Administration’s regulations.

Id. at 314 (footnote omitted). Consequently, in ‘Thomas, the Fourth Circuit held that there

was an apparent conflict between jobs requiting Level 2 reasoning and a limitation to “shott,

simple instructions.” Id. Moreover, in Lawrence v. Saul, 941 F.3d 140, 143 (4th Cir. 2019),

5 The Reasoning Levels relevant to this case, Level 1 and Level 2, ate defined as follows:

LEVEL 2

Apply commonsense understanding to carry out detatled but uninvolved written or oral

instructions. Deal with problems involving a few concrete variables in or from standardized

situations.

LEVEL 1

Apply commonsense understanding to carry out simple one- ot two-step instructions. Deal

with standardized situations with occasional or no variables in or from these situations

encountered on the job.

U.S. Dept. of Labor, DOT, App. C, 1991 WL 688702.

10

the Fourth Circuit clarified that the conflict in such cases results from the restriction to “short”

instructions, rather than the simplicity of the instructions or tasks:

“Short” is inconsistent with “detailed” because detail and length are highly

cortelated. Generally, the longer the instructions, the more detail they can

include. In contrast, the [AL]] found that Lawrence could perform jobs limited

to “simple, routine repetitive tasks of unskilled work.” There is no comparable

inconsistency between Lawrence’s [RFC] . . . and Level 2’s notions of “detailed

but uninvolved .. . instructions” and tasks with “a few [ ] variables.”

Id. (citations omitted). In the present case, the consultants’ opined limitation to “very short”

instructions further emphasizes Plaintiff’s inability to understand, remember, and carry out

detailed instructions, which would create an apparent conflict with the DOT with respect to

the jobs identified by the ALJ, which all involve Level 2 reasoning.

Of course, the AL] did not include the consultants’ limitation to “very short”

instructions in the RFC, so no apparent conflict arose. However, Plaintiff raises this issue to

highlight the impact of the AL]’s omission in evaluating the opinion evidence. Both State

agency consultants opined that Plaintiff would “have difficulty in following detailed

instructions,” and therefore requited greater limitations in this area, specifically limited to “very

short and simple instructions.” (I. at 107, 119.) The ALJ accepted these opinions and

presented no reasons for his departure from the consultants’ findings. Moreover, the only

other medical opinion evidence, that of Dr. Wurzelmann, concurred with the consultants on

this point. (See Tr. at 604-05, 607.) The Court acknowledges that, in finding a medical source’s

opinion persuasive, an AL] is not required to adopt every facet of that opinion. See Tranter

v. Kijakazi, No. 1:20-CV-280-MOC, 2021 WL 5018699, at *7 (WD.N.C. Oct. 28, 2021)

(explaining that, “where an ALJ [gave] a medical opinion ‘great weight, [the AL] was] not

obliged to adopt the opinion in its entirety or “give [it] controlling weight’ when examining this

11

issue under the prior [pre-2017] regulations,” and that “[t]he same logic holds when an ALJ

finds a medical opinion or prior administrative medical finding ‘persuastve’ under the revised

regulations.”) (internal citations and some internal quotation marks omitted). However, where,

as here, the ALJ, without explanation or evidentiary support, omits a limitation opined by all

of the claimant’s medical sources and, in doing so, significantly decreases the restrictiveness

of that clatmant’s RFC, substantial evidence fails to support the ALJ’s findings. In short, the

ALJ in this case improperly substituted his own findings for those of the medical sources

without any explanation. Further, that omission cannot be considered harmless, as all three

of the jobs identified and relied upon by the AL] at step five require a Reasoning Level of 2,

and therefore an ability to understand and carry out detailed but uninvolved instructions. (I't.

at 19, 80-83 (citing DOT 369.687-026, 1991 WL 673074; DOT 323.687-010, 1991 WL 672782,

DOT 920.587-018, 1991 WL 687916).) Therefore, remand is required so that the ALJ can

explain the decision to not include the limitation to “very short” instructions, reflected in all

of the medical opinions, including Drs. Kang and Parnell, relied on by the AL], or alternatively

if that limitation is included in the RFC, address the apparent conflict with the DOT for the

identified occupations with a Reasoning Level 2.

In addition to the above error, the ALJ’s treatment of Dr. Wurzelmann’s opinions

provides an additional basis for remand. As set out in the administrative decision, Dr.

Wurzelmann provided two medical opinions during the relevant time period:

On September 5, 2021, Dr. Wurzelmann submitted a statement opining that

[Plaintiff] has no useful ability to function in maintaining regular attendance,

being punctual, and sustaining an ordinary routine, and that he is unable to meet

competitive standards in remembering work-like procedures, carrying out even

very short and simple instructions, maintaining attention for two-hour

segments, working in coordination with others without being unduly distracted,

12

completing a normal workday without interruption from symptoms, and

performing at a consistent pace without an unreasonable number of breaks. He

is unable to meet competitive standards in semiskilled and skilled work. Dr.

Wurzelmann further opined that [Plaintiff] has extreme limitations in

remembering information, concentrating, and maintaining pace, with other

matked limitations, and that he will be absent more than four days per month.

In support of this opinion, Dr. Wurzelmann stated that [Plaintiffs] symptoms

ate managed with risperidone but that he tends to decompensate when he

misses it, that he is frequently quite disorganized and misses appointments, that

he often forgets medication changes, and that he sometimes misinterprets

everyday events in a way that he feels threatened, bordering on paranoia.

Again, on September 18, 2023, Dr. Wurzelmann submitted a statement opining

that [Plaintiff] has [] marked or extreme limitation|s] in all “paragraph B” criteria

ateas, and with respect to even very short and simple instructions, maintaining

attention and concentration, sustaining a routine, and getting along with

coworkers[.]

at 16-17) (citations omitted).

The ALJ found these statements unpersuasive. In doing so, he noted several factors,

including Dr. Wurzelmann’s “own treatment notes, which document some deficits in insight

and concentration, but otherwise intact memory, attention, and concentration, and normal

behavior.” (Tr. at 17 (citing Tr. at 709, 715, 728, 746, 773-74).) The ALJ further noted that,

at multiple appointments with Dr. Wurzelmann, Plaintiff reported “generally doing well with

no major concerns” (Tr. at 17(citing Tr. at 694, 702, 710, 713, 726, 731, 738, 744)), and that,

aside from “his brief rehab stay,” “the record does not include emergency, inpatient, ot

intensive outpatient services” supporting the disabling mental limitations opined by this

provider (Tr. at 17). In addition, the ALJ cited Plaintiffs “broad range of daily activities” as

inconsistent with Dr. Wurzelmann’s opinions, explaining that,

[Plaintiff] may not have done well in a hectic restaurant-type environment, but

he has found less stressful environments doing part-time and volunteer work

during the period at issue, including gardening, helping in a kitchen, and

working with dogs. He lives alone, cates for his pet dog, cooks, and cleans his

13

apartment. He appeats to have few issues interacting with others, as he works

out on a regular basis at the gym with a friend, attends fitness classes, plays the

guitar with others, goes to coffee shops and bars, and gets along with his

neighbors. [Plaintiffs] demonstrated ability to work at least part-time, care for

himself, and interact with others is not consistent with Dr. Wurzelmann’s

opinions that [Plaintiff] is essentially unable to complete any activities.

(Tr. at 17) (citations omitted).

Plaintiff contends that the AL] misrepresented or mischaracterized Dr. Wutzelmann’s

opined limitations and the supporting evidence. Notably, the nine-page Mental Impairment

Questionnaite completed by Dr. Wurzelmann in September 2021 provides a detailed and

nuanced account of Plaintiffs abilities, with extensive explanations for the findings, based on

his five years as Plaintiffs treating psychiatrist. (See Tr. at 601-09.)° In evaluating this opinion,

the ALJ found Dr. Wurzelmann’s opined limitations unsupported by his treatment notes,

because Plaintiff generally reported “doing well with no major concerns.” (Tr. at 17.)

However, both Dr. Wurzelmann’s medical statement and his treatment notes explain that

Plaintiffs lack of concern was actually a symptom of his schizophrenia. Specifically, Dr.

Wurzelmann explained that Plaintiff “has limited insight into his illness and often doesn’t think

he has any psychiatric illness. A few years ago, I wrote him a letter to support his disability

claim, but he refused to finish applying for disability because he felt he didn’t have any

problems.” (Tr. at 609.) Instead, Dr. Wurzelmann noted, Plaintiff “typically floats from job

to job, getting laid off after a few weeks to months due to frequent errors, inattentiveness, and

6 The two-page functional questionnaire completed by Dr. Wurzelmann in September 2023 only allowed the

provider to identify, via checkmark, areas in which Plaintiff had extreme or marked limitations. (T'r. at 804-05.)

Lesser degtees of limitation, such as mild or medium, were not provided as options. (Tr. at 804-05.) Therefore,

Dr. Wurzelmann was forced to choose between indicating that Plaintiff (1) had no limitations at all in a given

atea ot (2) marked or extreme limitations. Given only these polarized choices, the provider was, by default,

compelled to select the “extreme” limitations the AL] later cited when finding the opinions unpersuasive.

Plaintiff does not appeat to object to this finding, given the flawed nature of the questionnaire itself.

14

general low performance due to lacking organizational ability.” (Tr. at 609.) Dr. Wurzelmann

further explained that Plaintiff struggled at work to keep up with tasks, is often told to work

faster, “has a hard time following directions,” and struggles to get to work on time. (I'. at

604.) Dr. Wurzelmann noted that Plaintiff “was unable to finish high school” and that he

“has struggled across his many different jobs. He is often slow, struggling to get things done

in a timely manner, then supervisors put pressure on him, and he becomes stressed out.” (Tr.

at 605-06.) Dr. Wurzelmann added that Plaintiff “often drinks to relieve stress, which further

impairs his functioning.” (Tr. at 605.) As the ALJ noted, Plaintiffs drinking also led to a stay

in rehabilitation facility during the relevant time period. (Tr. at 15.) In addition, when asked

whether Plaintiff could manage benefits in his own interest, Dr. Wurzelmann stated that

Plaintiff “struggle[s] to maintain a budget and has difficulty tracking where his money goes.

When his mom puts money into his account, she notes [that] it rapidly disappears and he has

no explanation for it. When I asked him about it, he was also unable to explain.” (T'r. at 609.)

Dr. Wurzelmann clarified that these difficulties, along with Plaintiffs significant and ongoing

difficulty remembering instructions regarding medication changes and appointments, were

symptoms of the extreme mental disorganization caused by schizophrenia itself. (See Tr. at

601, 602, 604, 606, 608.) These difficulties are specifically reflected in Dr. Wurzelmann’s

treatment notes, including Plaintiffs difficulty maintaining a job, his limited insight and

inability to recognize his own cognitive disorganization, and his difficulty maintaining

medication compliance and remembering appointments and instructions. (See Tr. at 617-19,

623-26, 629-32, 636-41, 643-48, 650-55, 657-662, 664-70, 674-80, 682-88, 694-705, 707-10,

731-36, 738-42, 744-48; 758-61.) Because the AL] relied on Plaintiffs reports of “doing well”

15

to discount Dr. Wurzelmann’s opinion, even though Plaintiffs lack of insight was itself a

symptom of his schizophrenia, and because the ALJ did not address this issue or otherwise

address the majority of Dr. Wurzelmann’s supporting explanations, it is not clear that the ALJ

adequately or accurately addressed the supportability and consistency of Dr. Wurzelmann’s

opinion.’

There ate similar problems with the AL]’s assertion that Plaintiffs “broad range of

daily activities is inconsistent with Dr. Wurzelmann’s opinions.” (Tr. at 17.) In particular,

the ALJ found that Plaintiff's “demonstrated ability to work at least part-time, care for himself,

and interact with others is not consistent with Dr. Wurzelmann’s opinions that [Plaintiff] is

essentially unable to complete any activities.” (Tr. at 17.) However, this broad conclusion

mischaracterizes both Dr. Wurzelmann’s opinions and Plaintiffs activities. In Woods v.

Berryhill, the Fourth Circuit explained that “[a]n AL] may not consider the type of activities a

claimant can perform without also considering the extent to which she can perform them.”

Woods vy. Berryhill, 888 F.3d 686, 694 (4th Cir. 2018) (emphasis omitted); see also Lewis v.

Berryhill, 858 F.3d 858, 868, n.3 (4th Cit. 2017) (“The ALJ points to Lewis’ ability to perform

incremental activities interrupted by periods of rest, such as “driv|ing] short distances of up to

7 The Court also notes that, from the explanation the ALJ did provide, it remains unclear whether he adequately

considered Plaintiff's lack of medication compliance throughout much of the period, as described in detail in

Dr. Wurzelmann’s opinion and treatment notes, as a symptom of Plaintiff's schizophrenia. The ALJ repeatedly

characterized Plaintiffs condition as improving when he was compliant with medications (Tr. at 13, 14, 15, 16),

without considering the reason for noncompliance or the ongoing treatment records reflecting Plaintiffs

confusion and inconsistency with medications. See Pate—Fires v. Astrue, 564 F.3d 935, 945 (8th Cir. 2009)

(“[FJederal courts have recognized a mentally ill person’s noncompliance with psychiatric medications can be,

and usually is, the result of [the] mental impairment [itself] and, therefore, neither willful nor without a justifiable

excuse” and “[clourts considering whether a good reason supports a clatmant’s failure to comply with

prescribed treatment have recognized psychological and emotional difficulties may deprive a claimant of the

rationality to decide whether to continue treatment or medication.” (internal quotations omitted)); Preston v.

Heckler, 769 F.2d 988, 990-91 (4th Cir. 1985).

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30 miles, shop for groceries with the assistance of her mother or roommate, handle her

finances, and watch television.’ The AL]’s conclusion that Lewis’ activities demonstrate she

is capable of work is unsupported by the record.”) (citation omitted); Brown v. Comm’r, 873

F.3d 251, 263 (4th Cir. 2017) (“[T]he ALJ noted that Brown testified to daily activities of living

that included ‘cooking, driving, doing laundry, collecting coins, attending church and

shopping.’ The AL] did not acknowledge the extent of those activities as described by Brown,

e.g., that he simply prepared meals in his microwave, could drive only short distances without

significant discomfort, only occasionally did laundry and looked at coins, and, by the time of

the second ALJ hearing, had discontinued regular attendance at church and limited his

shopping to just thirty minutes once a week. Moreover, the AL] provided no explanation as

to how those particular activities—or any of the activities depicted by Brown—showed that

he could persist through an eight-hour workday.’’) (citation omitted); see_also Fletcher □□

Colvin, No. 1:14CV380, 2015 WL 4506699 at *5-8 (M.D.N.C. July 23, 2015).

Here, the AL] stated that Plaintiff could do “part-time and volunteer work during the

period at issue, including gardening, helping in a kitchen, and working with dogs,” and that he

“lives alone, cates for his pet dog, cooks, and cleans his apartment.” (Tr. at 17.) However, as

in Woods, the ALJ failed to qualify the extent of Plaintiffs activities. Although no one lives

with Plaintiff, his mother testified that she, along with Plaintiffs father and grandmother, pay

all of Plaintiffs bills and deposit small amounts of money in his account to pay for food, gas,

and other essentials. (Ir. at 69-70.) Plaintiffs mother also testified that she typically visits

Plaintiff on at least a weekly basis, at which point she has to remind him to clean up after

himself and take care of grooming activities such as showering and trimming his fingernails.

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at 69, 73.) When asked if she provides assistance regarding Plaintiffs daily medications,

his mother stated that, “[flor a long period [she] was going every day to... watch him

physically take [his] medication, because . . . he was being way too casual.” (Tr. at 70.) As

noted above, this difficulty with treatment compliance—and compliance generally—is

reflected repeatedly in Dr. Wurzelmann’s treatment notes.

In terms of Plaintiffs ability to work and volunteer on a part-time basis, Plaintiff

testified that he was fired from three jobs for working too slowly and having difficulty

following instructions. (Tr. at 57.) This difficulty in maintaining employment is reflected in

Dr. Wurzelmann’s treatment records. (See Tr. at 617-19, 623-26, 629-32, 636-41, 643-48.)

Plaintiff also clarified that “working with dogs” involves cleaning out kennels for about an

hour a day and that he can take his own dog with him. (Ir. at 44-45, 64-65.) Further, the

“two part-time jobs” relied upon by the ALJ—“one helping in a kitchen and the other

gardeninge”—are only mentioned in Dr. Wurzelmann’s treatment notes in February and March

of 2023. (Ir. at 16, 17, 751, 758.) The ALJ failed to consider that the jobs in question were

very limited and only lasted for a short time. Specifically, at his appointments in February and

Match of 2023, Plaintiff reported that he was “doing some gardening . . . just a few hours here

and there a few days pet week.” (Tr. at 758.) At his Match appointment, Plaintiff also reported

that he had “restarted [a] part-time job working a few hours in a kitchen,” which he found

“less stressful than prior jobs.” (Tr. at 764.) However, when questioned about work six

months later at the administrative hearing, Plaintiff did not indicate that he continued to

perform either the gardening or kitchen jobs, instead identifying only his work at the kennels.

(Tr. at 44-45.) Accordingly, the evidence cited by the AL] fails to support his finding that

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Plaintiff had a “demonstrated ability to work at least part-time [and] care for himself,” and

fails to support the conclusion that Plaintiff could therefore work full time and that Dr.

Wurzelmann’s opinion was unsupported. (Tr. at 17.) Instead, the inconsistency and instability

of Plaintiff's efforts to even work a few hours per week in limited or volunteer-type positions

appears to provide further support to Dr. Wurzelmann’s opinions. See Lewis, 858 F.3d at 869

(“An ALJ has the obligation to consider all relevant medical evidence and cannot simply

cherty-pick facts that support a finding of nondisability while ignoring evidence that points to

a disability finding.” (internal quotation omitted)); Arakas v. Comm’r, Soc. Sec. Admin., 983

F.3d 83, 98 (4th Cir. 2020) (finding that the AL]’s decision was “unsupported by substantial

evidence” where “the ALJ erred by [] selectively citing evidence from the record’’).

In light of these issues with respect to the consideration of Dr. Wurzelmann’s opinion,

and in light of the ALJ’s failure to address material limitations included in the opinions of Dr.

Kang and Dr. Parnell as discussed above, substantial evidence fails to support the AL]’s

analysis and remand 1s required.

IT IS THEREFORE RECOMMENDED that the Commissioner’s decision finding

no disability be REVERSED, that Defendant’s Dispositive Brief [Doc. #11] be DENIED,

that Plaintiffs Dispositive Brief [Doc. #10] be GRANTED, and that this action be

REMANDED for further consideration in accordance with the directives set out herein.

This, the day of August, 2025.

Yada

nited States Magistrate Judge

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