The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF NORTH CAROLINA
MATTHEW F., )
)
Plaintiff, )
)
v. ) 1:24CV307
)
FRANK BISIGNANO, )
Commissioner of Social Security,! )
)
Defendant. )
MEMORANDUM OPINION AND ORDER
OF UNITED STATES MAGISTRATE JUDGE
Plaintiff Matthew F. (“Plaintiff”) brought this action pursuant to Section 205(g) of the
Social Security Act (the “Act”), as amended (42 U.S.C. § 405(g)), to obtain judicial review of a
final decision of the Commissioner of Social Security (“Defendant”) denying his claim for
Disability Insurance Benefits (“DIB”) under Title II 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 his application for DIB on June 1, 2021, alleging a disability
onset date of May 19, 2021. (Tr. at 20, 294-300.)? His application was denied initially (Tr. at
113-20, 131-35) and upon reconsideration (Tr. at 121-30, 142-61). Thereafter, Plaintiff
1 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 Procedute,
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 Security
Act, 42 USS.C. § 405(g).
2 Transcript citations refer to the Sealed Administrative Record [Doc. #5].
requested an administrative heating de novo before an Administrative Law Judge (“ALJ”).
(Tr. at 162-63.) On March 30, 2023, Plaintiff, along with his attorney, attended the subsequent
telephone hearing, at which Plaintiff and an impartial vocational expert (“VE”) testified. (Tr.
at 20, 49-82.) Following the hearing, the AL] concluded that Plaintiff was not disabled within
the meaning of the Act (I'r. at 42-43), and, on February 8, 2024, the Appeals Council denied
Plaintiffs request for review, thereby making the ALJ’s ruling the Commissionet’s final
decision for purposes of judicial review (Tt. at 1-7).
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
ALJ if they are supported by substantial evidence and were teached 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. 1992)
(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 Cit. 2001) (internal 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).
“Tn 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
ALJ’s finding that [the claimant] is not disabled is supported by substantial evidence and was
teached based upon a cortect 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 beats the burden of proving a disability.” Hall v. Hartis, 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 (SSDN), 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 program 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 petsons. 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 are,
in all aspects relevant here, substantively identical.” Craig, 76 F.3d at 589 1.1.
“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 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
capacity (RFC’).” Id. at 179.4 Step four then requires the AL] to assess whether, based on
+ “RFC is a measurement of the most a claimant can do despite [the claimant’s] limitations.” Hines, 453 F.3d
at 562 (noting that administrative regulations require RFC to reflect claimant’s “ability to do sustained work-
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 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 AL] only after
[the ALJ] considers all relevant evidence of a claimant’s impairments and any related symptoms (¢,2., 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
wotk, 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 AL] 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
“evidentiaty 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.
Ill. DISCUSSION
In the present case, the ALJ found that Plaintiff had not engaged in “substantial gainful
activity” since his alleged onset date. (Tr. at 22.) Plaintiff therefore met his burden at step
one of the sequential evaluation process. At step two, the ALJ further determined that Plaintiff
suffered from the following severe impairments:
[B]ipolar disorder, unspecified; schizoaffective disorder, unspecified; insomnia;
and alcoholism|.|
(Tr. at 23.) The ALJ found at step three that none of these impairments, individually or in
combination, met or equaled a disability listing. (Tr. at 23-28.) Therefore, the ALJ 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] is limited to unskilled work and should have all safety precautions
[including] no work on ladders, ropes or scaffolds; no work at unprotected
heights or around dangerous moving machinery[; and njo commercial driving.
He retains the capacity to understand and remember simple one and two step
instructions as defined by the Dictionary of Occupational Titles. [Plaintiff]
retains the capacity to concentrate and remain on task on these simple one and
two step jobs for two hour periods over an eight-hour day throughout a forty-
hour workweek with all customary breaks. [He] can have occasional contact
with the general public but no direct contact with the general public such as a
retail sales or information clerk. He retains the social interaction capacity for
routine interactions with coworkers and supervisors on an occasional basis.
at 28.) At step four of the analysis, the AL] determined that all of Plaintiffs past relevant
work exceeded his RFC. (Tr. at 41.) However, the AL] determined at step five that, given
Plaintiffs age, education, work experience, RFC, and the testimony of the VE as to these
factors, he could perform other jobs available in the national economy. (Tr. at 42.) Therefore,
the ALJ concluded that Plaintiff was not disabled under the Act. (Tr. at 42-43.)
Plaintiff now contends that the AL] “erred by failing to apply the correct legal standards
when evaluating [Plaintiffs] psychological impairments.” (PI. Br. [Doc. #12] at 1.) In making
this challenge, Plaintiff primarily argues that the AL] erred in evaluating Plaintiffs symptoms
and the limiting effects of his impairments by relying on the lack of “objective” medical
evidence to support his contentions.
Under the applicable regulations, the AL]’s decision must “contain specific reasons for
the weight given to the individual’s symptoms, be consistent with and supported 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
and XVI: Evaluation of Symptoms in Disability Claims, SSR 16-3p, 2017 WL 5180304, at
*10 (Oct. 25, 2017) (“SSR 16-3p”); see also 20 C.F.R. § 404.1529. In Arakas v. Commissioner
of Social Security, 983 F.3d 83 (4th Cir. 2020), the Fourth Circuit clarified the procedure 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 impairment” 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 required to find the claimant disabled. SSR 16-3p, 2016
WL 1119029, at *4-5. SSR 16-3p recognizes that “[s]ymptoms cannot always
be measuted objectively through clinical or laboratory diagnostic
techniques.” Id. at *4. Thus, the ALJ must consider the entire case record 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.
983 F.3d at 95. The Fourth Circuit later affirmed and expanded its previous holdings when
issuing Shelley C. v. Commissioner of Social Security, 61 F.4th 341, 361-62 (4th Cir. 2023). In
Shelley C., the Court explained that some conditions, including major depression, do not
manifest themselves in objective signs and symptoms. Id. “[B]Jecause of the unique and
subjective nature of [such impairments], subjective statements from claimants [in these cases]
‘should be treated as evidence substantiating the claimant’s impairment.”’ Id. (quoting Arakas,
983 F.3d at 97-98).
In this case, as noted by Plaintiff, the ALJ included language that appeared to require
supporting objective evidence, in contradiction to the Fourth Circuit’s directives. For
example, when explaining his basis for discounting the severity of Plaintiffs symptoms, the
AL] found as follows:
[Plaintiff] has multiple medically determinable mental impairments that could
reasonably be expected to produce some of the alleged symptoms and
functional limitations; however, the severity of his condition is not supported
by the objective findings. As will be discussed in more detail below, the record
cleatly shows [that Plaintiffs] condition is stable and does not significantly
affect his ability to perform work activity.
at 29 (emphasis added).) The AL] repeatedly noted normal mental status examinations
and unremarkable examinations. (I'r. at 29-32 (citing T’r. at 687-89 (January 8, 2018), 659-86
(April 11, 2018, July 10, 2018, October 1, 2018, January 2, 2019, April 3, 2019, July 2, 2019,
October 2, 2019, January 2, 2020), 643-46 (December 1, 2020)).) These records reflect that in
the years prior to the May 2021 alleged onset date, Plaintiff was suffering with symptoms of
bipolar disorder and schizoaffective disorder, with ongoing adjustments in his medication, but
was generally stable. The records further reflect increasing symptoms after May 2021. At
visits in June 2021, he reported panic episodes with angry outburst and manic episodes, and
on exam his mood was anxious and restless, but the AL] noted the otherwise normal
examination, oriented to time, person, and place. (I'r. at 31 (citing Tr. at 630-38, 625-29).)
Notably, the next month, in July 2021, Plaintiff was involuntarily hospitalized on petition by
the county, based on homicidal ideation and being a danger to himself and others. (Tr. at 31,
694-768.) ‘The ALJ again found that at visits following Plaintiffs release, mental status
examinations were “generally unremarkable” and his providers continued to adjust his
medications. (Tr. at 32.) The ALJ also summarized the consultative examination in September
2021, where Plaintiff reported auditory hallucinations and his belief that other people could
read his mind, but the ALJ also noted that on examination memoty was intact, and stream of
thought was logical and orderly. (Tr. at 33.) The Consultative Examiner, Dr. Lucas, found
that Plaintiff would likely experience intermittent difficulty with stress tolerance and coping
with vocational pressures secondaty to schizoaffective disorder, but the ALJ did not find the
Consultative Examiner’s opinion persuasive. (Tr. at 34,545.) Plaintiff was again hospitalized
for worsening psychiatric symptoms in December 2021, June 2022, July 2022, and August
2022, with three separate psychiatric hospitalizations of roughly 34 days total in the 10-month
petiod prior to the heating, with auditory hallucinations and paranoid delusions. (Tr. at 35-
37, 1054-73, 961-1053, 1078-125, 1126-69.)> However, the AL] again noted examinations that
were “completely unremarkable, other than [Plaintiffs] mood and affect being anxious.” (Tr.
at 35, 37.) In evaluating PlaintifPs symptoms, the ALJ further noted that “[w]hile he
complains people can heat what he is thinking in his mind, he is consistently noted as alert
and oriented x 3.” (Tr. at 38.) The ALJ concluded that “the objective medical evidence
supports that when [Plaintiff] is compllia]nt with his medications and compllfia]nt with his
doctot’s instructions not to self-medicate with beer, his condition significantly improved to
allow him to perform work as noted in the residual functional capacity.” (Tr. at 32.) As noted
above, this analysis appeats to reflect a determination based on the lack of objective medical
evidence supporting Plaintiffs symptoms, and a disregard of his ongoing symptoms of bipolar
disorder and schizophrenia, including auditory hallucinations and paranoia, based on Plaintiff
being oriented to person, place and time and otherwise having what the ALJ viewed as
“unremarkable” examinations.
Moreover, Defendant contends that the AL] properly relied on “Plaintiffs significant
improvement when he was sober and compliant with medication” and the “largely
unremarkable mental status findings when he was compliant.” (Def. Br. [Doc. #13] at 12.)
5 At the hearing, the VE testified that this level of absenteeism would preclude employment and would result
in termination. (Tr. at 76-77.)
On this point, Defendant contends that the ALJ properly emphasized that Plaintiffs episodes
of increased symptomology during the time period at issue primarily stemmed from his failure
to fully comply with medical treatment recommendations, including correct medication usage,
follow-up appointments, and maintaining sobriety. (See, e.g., Tr. at 30, 32-33, 35.) However,
as numerous courts, including those in this Circuit, have explained, an AL] may not rely on
noncompliance to discount the severity of a claimant’s mental impairments without also
considering why the claimant was noncompliant. An ALJ who fails to undertake the second
part of this analysis errs, because it is axiomatic that
noncompliance [itself] may be a symptom of mental illness. See McKoy v. Saul,
No. 7:19-CV-00223-FL, 2020 WL 8084961, at *9 (E.D.N.C. Novy. 22, 2020)
(finding that citing a mental health patient’s medication non-compliance,
without exploring the reasons underlying it, offered little in the way of
substantial evidence to support the AL]’s RFC assessment), report and
recommendation adopted, 2021 WL 76956 (E.D.N.C. Jan. 8, 2021); Turner v.
Saul, No. 5:19-CV-190-D, 2020 WL 3866669, at *7 (E.D.N.C. June 9, 2020)
(“treatment [n]on-compliance may be intentional or a symptom of mental
illness[,] . . . [s]o citing . . . non-compliance, without exploring the reasons
underlying it, offers little in the way of substantial evidence to uphold the RFC
determination.) (citing Pate-Fires v. Astrue, 564 F.3d 935, 945-46 (8th Cir.
2009) (“[N]Joncompliance with psychiatric medications can be, and usually is,
the result of the mental impairment itself, and, therefore, neither willful nor
without a justifiable excuse. ... Courts considering whether a good reason
supports a claimant’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.”’)), report
and recommendation adopted, 2020 WL 3840510 (E.D.N.C. July 8, 2020).
Furthermore, SSR 16-3p requires the AL] to consider possible reasons for
failure to comply with treatment before finding an indtvidual’s symptoms
inconsistent with the evidence of record on that basis. 2017 WL 5180304, at
*9—10 (Oct. 25, 2017).
Howe v. Kijakazi, No. 7:22-CV-66-FL, 2023 WL 5363719, at *5 (E.D.N.C. July 31, 2023).
Here, the AL] determined that “the objective medical evidence supports that when
[Plaintiff] is compl{ia]nt with his medications and compl|ia]nt with his doctotr’s instructions to
10
not self-medicate with beer, his condition significantly improved to allow him to perform work
as noted in the [RFC].” (Ir. at 32.) However, at no point did the ALJ explore the reasons for
PlaintifPs non-compliance. This failure is particularly problematic in the present case, which
involves only mental impairments, including bipolar disorder, schizoaffective disorder, and
alcoholism, all of which may impair rational decision-making. (Tr. at 23.) Moreover, the
record chronicles that Plaintiffs providers adjusted his medications many times throughout
the period at issue in an effort to address his ongoing problems with depression, manic
episodes, anxiety, anger, insomnia, paranota, and auditory hallucinations, as well as side effects
from the medications themselves. Although Plaintiff did experience some brief periods of
improvement when compliant with his treatment advice, he also required inpatient psychiatric
cate on at least four occasions during the alleged disability period, with ongoing hallucinations,
patanoia, and manic behavior. The record further reveals that, in between appointments and
hospitalizations, Plaintiff titrated his medications up and down, sometimes at the advice of his
providers and sometimes on his own, in an apparent attempt to better control his symptoms.
(Tr. at 35.) These records generally support Plaintiffs contention that the medication would
work for a time but would then stop working as well, requiting ongoing adjustment, with
significant deterioration after each hospitalization. ‘Thus, it is not clear that there is even
substantial evidence that Plaintiff was noncompliant, or whether the medication simply
stopped working over time. Moreover, even if there were periods of medication
noncompliance, the AL] never addressed whether Plaintiffs non-compliance was (1) a willful
act ot (2) a manifestation of his mental illness, particularly the paranoia and disordered
11
thinking associated with his schizophrenia. Without this analysis, substantial evidence fails to
support the AL]J’s decision.
Similarly, the ALJ focused extensively on Plaintiffs use of alcohol (I'r. at 56, 57, 58-59,
69, 29, 31, 35), and the record reflects that Plaintiff used alcohol at times “in an attempt to
self-medicate” as noted by the Consultative Examiner. (Ir. at 545.) The ALJ therefore
discounted Plaintiffs hospitalizations and significant mental health symptoms to the extent
Plaintiff consumed alcohol. However, the ALJ did not undertake the required analysis for
evaluating cases involving alcoholism. Specifically, a claimant cannot be considered disabled
for Social Security purposes if alcoholism and/or drug addiction is “a contributing factor
material to the Commissioner’s determination that the individual is disabled.” 42 U.S.C.
§ 423(d)(2)(C). To determine whether this is the case, the regulations provide as follows:
(1) The key factor we will examine in determining whether drug addiction or
alcoholism is a contributing factor material to the determination of disability is
whether we would still find you disabled if you stopped using drugs or alcohol.
(2) In making this determination, we will evaluate which of your current physical
and mental limitations, upon which we based our current disability
determination, would remain if you stopped using drugs or alcohol and then
determine whether any or all of your remaining limitations would be disabling.
(1) If we determine that your remaining limitations would not be
disabling, we will find that your drug addiction or alcoholism is a
contributing factor material to the determination of disability.
(it) If we determine that your remaining limitations are disabling,
you ate disabled independent of your drug addiction or
alcoholism and we will find that your drug addiction or
alcoholism is not a contributing factor material to the
determination of disability.
20 C.F.R. § 404.1535(b). In other words, § 404.1535 describes a two-step process, which has
been further codified and clarified in Social Security Ruling 13-2p. Social Security Ruling 13-
12
2p, Titles I] And XVI: Evaluating Cases Involving Drug Addiction And Alcoholism (DAA),
SSR 13-2p, 2013 WL 621356 (Feb. 20, 2013) (“SSR 13-2p”). As part of that two-step process,
an AL] “must first make a determination as to disability by following the five-step sequential
evaluation process, ‘without segregating out any effects that might be due to substance use
disorders.” Piccini v. Comm’r of Soc. Sec., No. 13-CV-3461 AJN SN, 2014 WL 4651911, at
*12 (S.D.N.Y. Sept. 17, 2014) (quoting Brueggemann v. Barnhart, 348 F.3d 689, 694 (8th Cir.
2003)). If the ALJ finds the claimant disabled based on symptomology alone, he must then
follow the five-step sequential analysis a second time to determine “whether the claimant
would still be considered disabled if [she] stopped abusing drugs or alcohol.” See Piccini, 2014
WL 4651911, at *12.
In this case, the AL] never explicitly considered the materiality of Plaintiffs substance
abuse disorders as prescribed by 20 C.F.R. § 404.1535(b) and SSR 13-2p. The ALJ clearly
included alcoholism among Plaintiffs severe impairments at step two of the sequential
analysis, but ultimately concluded that the records “do not show continuous and heavy
substance abuse to such a point that the alcohol abuse 1s a contributing factor to his disability.”
(Tr. at 38.)° The AL] nevertheless repeatedly considered PlaintifPs use of alcohol in
6 ... [BJefore evaluating whether polysubstance abuse is a contributing fact to a finding of
disability, the ALJ must first conduct the regular five-step disability inquiry to determine if a
claimant is disabled, including as part of this inquiry the impact of any alcoholism or drug
addiction. It is only after that point, if the ALJ finds that the claimant is disabled and there is
“medical evidence of [his or her] drug addiction or alcoholism,” that the AL] then proceeds
under § 404.1535 to determine whether the clatmant “would still [be found] disabled if [he or
she] stopped using alcohol or drugs.” 20 C.F.R §§ 404.1535, 416.935; see Bustamante v.
Massanari, 262 F.3d 949, 955 (9th Cir. 2001); Drapeau v. Massanari, 255 F.3d 1211, 1213 (10th
Cir. 2001); Fennell v. Astrue, No. 4:09-3051—JFA-TER, 2011 WL 1049094, at *4 (D.S.C, Mar.
21, 2001); Puffenbarger v. Commissioner, No. 1:09CV77, 2010 WL 3521583, at *3 (N.D.W.
Va. Sept. 7, 2010). Stated another way, if the AL] finds that a Plaintiffs condition is disabling,
he is then required to determine whether the Plaintiff's alcohol and substance abuse was a
contributing factor material to the determination of disability, as disability due to drug
13
discounting the symptoms of his bipolar disorder and schizophrenia, and “it is not clear from
the AL]’s decision that he actually went through the full five-step sequential evaluation first
with an eye ‘strictly [on the] symptoms, not [the] causes,” as requited by the regulations.
Morales v. Colvin, No. 13 CIV. 06844 LGS DF, 2015 WL 2137776, at *25 (S.D.N.Y. May 4,
2015) (quoting Newsome v. Astrue, 817 F. Supp. 2d 111, 134 (E.D.N.Y. 2011)). Significantly,
despite noting Plaintiffs hospitalization for significant psychiatric deterioration and ongoing
psychiatric symptoms, the AL] discounted these symptoms based on the objective evidence
from examinations when Plaintiff was not using alcohol, and concluded that “the objective
medical evidence supports that when [Plaintiff] is complfia]nt with his medications and
complfiajnt with his doctor’s instructions to not self-medicate with beer, his condition
significantly improved to allow him to perform work as noted in the [RFC].” (Ir. at 32.)
Thus, it appears that the AL]’s focus on alcohol abuse as a “cause” of Plaintiffs mental health
symptoms led him to improperly discount the evidence of disabling psychiatric symptoms in
the record. At the very least, it is “not entirely clear that the AL] would have . . . reached the
same conclusion had he adhered to the regulations.” Morales, 2015 WL 2137776, at *27.
addiction and alcoholism is not a proper basis for an award of benefits under the Social
Security Act if the addiction is a contributing factor material to the determination of disability.
42 US.C. §§ 423(d)(2)(c), 1382c (a)(3)(J); see also 20 C.F.R. § 416.935. See also Farkas v.
Astrue, No. 11-242, 2012 WL 750547, at * 2 (M.D. Fla. Mar. 8, 2012) (“The Regulations make
clear that a finding of disability is a condition precedent to the application of [the law requiring a
determination of whether alcohol or drug addiction is a contributing factor material to the
determination of disability]”] (emphasis added).
Hundley v. Colvin, No. CV 9:14-4115-BHH-BM, 2016 WL 423548, at *5 (D.S.C. Jan. 12, 2016), report and
recommendation adopted, No. CV 9:14-4115-BHH, 2016 WL 404075 (D.S.C. Feb. 3, 2016).
Notably, at least some of his hospitalizations reflect no alcohol use prior to the hospitalization (T'r. at 1055),
and others reflect the potential that increased psychiatric symptoms came before and potentially triggered the
alcohol use that then caused further deterioration. These ate the types of issues that would be more fully and
appropriately considered using the process set out in the regulations and in SSR 13-2p.
14
“The Coutt is mindful that, when the proper legal analysis is followed, the ALJ may
conclude that substantial evidence supports a finding of no disability. But to assume that
conclusion ‘creates an unacceptable risk that a claimant will be deprived of the right to have
her disability determination made according to the correct legal principles.”’ Piccini, 2014 WL
4651911, at *16 (quoting Schaal v. Apfel, 134 F.3d 496, 504 (2d Cir. 1998)). Accordingly, upon
remand, “[t]he AL] must base his initial disability determination on substantial evidence of
[Plaintiff's] medical limitations without deductions for the assumed effects of substance abuse
disorders.” Brueggemann, 348 F.3d at 694. Then, and only then, may the ALJ separately
determine whether Plaintiffs substance abuse constitutes a contributing factor material to that
determination. See also Hundley, 2016 WL 423548, at *5, *7 (similarly concluding that remand
was required so that substance abuse could be properly evaluated using the process set out in
SSR 13-2p). §
§ The Court notes that in determining materiality in the context of other mental disorders, SSR 13-2p provides
additional guidance:
7. What do we do of the claimant's co-occurring mental disorder(s) improve in the absence of DAA?
a. Many people with DAA have co-occurring mental disorders; that is, a mental disorder(s)
diagnosed by an acceptable medical source in addition to their DAA. We do not know of any
research data that we can use to predict reliably that any given claimant's co-occurring mental
disorder would tmprove, or the extent to which it would improve, if the claimant were to stop
using drugs or alcohol.
b. To support a finding that DAA is material, we must have evidence in the case record that
establishes that a claimant with a co-occurring mental disordet(s) would not be disabled in the
absence of DAA. Unlike cases involving physical impairments, we do not permit adjudicators
to rely exclusively on medical expertise and the nature of a clatmant’s mental disorder.
c. We may purchase a CE in a case involving a co-occurring mental disorder(s). We will
purchase CEs primarily to help establish whether a claimant who has no treating source
records has a mental disorder(s) tn addition to DAA. See Question 8. We will provide a copy
of this evidence, or a summary, to the CE provider.
d. We will find that DAA is not material to the determination of disability and allow the claim
if the record is fully developed and the evidence does not establish that the claimant’s co-
occurring mental disorder(s) would improve to the point of nondisability in the absence of
DAA.
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Thus, remand is required in light of the ALJ’s disregard of Plaintiffs psychiatric
symptoms based on a lack of “objective medical evidence,” particularly the lack of objective
medical evidence when Plaintiff was compliant with his medications and not using alcohol,
reflecting an appatent requirement of objective medical evidence in evaluating Plaintiffs
symptoms and a related failure to consider the treason for medication noncompliance and
failure to undertake the proper analysis for considering Plaintiffs use of alcohol.
IT IS THEREFORE ORDERED that the Commissioner’s decision finding no
disability be REVERSED, that Defendant’s Dispositive Brief [Doc. #13] be DENIED, that
Plaintiffs Disposittve Brief [Doc. #12] be GRANTED, and that this action be REMANDED
for further consideration in accordance with the directives set out herein.
This, the 30 day of September, 2025.
Lda.
nited States Magistrate Judge
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